patient would not actually need increased dosing or additional antihypertensive medications. Similarly, a patient with a systolic BP of approximately 110 mm Hg using routine clinic BPs who may be considered below goal may actually have a systolic BP of ,100 mm Hg and should be more carefully screened for symptoms of hypotension. On the other end, higher systolic BPs obtained by non-AHA techniques likely lead to over-diagnosis and over-treatment of hypertension. Last, aggressive BP lowering may increase the likelihood of harm, such as hypotension, syncope, and AKI. When implementing SPRINT results into clinical practice, it seems prudent to consider close follow-up, orthostatic BP checks, and laboratory studies to assess safety as was done during SPRINT. The 5 minutes of rest and three BP measurements 1 minute apart mean that measurement using the AHA protocol typically takes 8–10 minutes. Clinic space, staffing, and organizational inertia may be considered potential obstacles to implementing such protocols in clinical practice. Fortunately, newer BP monitors allow for unobserved BP measurement as was suggested in SPRINT. During the 8–10 minutes protocol, clinic staff can begin rooming other patients, document in the medical record, and perform other tasks. The time that patients wait, either before getting roomed or after the rooming process before being seen by a provider, should be seen as an opportunity to implement such protocols. Indeed, the average time that a patient waits to see their provider in the United States was recently reported to be .18 minutes.22 As nephrologists, we are frequently asked to provide opinions on patients with resistant hypertension and hypertensive emergencies. It is time for us, as hypertension specialists, to push our colleagues, clinics, organizations, and health systems to stop treating measurement of BP as an obstacle to rapid patient flow in clinic, but rather as one of the most important aspects of each visit. At a minimum, BP measurement protocols should include a 3–5 minutes period of quiet rest, measurement of 2–3 BPs which are averaged, use of an appropriately sized cuff placed on a bare arm, and proper patient positioning including back support and arm supported at heart level. This recommendation applies to all patients, irrespective of CKD status. Nonprotocolized, routine clinic BP measurement almost certainly leads to over-diagnosis and over-treatment of hypertension. The response to the SPRINT trial results should not be to discount the findings as irrelevant or too challenging to be translated to clinical care. BP is a vital sign, after all, and should be measured as in the clinical trials so that we can provide evidence-based care to our patients, prevent harm, and improve quality and length of life. DISCLOSURES None. REFERENCES 1. Wright JT Jr., Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC Jr., Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT; SPRINT Research Group: A randomized trial of intensive versus standard bloodpressure control. N Engl J Med 373: 2103– 2116, 2015 2. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ: Recommendations for blood pressure measurement in humans and experimental animals: Part 1: Blood pressure measurement in humans: A statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 111: 697–716, 2005 3. Kjeldsen SE, Lund-Johansen P, Nilsson PM, Mancia G: Unattended blood pressure measurements in the systolic blood pressure intervention trial: Implications for entry and achieved blood pressure values compared with other trials. Hypertension 67: 808–812, 2016 4. Cheung AK, Rahman M, Reboussin DM, Craven TE, Greene T, Kimmel PL, Cushman WC, Hawfield AT, Johnson KC, Lewis CE, Oparil S, Rocco MV, Sink KM, Whelton PK, Wright JT Jr., Basile J, Beddhu S, Bhatt U, Chang TI, Chertow GM, Chonchol M, Freedman BI, Haley W, Ix JH, Katz LA, Killeen AA, Papademetriou V, Ricardo AC, Servilla K, 386 Journal of the American Society of Nephrology J Am Soc Nephrol 29: 383–388, 2018 BRIEF REVIEW www.jasn.org Wall B, Wolfgram D, Yee J; SPRINT Research Group: Effects of intensive BP control in CKD. J Am Soc Nephrol 28: 2812–2823, 2017 5. Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, Striker G; Modification of Diet in Renal Disease Study Group: The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med 330: 877–884, 1994 6. Wright JT Jr., Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, Cheek D, DouglasBaltimore JG, Gassman J, Glassock R, Hebert L, Jamerson K, Lewis J, Phillips RA, Toto RD, Middleton JP, Rostand SG; African American Study of Kidney Disease and Hypertension Study Group: Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: Results from the AASK trial. JAMA 288: 2421– 2431, 2002 7. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317: 703– 713, 1998 8.