A meta‐analysis that helps clarify the use of automated office blood pressure in clinical practice

Myers, Martin G.

doi:10.1111/jch.13511

Cited by 4 publications

(11 citation statements)

References 19 publications

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“…Only 60% of clinicians and 21% of MAs correctly identified that a u‐AOBP of 135/85 mm Hg corresponds to an accurately measured, observed office BP of 140/90 mm Hg, and only 47% of clinicians and 18% of MAs recognized that a u‐AOBP of 130/80 mm Hg corresponds to an accurately measured, observed office BP of 130/80 mm Hg, the new office hypertension threshold recommended by the 2017 American College of Cardiology/American Heart Association hypertension guideline . Although u‐AOBP does not entirely eliminate white‐coat BP elevation, 40% of clinicians and 14% of MAs incorrectly indicated that an elevated u‐AOBP at two or more office visits confirms the diagnosis of hypertension without the need for out‐of‐office BP monitoring. Similarly, 47% of clinicians and 7% of MAs incorrectly indicated that an elevated u‐AOBP at one office visit warranted an adjustment of therapy in treated hypertension patients without resort to out‐of‐office BP monitoring.…”

Section: Resultsmentioning

confidence: 98%

“…Twenty‐one percent of MAs and 7% of clinicians reported performing u‐AOBP on all, most, or some patients rather than limiting u‐AOBP to patients with initially elevated observed BP . Eleven percent of MAs and 33% of clinicians indicated that the patient was entirely alone in the exam room on just 30%‐69% of u‐AOBP procedures . Only 36% of MAs and 27% of clinicians were aware that our clinic protocol and u‐AOBP device settings utilized a 0‐second time delay, the rest indicating that a 1‐5 minute rest period was in place.…”

Section: Resultsmentioning

confidence: 99%

“…Some medical staff appear to place undue reliance on elevated u‐AOBP results as 40% of clinicians and 14% of MAs incorrectly indicated that at an elevated u‐AOBP at two or more office visits confirmed the diagnosis of hypertension. Confirmatory out‐of‐office BP monitoring is currently recommended for patients with elevated u‐AOBP …”

Section: Discussionmentioning

confidence: 99%

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Unattended automated office blood pressure measurement: Time efficiency and barriers to implementation/utilization

Doane

Flynn

Archibald

et al. 2020

J of Clinical Hypertension

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Because of the 15%-30% prevalences of white-coat blood pressure (BP) elevation 1 and masked hypertension, 2 out-of-office BP measurement is recommended to confirm the diagnosis of hypertension for most patients using either 24-hour ambulatory or home BP monitoring. [3][4][5][6][7][8] Still, accurate office BP measurement (OBPM) remains essential to limit the need for labor-intensive and expensive out-of-office BP monitoring. Unfortunately, OBPM in routine clinical practice is often performed inaccurately due to incorrect patient preparation and manual auscultatory measurement technique. 9,10 To improve OBPM accuracy, current guidelines recommend validated, automatic oscillometric devices to replace manual auscultatory BP measurement. 3-7 But guideline-recommended OBPM with these devices does not eliminate white-coat BP elevation. 10,11 In contrast, validated, automated oscillometric devices that automatically perform and average three to five BP measurements over 3-5 minutes while the patient rests alone in the exam room or another quiet place have been demonstrated to substantially reduce white-coat BP elevation. 12,13 This approach to OBPM, termed unattended automated office BP measurement (u-AOBP), is recommended as the preferred OBPM technique for patients with an initial elevated observed BP measurement by the Abstract Unattended automated office blood pressure (BP) measurement (u-AOBP) improves office BP measurement accuracy and reduces white-coat BP elevation, but there are reservations about its time efficiency in primary care. We used time-stamp methodology to measure u-AOBP procedure times performed without a rest period in 130 patients during routine clinic visits to three primary care clinics with 2.5-4.9 years u-AOBP experience. We documented the clinical activities of 30 medical assistants during the u-AOBP procedures. We also assessed MA and clinician satisfaction and knowledge about u-AOBP performance and interpretation. Median u-AOBP procedure time was <5 minutes, and MAs engaged in productive clinical activities during 83% of the procedures. Ninety-three percent of MAs and 100% of clinicians in the clinics agreed that u-AOBP is an efficient method to improve hypertension management. Barriers to effective u-AOBP implementation and ongoing utilization included initial difficulty incorporating u-AOBP into clinic workflow and medical staff knowledge deficiencies concerning correct u-AOBP performance and interpretation despite prior training and experience with the procedure. Intensive u-AOBP education and training programs are needed to facilitate effective u-AOBP implementation into primary care. The time required to perform u-AOBP can be utilized productively by staff.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

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Unattended automated office blood pressure measurement: Time efficiency and barriers to implementation/utilization

Doane

Flynn

Archibald

et al. 2020

J of Clinical Hypertension

View full text Add to dashboard Cite

show abstract

“…u-AOBP reduces but does not entirely eliminate white-coat BP elevation, so out-of-office BP monitoring is necessary to confirm the diagnosis of hypertension when u-AOBP is elevated, whether using the threshold of 135/85 or 130/80 mmHg [1,7,8,22]. However, only about 40% of clinics reported that they prescribe HBPM and only about 5% of clinics prescribe 24-h ABPM to confirm the diagnosis of hypertension in patients with elevated u-AOBP, potentially resulting in substantial overdiagnosis of hypertension.…”

Section: Discussionmentioning

confidence: 99%

Use of unattended automated office blood pressure in Utah primary care clinics

Stuligross

Hoj

Brown

et al. 2021

Blood Pressure Monitoring

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Aim Unattended automated office blood pressure (BP) measurement (u-AOBP) improves office BP measurement accuracy and reduces white-coat BP elevation. u-AOBP is recommended as the preferred office BP measurement technique by multiple hypertension guidelines. This study examines utilization, performance, and potential barriers to implementation of u-AOBP in Utah primary care clinics following 5 years of promotional efforts by the Utah Million Hearts Coalition (UMHC). Methods An online questionnaire was administered to 285 Utah primary care clinics to evaluate self-reported use of u-AOBP and u-AOBP technique, interpretation of results, and perceived barriers to implementation. Results Seventy-nine of 285 clinics (27.7%) completed the full questionnaire. Fifty-nine clinics (74.7%) use u-AOBP. Nearly 65% first learned about u-AOBP through UMHC promotional efforts rather than from the medical literature. One-half of these clinics noted no significant barriers to u-AOBP implementation, and over 80% noted no reduction in medical staff productivity. However, important knowledge deficits concerning correct u-AOBP performance and interpretation of results were apparent from answers to the questionnaire. Conclusion After 5 years of UMHC promotional efforts, at least 20% of the 285 Utah primary care clinics invited to take the questionnaire and 75% of the 79 clinics completing the survey have incorporated u-AOBP and found it feasible in a primary care setting. Ongoing promotion of u-AOBP implementation at the local and regional level is required to extend its utilization. Effective, accessible educational materials and local technical assistance from public health and community partners are needed to correct knowledge and performance deficits to optimize u-AOBP utilization in primary care.

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“…1 Therefore, we thank Martin Myers for his comments on our meta-analysis, as he highlighted important methodological aspects of OBP measurement. 2,3 Our work aimed to examine the net effect of the "presence" of an observer during "automated" OBP measurement.…”

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confidence: 99%

A meta‐analysis helps to clarify the use of automated office blood pressure in clinical practice

Stambolliu

Kyriakoulis

Gravvani

et al. 2019

J of Clinical Hypertension

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A meta‐analysis that helps clarify the use of automated office blood pressure in clinical practice

Cited by 4 publications

References 19 publications

Unattended automated office blood pressure measurement: Time efficiency and barriers to implementation/utilization

Unattended automated office blood pressure measurement: Time efficiency and barriers to implementation/utilization

Use of unattended automated office blood pressure in Utah primary care clinics

A meta‐analysis helps to clarify the use of automated office blood pressure in clinical practice

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