Attended and Unattended Automated Office Blood Pressure Measurements Have Better Agreement With Ambulatory Monitoring Than Conventional Office Readings

Abstract

BackgroundAutomated office blood pressure (AOBP) measurement is superior to conventional office blood pressure (OBP) because it eliminates the “white coat effect” and shows a strong association with ambulatory blood pressure.Methods and ResultsWe conducted a cross‐sectional study in 146 participants with office hypertension, and we compared AOBP readings, taken with or without the presence of study personnel, before and after the conventional office readings to determine whether their variation in blood pressure showed a difference in blood pressure values. We also compared AOBP measurements with daytime ambulatory blood pressure monitoring and conventional office readings. The mean age of the studied population was 56±12 years, and 53.4% of participants were male. Bland–Altman analysis revealed a bias (ie, mean of the differences) of 0.6±6 mm Hg systolic for attended AOBP compared with unattended and 1.4±6 and 0.1±6 mm Hg bias for attended compared with unattended systolic AOBP when measurements were performed before and after conventional readings, respectively. A small bias was observed when unattended and attended systolic AOBP measurements were compared with daytime ambulatory blood pressure monitoring (1.3±13 and 0.6±13 mm Hg, respectively). Biases were higher for conventional OBP readings compared with unattended AOBP (−5.6±15 mm Hg for unattended AOBP and oscillometric OBP measured by a physician, −6.8±14 mm Hg for unattended AOBP and oscillometric OBP measured by a nurse, and −2.1±12 mm Hg for unattended AOBP and auscultatory OBP measured by a second physician).ConclusionsOur findings showed that independent of the presence or absence of medical staff, AOBP readings revealed similar values that were closer to daytime ambulatory blood pressure monitoring than conventional office readings, further supporting the use of AOBP in the clinical setting.

Unobserved automated office BP is similar to other clinic BP measurements: A prospective randomized study

“…The authors concluded that unattended and attended office BP measurements are comparable when measurements take place at a familiar general practitioner's office. In another recently published study, in 146 patients, we also found that there was no difference between attended and unattended AOBPs and both were similar to daytime ambulatory BP measurements.…”

Comparison of Automated Office Blood Pressure With Office and Out-Off-Office Measurement Techniques

“…Only attrition bias was relevant in 7 studies due to missing data (BP readings missing, patients lost at follow-up). 16 studies compared AOBP with traditional OBP taken by physicians 4,8,10,12,19,[21][22][23][24]27,28,30,[32][33][34]37 ; 16 studies compared AOBP with awake ABPM 4,8,10,18,19,20,22,[24][25][26]29,[33][34][35]37,38 ; AOBP was compared with HBPM in 7 studies 10,12,24,27,28,30,38 and with non-physician OBP in 10 studies 4,8,15,[18][19][20]31,[36][37][38] .…”

The optimal use of automated office blood pressure measurement in clinical practice

“…Recently, AOBP readings have been shown to yield similar values when BP measurements were taken with or without medical staff. These readings were devoid of order effect and were comparable with awake ABP rather than conventional office values . The unattended office BP, however, is a guarantee that talking will be strictly avoided.…”