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

Abstract

Results of the SPRINT study have been disputed, based on the assumption that unattended BP measurements do not correlate with usual BP measurements. In this study, the authors investigated the correlation of unattended SPRINT‐like measurements with other conventional measurements. All BP measurements were taken with the patient seated in a comfortable chair with the legs uncrossed and not speaking during the procedure. For the purpose of this study, sixty‐five patients, mostly male (93%), were recruited from our hypertension clinic and all were on antihypertensive medication (av 3.0 ± 1.1). Patients were at high cardiovascular risk with high rates of comorbidities, av age 68 ± 12 years, 49% with diabetes, 34% with mild CKD (CKD 1‐3, average eGFR 55.0 ± 13 mL/min/1.73 m2), and 20% with history of stable coronary artery disease. All BP measurements were similar with no statistically significant difference (one‐way ANOVA, P = 0.621). Compared to unattended SPRINT BP values (139.77 ± 19.22/75.42 ± 11.72 mm Hg), the clinic BP measurements were numerically slightly higher but with a NS P value (P = 0.163). Similarly, unattended BP measurements were similar to values taken by the clinic physician. In a smaller cohort of 11 patients, the authors compared unobserved vs observed SPRINT‐like BP measurements, and in 13 patients, the authors compared unobserved SPRINT‐like BP measurements to average home BP measurements (Table 3). There were no significant differences between any of the subgroups (one‐way ANOVA, P = 0.816 for systolic and P = 0.803 for diastolic). The authors conclude that unattended BP measurements taken (the SPRINT way) are similar to other conventional office blood pressure measurements.

The clinical value of automated office blood pressure: What is the latest evidence on attended vs unattended automated readings in clinical practice?

“…Their study, performed in a specialized hypertension center, found unattended systolic office BP not only to be lower than conventional manual office BP readings but also 6 mm Hg lower than home BP . Similarly, Papademetriou et al investigated the correlation of unattended SPRINT‐like measurements with other conventional BP measurements and concluded that all BP measurements were similar with no statistically significant difference . On the other hand, a cross‐sectional study of 158 patients conducted in the offices of four general practitioners compared conventional auscultatory office BP and unattended AOBP measurements in 107 subjects, and unattended and attended AOBP in another 51 subjects .…”

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

“…Available fully automated devices are listed at http://www.dableducational.org/ and in the British and Irish Hypertension Society (https://bihsoc.org/bpmonitors/) (ie, BpTRU, Microlife WatchBP Office, Omron HEM 907, Omron HEM 705CP) . Other BP devices that have been used to perform automated measurements in published studies are the following: the BP monitor CB‐1805‐B Biox the Dinamap pro‐Care the Omron M10IT the Task Force Monitor CNS (this monitor performs beat‐to‐beat BP monitoring but it has also been used to perform automated measurements) the Omron 9000Ai, and the Omron HEM 7080 IC …”

“…Its results revealed that, at the first office visit, the difference in systolic BP values between AOBP and awake ABP was smaller compared with the systolic BP values between auscultatory office and the mean awake ABP by 2.3 mm Hg and 6.5 mm Hg, for AOBP and auscultatory technique, respectively . Meanwhile when conventional clinic measurements, using oscillometric or auscultatory technique, were taken carefully following a standardized BP measurement procedure, similar BP values were recorded . Moreover, it has been shown that the unattended AOBP readings have a stronger association with subclinical CV disease and organ damage, including left ventricular hypertrophy .…”

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

“…Four studies have specifically addressed the impact of the presence of an observer on OBP by using the SPRINT study measurement protocol. [10][11][12][13] Three of these studies showed minor differences in the range of <3 mm Hg, [10][11][12] and only one showed attended systolic OBP to be higher by 8.6 mm Hg. 13 In conclusion, we fully agree with Martin Myers that for the accurate diagnosis and optimal management of hypertension OBP must be carefully standardized and complemented by out-of-office BP measurement.…”