Use of automated office blood pressure measurement to reduce the white coat response

Myers, Martin G.; Valdivieso, Miguel; Kiss, Alexander

doi:10.1097/hjh.0b013e32831b9e6b

Cited by 194 publications

(155 citation statements)

References 25 publications

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“…In the aforementioned study by Beckett and Godwin, 12 in 481 patients mean awake ambulatory BP (142/80 mm Hg) was similar to the mean of 5 readings taken with the fully automated BpTRU device (140/80 mm Hg) with the patients resting alone in a quiet examining room. Similar findings were noted in a report 9 from another one of our centers with the mean awake ambulatory BP in 309 patients (134/77 mm Hg) being similar to the mean of 5 automated office BP (AOBP) readings (132/75 mm Hg), once again, taken with the patients resting alone in a quiet examining room.…”

Section: Automated Bp Measurement In the Office Settingsupporting

confidence: 73%

“…Recent data from one of our centers 9 showed that the routine office BP tends to be higher at all levels of readings when compared with the awake ambulatory BP as displayed in a BlandAltman 16 …”

Section: Automated Bp Measurement In the Office Settingmentioning

confidence: 99%

“…In this instance, 9 BP data were collected from 309 patients referred by their family physicians in the community for 24-hour ABPM (Table). At the time of referral, the physicians were asked to provide the last BP recorded in the patient's chart by either the physician or nurse as part of routine clinical practice.…”

Section: Comparison Of Casual and Research-quality Manual Bp Measurementmentioning

confidence: 99%

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Measurement of Blood Pressure in the Office

et al. 2010

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T he widely accepted cut-point for normal blood pressure (BP) in the office setting evolved over several decades, based on data derived from a variety of sources. The Actuarial Society of America was one of the first organizations to publish BP data on thousands of community residents, followed by other classic studies such as Framingham, Western Electric Company, Kaiser Permanente, and the Multiple Risk Factor Intervention Trial. 1,2 In every instance, BP readings were based on measurements taken by specially trained health professionals following guidelines for proper BP measurement. As a result of these and other population studies examining the association between different BP levels and cardiovascular outcomes, the importance of systolic and diastolic hypertension was recognized and an office BP of 140/90 mm Hg became the universally established cut-point for separating normal BP from hypertension. Hypertension Is Not Defined by 140/90 in the "Real World"There are robust scientific data to support the use of 140/90 mm Hg to define hypertension in clinical practice guidelines. However, the guidelines do not take into account widely recognized problems associated with the quality of manual BP measurement in routine clinical practice. 3 More recent recommendations 4 for diagnosing hypertension clearly acknowledge that an increase in BP attributable to the "white coat response" is frequently associated with manual BP recordings performed in community-based practice. In recognizing this limitation of manual office BP, some guidelines have gone so far as to recommend that home BP and 24-hour ambulatory BP monitoring (ABPM) may need to be performed to obtain an accurate measure of a patient's BP status. The greater reliance on 24-hour ABPM and home BP in the diagnosis and management of hypertension is the result of numerous clinical outcome studies 5,6 that show that these measurement techniques are better predictors of cardiovascular events when compared to manual BP readings, even when manual readings are taken carefully in accordance with guidelines.However, most guidelines do not seem to have fully considered the impact conventional routine office BP might have on both the cut-point and ongoing management of hypertension as experienced by primary care physicians. In most instances, an office BP of 140/90 mm Hg is equated to a mean home BP or mean awake ambulatory BP of 135/ 85 mm Hg. However, this relationship has been based on BP readings carefully recorded in accordance with guidelines 4 for proper BP measurement (research-quality office BP readings) and may not reflect the BP obtained by doctors, nurses, and other health professionals in routine office practice. Comparison of Casual and Research-Quality Manual BP MeasurementWhen the primary care physician records BP using a mercury or aneroid device, the resulting value frequently tends to be higher than what it would be if measurement guidelines were strictly adhered to. In a 1995 report from one of our centers, 7 BP data were obtained from 147 hypertensiv...

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Section: Automated Bp Measurement In the Office Settingsupporting

confidence: 73%

Section: Automated Bp Measurement In the Office Settingmentioning

confidence: 99%

Section: Comparison Of Casual and Research-quality Manual Bp Measurementmentioning

confidence: 99%

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Measurement of Blood Pressure in the Office

et al. 2010

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“…To take extra precaution in measurement technique in trials, when being observed, compared with routine practice has been termed the "Hawthorne effect" [16,17]. Since the measurement technique, the BP recorder, in our study was identical in the two settings, our results of similar BP whether measured by SMOPB or OBP suggests that the higher BP recorded manually in other studies could to some extent be dependent on lack of expertise.…”

Section: Discussionsupporting

confidence: 70%

“…Thus our findings of that there in general is no increase in BP when the same technical automated equipment is used by a doctor or a nurse when compared with selfmeasurement is in line with the fact that technical issues can affect, i.e. increase, recorded blood pressure levels during routine manual recordings [16].…”

Section: Discussionsupporting

confidence: 51%

RF calibration of on-chip DfT chain by DC stimuli and statistical multivariate regression technique

Ramzan

Dąbrowski

2015

Integration

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Objective We aimed to compare blood pressure (BP) levels recorded using the semiautomatic oscillometric Omron i-C10 blood pressure device in patients with or without hypertension in three different settings: 1, when used by a doctor or a nurse at the office (OBP); 2, when used for self-measurement by the patient at the office (SMOBP); 3, when used for 7 consecutive days at home (HBP).Methods A total of 247 subjects were invited to participate but 78 of these declined and a further 7 were excluded, leaving a final cohort of 162 participants.Results Mean OBP was higher than HBP (difference 8.1±14/3.1±8.8 mmHg, p<0.0001) and so was SMOBP compared with HBP (difference 7.0±13/4.2±7.3 mmHg, p<0.0001). Sixteen participants (9.9%) had ≥10 mmHg higher systolic SMOBP than OBP and 28 (17%) participants had ≥10 mmHg lower systolic SMOBP than OBP. Subjects that were current smokers had a larger mean difference between systolic OBP and SMOBP than non-smokers (OBP -SMOBP in smokers: 6.6 ± 9.4 mmHg, OBP -SMOBP in non-smokers: 0.5 ± 9.2 mmHg, p= 0.011 between groups) Conclusion Self-measurement of BP in the office does not preclude an increase in BP when levels in the individual patients are compared with HBP using the same equipment. Thus SMOBP with a semi-automatic device does not achieve the reduction of the white-coat effect in the same manner as fully automatic devices.

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Association of Office and Ambulatory Blood Pressure With Mortality and Cardiovascular Outcomes

Yang

Melgarejo

Thijs

et al. 2019

JAMA

322

229

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Use of automated office blood pressure measurement to reduce the white coat response

Abstract: The white coat response associated with office BP measurements can be virtually eliminated by recording BP with the automated BpTRU device with patients resting alone in a quiet examining room.

Cited by 194 publications

References 25 publications

Measurement of Blood Pressure in the Office

Measurement of Blood Pressure in the Office

RF calibration of on-chip DfT chain by DC stimuli and statistical multivariate regression technique

Association of Office and Ambulatory Blood Pressure With Mortality and Cardiovascular Outcomes

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