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Automated Office BP Compared to Other BP Measurement Methods
Study Questions:
What is the association between automated office blood pressure (AOBP) and a fully automated oscillometric resting blood pressure as a standard for predicting future cardiovascular events?
Methods:
A literature search of MEDLINE, Embase, and Cochrane Library was performed to identify papers published between 2003 and April 2018. Studies were selected if they included systolic and diastolic BP measurement by AOBP in comparison with awake ambulatory BP, routine office BP, and research BP measurements in ≥30 patients. Study characteristics were abstracted independently, and random-effects meta-analyses and meta-regressions were conducted. The primary outcome of interest was pooled mean differences (95% confidence interval [CI]) of systolic and diastolic BP between types of BP measurement.
Results:
A total of 2,359 unique publications were identified, of which 59 were reviewed in full and 28 were excluded based on pre-established eligibility criteria. A total of 31 articles with 9,279 participants (4,736 men and 4,543 women) were included. The mean age was 55.9 years (range, 39-69.5 years). Average systolic AOBP of ≥130 mm Hg was present in half of the studies. In samples with systolic AOBP of ≥130 mm Hg, routine office and research systolic BP readings were substantially higher than AOBP readings, with a pooled mean difference of 14.5 mm Hg (95% CI, 11.8-17.2 mm Hg; n = 9; I2 = 94.3%; p < 0.001) for routine office systolic BP readings and 7.0 mm Hg (95% CI, 4.9-9.1 mm Hg; n = 9; I2 = 85.7%; p < 0.001) for research systolic BP readings. Systolic awake ambulatory BP and AOBP readings were similar, with a pooled mean difference of 0.3 mm Hg (95% CI, −1.1 to 1.7 mm Hg; n = 19; I2 = 90%; p < 0.001).
Conclusions:
The authors concluded that AOBP readings, only when recorded properly with the patient sitting alone in a quiet place, are more accurate than office BP readings in routine clinical practice and are similar to awake ambulatory BP readings, with mean AOBP being devoid of any white coat effect. The results of this systematic review and meta-analysis suggest that AOBP should be a recommended preferred method for recording BP in routine clinical practice.
Perspective:
These data suggest that AOBP is a recommended method for measuring BP in clinical practice when performed properly. Accurate measurement is a significant concern, given such measures are used for identification of hypertension and BP management.
Keywords: Blood Pressure, Blood Pressure Monitors, Blood Pressure Determination, Blood Pressure Monitoring, Ambulatory, Hypertension, Primary Prevention, Systole
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