Should automated office blood pressure (recording several blood pressure readings using a fully automated oscillometric sphygmomanometer with the patient resting alone in a quiet place) measurement replace readings recorded by nurses and physicians in routine clinical practice?
This systematic review and meta-analysis of 31 articles comprising 9279 participants compared automated office blood pressure with awake ambulatory blood pressure, a standard for predicting cardiovascular risk. Mean automated office blood pressure readings were similar to the awake ambulatory blood pressure readings and did not exhibit the “white coat effect” associated with routine office blood pressure measurement.
Automated office blood pressure measurement should replace the recording of blood pressure by nurses and physicians in routine clinical practice.
Automated office blood pressure (AOBP) measurement involves recording several blood pressure (BP) readings using a fully automated oscillometric sphygmomanometer with the patient resting alone in a quiet place. Although several studies have shown AOBP measurement to be more accurate than routine office BP measurement and not subject to a “white coat effect,” the cumulative evidence has not yet been systematically reviewed.
To perform a systematic review and meta-analysis to examine the association between AOBP and office BP readings measured in routine clinical practice and in research studies, and ambulatory BP recorded during awake hours, as the latter is a standard for predicting future cardiovascular events.
The MEDLINE, Embase, and Cochrane Library were searched from 2003 to April 25, 2018.
Studies on systolic and diastolic BP measurement by AOBP in comparison with awake ambulatory BP, routine office BP, and research BP measurements were included if they contained 30 patients or more.
Data Extraction and Synthesis
Study characteristics were abstracted independently and random effects meta-analyses and meta-regressions were conducted.
Main Outcomes and Measures
Pooled mean differences (95% CI) of systolic and diastolic BP between types of BP measurement.
Data were compiled from 31 articles comprising 9279 participants (4736 men and 4543 women). In samples with systolic AOBP of 130 mm Hg or more, 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 < .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 < .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 < .001).
Conclusions and Relevance
Automated office blood pressure 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. There has been some reluctance among physicians to adopt this technique because of uncertainty about its advantages compared with more traditional methods of recording BP during an office visit. Based on the evidence, AOBP should now be the preferred method for recording BP in routine clinical practice.
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Roerecke M, Kaczorowski J, Myers MG. Comparing Automated Office Blood Pressure Readings With Other Methods of Blood Pressure Measurement for Identifying Patients With Possible Hypertension: A Systematic Review and Meta-analysis. JAMA Intern Med. Published online February 04, 2019. doi:10.1001/jamainternmed.2018.6551
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