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Original Investigation
February 4, 2019

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

Author Affiliations
  • 1Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  • 2University of Montreal Hospital Research Centre, Department of Family and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada
  • 3Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
JAMA Intern Med. 2019;179(3):351-362. doi:10.1001/jamainternmed.2018.6551
Key Points

Question  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?

Findings  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.

Meanings  Automated office blood pressure measurement should replace the recording of blood pressure by nurses and physicians in routine clinical practice.


Importance  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.

Objective  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.

Data Sources  The MEDLINE, Embase, and Cochrane Library were searched from 2003 to April 25, 2018.

Study Selection  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.

Results  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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    2 Comments for this article
    Improper testing technique
    Patricia Murphy, ANP | Clinic
    I frequently get incorrect readings from med techs who are in a hurry and open up the valve to speed the process, resulting in inaccuracies especially in patients with slow heart rates. The guidlines for opening a valve are 2mm per second, way slower than many assistants are willing to do the process. Unfortunately I have seen this in OB/GYN settings where this measurement is crucial. It is the responsibility of the provider to check the competency of staff, especially if you keep seeing "120/80" on the majority of your patients.
    BP in office
    Sally Lederman, PhD | University
    I had a high blood pressure event several years ago. Since then I have monitored my BP at home, sitting with both feet flat on the floor, not eating or drinking, not speaking or moving around, on a chair with a back, and without clothes on the arm being used for the measure. My BP remains normal.

    I have never had my BP taken correctly in a doctor's office. They will do it while I am speaking with the doctor, sitting on an exam table with my legs swinging, with the monitor band over my heavy
    winter sweater, right after I have sat down. They do not ensure that my arm is supported or at the right height. If I recommend that I take off my sweater, or move to a chair with a back, they tell me that is not needed. I have decided to refuse such measurements. How can they possibly be monitoring my health this way?