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Identification of the optimal protocol for automated office blood pressure measurement among patients with treated hypertension

Moore, MN, Schultz, MG ORCID: 0000-0003-3458-1811, Nelson, MR ORCID: 0000-0001-9941-7161, Black, JA, Dwyer, NB ORCID: 0000-0002-1583-8290, Hoban, E, Jose, MD ORCID: 0000-0002-9589-0071, Kosmala, W, Przewlocka-Kosmala, M, Zachwyc, J, Otahal, P ORCID: 0000-0003-4042-1769, Picone, DS ORCID: 0000-0002-4760-1634, Roberts-Thomson, P, Veloudi, P ORCID: 0000-0001-6707-7836 and Sharman, JE ORCID: 0000-0003-2792-0811 2017 , 'Identification of the optimal protocol for automated office blood pressure measurement among patients with treated hypertension' , American Journal of Hypertension, vol. 31, no. 3 , pp. 299-304 , doi: 10.1093/ajh/hpx180.

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Background: Automated office blood pressure (AOBP) involving repeated, unobserved blood pressure (BP) readings during one clinic visit is recommended for in-office diagnosis and assessment of hypertension. However, the optimal AOBP protocol to determine BP control in the least amount of time with the fewest BP readings is yet to be determined and was the aim of this study.Methods: One hundred and eighty-nine patients (mean age 62.8 ± 12.1 years; 50.3% female) with treated hypertension referred to specialist clinics at 2 sites underwent AOBP in a quiet room alone. Eight BP measurements were taken starting immediately after sitting and then at 2-minute intervals (15 minutes total). The optimal AOBP protocol was defined by the smallest mean difference and highest intraclass correlation coefficient (ICC) compared with daytime ambulatory BP (ABP). The same BP device (Mobil-o-graph, IEM) was used for both AOBP and daytime ABP.Results: Average 15-minute AOBP and daytime ABP were 134 ± 22/82 ± 13 and 137 ± 17/83 ± 11 mm Hg, respectively. The optimal AOBP protocol was derived within a total duration of 6 minutes from the average of 2 measures started after 2 and 4 minutes of seated rest (systolic BP: mean difference (95% confidence interval) 0.004(-2.21, 2.21) mm Hg, P = 1.0; ICC = 0.81; diastolic BP: mean difference 0.37(-0.90, 1.63) mm Hg, P = 0.57; ICC = 0.86). AOBP measures taken after 8 minutes tended to underestimate daytime ABP (whether as a single BP or the average of more than 1 BP reading).Conclusions: Only 2 AOBP readings taken over 6 minutes (excluding an initial reading immediately after sitting) may be needed to be comparable with daytime ABP.

Item Type: Article
Authors/Creators:Moore, MN and Schultz, MG and Nelson, MR and Black, JA and Dwyer, NB and Hoban, E and Jose, MD and Kosmala, W and Przewlocka-Kosmala, M and Zachwyc, J and Otahal, P and Picone, DS and Roberts-Thomson, P and Veloudi, P and Sharman, JE
Keywords: blood pressure, blood pressure monitoring, clinical decision making, diagnostic errors, hypertension
Journal or Publication Title: American Journal of Hypertension
Publisher: Elsevier Science Inc
ISSN: 0895-7061
DOI / ID Number: 10.1093/ajh/hpx180
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© American Journal of Hypertension, Ltd 2017. All rights reserved.

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