From the Journals

Automated office BP readings best routine measures


 

FROM JAMA INTERNAL MEDICINE

Automated office blood pressure readings appear to be more accurate than routine office readings and BP readings in research settings, according to a recent systematic review and meta-analysis.

Based on the evidence, automated office BP (AOBP) readings should now be the preferred method of reading a patient’s BP in clinical practice despite initial reluctance to incorporate this technique over other methods, the researchers wrote in JAMA Internal Medicine.

“The existing evidence supports the use of AOBP to screen patients for possible hypertension in clinical practice, especially if one takes into account the white coat effect associated with current manual or oscillometric techniques for office BP measurement,” wrote Michael Roerecke, PhD, of the University of Toronto, and his colleagues.

Dr. Roerecke and his colleagues identified 31 articles with 9,279 participants (4,736 men, 4,543 women) where AOBP was compared with another method of BP reading, such as awake ambulatory, routine office, and research BP readings. The AOBP reading was performed with a fully automated oscillometric sphygmomanometer with the patient resting in a quiet area.

The researchers found systolic AOBP of 130 mm Hg was associated with significantly higher readings from routine office (mean difference, 14.5 mm Hg) or research BP readings (7.0 mm Hg), while participants had similar AOBP and awake ambulatory BP readings (0.3 mm Hg). All differences were statistically significant (P less than .001).

“If AOBP is to be used in clinical practice, readings must closely adhere to the procedures used in the AOBP studies in this meta-analysis, including multiple BP readings recorded with a fully automated oscillometric sphygmomanometer while the patient rests alone in a quiet place,” the researchers wrote.

Potential limitations of the study were the large statistical heterogeneity of the sample, though the researchers noted little clinical heterogeneity, and that most studies measured AOBP and awake ambulatory BP on the same day to limit differences in timing.

The authors reported no relevant conflicts of interest.

SOURCE: Roerecke M et al. JAMA Intern Med. 2019 Feb 4. doi: 10.1001/jamainternmed.2018.6551.

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