Automated office BP measurement: The new standard in HTN screening

STUDY SUMMARY

Automated office BP devices are just as accurate as more expensive ABP studies

This systematic review and meta-analysis (N = 9279; 23 cross-sectional, 1 cohort, and 7 randomized controlled trials [N = 1304], of which 17 studies overlapped with those included in the previously mentioned meta-analysis⁹) compared SBP and diastolic blood pressure measured by an oscillometric AOBP device to awake or daytime ABP (continuously monitoring BP while awake, used as a standard for BP measurement), routine manual office BP, or research BP measurements.

The study also explored the protocol by which the best AOBP results could be obtained. For AOBP measurement, the included trials had no more than 2 minutes of elapsed time between individual AOBP measurements and had at least 3 AOBP readings to calculate the mean.

Compared with AOBP, in samples with an SBP of ≥ 130 mm Hg, SBP readings were significantly higher for both routine office visits (mean difference [MD] = 14.5 mm Hg; 95% CI, 11.8–17.2) and research (MD = 7 mm Hg; 95% CI, 4.9–9.1). However, no difference was found between AOBP and awake ambulatory SBP values (MD = 0.3 mm Hg; 95% CI, −1.1 to 1.7). In all cases, heterogeneity of the included studies was high (I² was > 75%). There was no evidence of small-study effect or publication bias, and little evidence of potential financial bias. The most accurate methodology for AOBP measurements included multiple BP readings and the patient resting alone in a quiet location.

This meta-analysis supports the use of an automated office blood pressure device to accurately screen for hypertension and avoid the white-coat effect.

Although there was statistical heterogeneity, the results were confirmed in the authors’ analysis of studies with high methodologic quality. In addition, researchers performed multiple meta-regression analyses to evaluate the statistical heterogeneity and found no significant differences based on age, body mass index, number of treated patients, gender, measurement interval, or added rest before AOBP.

WHAT'S NEW

Study confirms unattended, automated office BP as preferred technique

This is the second recent comprehensive systematic review and meta-analysis to directly compare AOBP with other common techniques of BP measurement in screening for and diagnosing hypertension in the clinical setting. ⁹

Continue to: This meta-analysis...