Blood pressure measurement in an ambulatory setting: concordance between physician and patient self-measurement

Area of Science:

• Cardiology
• Hypertension Management
• Diagnostic Accuracy

Background:

• Accurate blood pressure (BP) monitoring is crucial for effective hypertension management.
• Discrepancies between physician and patient BP readings can impact treatment decisions.
• Ambulatory and self-measurement techniques are increasingly used to capture real-world BP data.

Purpose of the Study:

• To assess the concordance between physician and patient blood pressure measurements taken in a clinical setting.
• To compare BP readings obtained using a mercury sphygmomanometer versus an automated oscillometric device.
• To evaluate the impact of patient self-measurement on BP control.

Main Methods:

• A cross-sectional study involving 106 hypertensive patients.
• BP measurements were taken nine times per patient: three by a physician (mercury sphygmomanometer), three by the physician (automated oscillometer), and three by the patient (automated oscillometer).
• Intraclass correlation coefficients (ICCs) were calculated to determine measurement concordance.

Main Results:

• All three measurement methods demonstrated significant concordance (ICCs ranging from 0.64 to 0.83 for systolic/diastolic pressures, P < 0.001).
• Mean systolic BP was 136/80 mmHg (physician-mercury), 137/80 mmHg (physician-automated), and 139/80 mmHg (patient-automated).
• Blood pressure control rates were 48.1% (physician-mercury), 48.1% (physician-automated), and 36.8% (patient-automated), with patient self-measurement showing a statistically significant lower control rate (P < 0.05).

Conclusions:

• Physician and patient BP measurements in the medical office setting exhibit significant concordance.
• Patient self-measurement in the office setting may lead to an overestimation of systolic BP.
• The findings suggest that while patient self-measurement is concordant, it may negatively affect the assessment of BP control.