BpTRUth: do automated blood pressure monitors outperform mercury?

Area of Science:

• Cardiology
• Hypertension Management
• Diagnostic Accuracy

Background:

• Manual office blood pressure (MOBP) measurements lack accuracy due to white coat and masked effects.
• Automated office blood pressure (AOBP) devices, such as BpTRU, are suggested to mitigate the white coat effect.

Purpose of the Study:

• To retrospectively review the diagnostic accuracy of MOBP and AOBP compared to ambulatory blood pressure measurements (ABPM).
• To evaluate the performance of BpTRU in a Renal Hypertension Clinic setting.

Main Methods:

• Retrospective review of 329 hypertensive patients.
• Bland-Altman analysis comparing MOBP and AOBP with ABPM for systolic and diastolic blood pressure.
• Assessment of treatment-relevant classification errors.

Main Results:

• 95% limits of agreement for systolic AOBP vs. ABPM were -31 to 33 mm Hg; for MOBP vs. ABPM, -27.8 to 37.4 mm Hg.
• Systolic MOBP showed a bias of 4.9 mm Hg vs. ABPM; systolic AOBP showed a bias of -3.2 mm Hg vs. ABPM.
• AOBP did not significantly improve treatment classification errors compared to MOBP (28% vs. 23%, P = .052).

Conclusions:

• AOBP, specifically BpTRU, improves but does not eliminate the white coat effect.
• Systematic downward bias in AOBP may undermine the detection of masked hypertension.
• Further research is needed to fully understand the clinical implications of AOBP bias.