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A multicentre study on unattended automated office blood pressure measurement in treated hypertensive patients
Jan Filipovský1,2, Jitka Seidlerová1,2, Jiří Ceral3
1a Internal Department II, Faculty of Medicine in Pilsen , Charles University , Plzen , Czech Republic.
Insights
Unattended automated office blood pressure (uAutoOBP) readings are lower than attended measurements. While uAutoOBP may reduce white-coat hypertension, its association with 24-hour ambulatory blood pressure (BP) is not closer than traditional attended BP.
Area of Science:
- Cardiovascular medicine
- Hypertension research
- Diagnostic technologies
Background:
- The white-coat effect can elevate office blood pressure (BP) readings.
- Unattended automated office blood pressure (uAutoOBP) offers a potential method to mitigate this effect.
- Understanding the relationship between uAutoOBP, attended office BP, and ambulatory BP monitoring (ABPM) is crucial for accurate hypertension management.
Purpose of the Study:
- To investigate the relationship between unattended automated office blood pressure (uAutoOBP) and attended office blood pressure (BP) measurements.
- To compare uAutoOBP with ambulatory blood pressure monitoring (ABPM) in stable, treated hypertensive subjects.
- To assess whether uAutoOBP provides a closer association with 24-hour BP than traditional attended measurements.
Main Methods:
- Stable, treated hypertensive patients from four Czech academic centers participated.
- Unattended automated office blood pressure (uAutoOBP) was measured using the BP Tru device.
- Attended BP was measured using both auscultatory (AuscOBP) and oscillometric (OscOBP) methods; ABPM was performed within one week.
Main Results:
- Unattended automated office blood pressure (uAutoOBP) readings were consistently lower than auscultatory attended office BP (AuscOBP) by 8.5/3.0 mm Hg.
- The difference between AuscOBP and uAutoOBP increased with higher AuscOBP levels.
- uAutoOBP did not demonstrate a closer correlation with 24-hour ambulatory BP than attended office BP measurements.
Conclusions:
- Attended BP measurements, whether auscultatory or oscillometric, yield higher values compared to uAutoOBP.
- There is significant inter-individual variability in the differences between uAutoOBP and attended BP, as well as between uAutoOBP and ABPM.
- The study did not confirm that uAutoOBP is more closely associated with 24-hour ambulatory BP than attended BP measurements.
Aims:
Unattended automated office blood pressure (uAutoOBP) may eliminate white-coat effect. In the present study, we studied its relationships to attended office blood pressure (BP) and ambulatory BP monitoring (ABPM).
Material And Methods:
Stable treated hypertensive subjects were examined in four Czech academic hypertension centres. uAutoOBP was measured with the BP Tru device; attended BP was measured six times: three times with auscultatory method (AuscOBP) by the physician followed optionally by three oscillometric measurements (OscOBP). ABPM was performed within one week from the clinical visit.
Results:
Data on 172 subjects aged 63.7 ± 12.4 years with AuscOBP 127.6 ± 12.1/77.6 ± 10.0 mm Hg are reported. uAutoOBP was by 8.5 ± 9.0/3.0 ± 6.1 mm Hg lower than AuscOBP. The AuscOBP-uAutoOBP difference increased with the AuscOBP level and it did not depend on any other factor. OscOBP differed by 8.6 ± 8.6/1.9 ± 5.7 mm Hg from uAutoOBP. 24-hour mean BP was by 4.2 ± 12.1/3.5 ± 7.8 mm Hg lower than AuscOBP and by 4.3 ± 11.0/0.5 ± 6.9 mm Hg higher than uAutoOBP; the correlation coefficients of 24-hour mean BP with AuscOBP and with uAutoOBP did not differ (p for difference ≥.13). In the lowest BP group (systolic AuscOBP <120 mm Hg or diastolic AuscOBP <70 mm Hg), both AuscOBP and uAutoOBP were lower than 24-hour mean BP, while in the highest BP group (systolic AuscOBP ≥140 mm Hg or diastolic AuscOBP ≥90 mm Hg), they were higher.
Conclusions:
Compared to uAutoOBP, attended BP measurement gives higher values, both when measured with auscultatory or oscillometric method. Inter-individual variability of AutoOBP - uAuscOBP difference, as well of uAutoOBP - ABPM difference, is large. We did not prove that uAutoOBP would be associated to 24-hour ambulatory BP more closely than attended BP.
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