Assessment of Automated vs Conventional Blood Pressure Measurements in a Veterans Affairs Clinical Practice Setting

Automated office blood pressure (AOBP) measurement devices that generate multiple measurements of an unattended patient are increasingly common but their efficacy in a veteran population has not been determined. This study evaluated the difference between automated and conventional BP measurements obtained during cardiology clinic visits at the West Palm Beach VA Medical Center (WPBVAMC).

This retrospective review compared BP measurements taken in the WPBVAMC cardiology clinic between May 2017 and February 2019. Data were evaluated with descriptive statistics. Where appropriate, paired comparisons of continuous and binary variables were evaluated with the paired t test and McNemar test for change, respectively.

AOBP and conventional office BP measurements for 95 patients were included. AOBP measurements were taken with the patient sitting alone in a clinic office or in the nursing triage area. The mean values of systolic BP (SBP) and diastolic BP (DBP) were lower for the AOBP method vs the conventional office measurement method, with a difference of 14.6 mm Hg (P < .001) and 3.5 mm Hg (P = .0002), respectively. A white coat effect was suggested based on an SBP reduction of > 20 mm Hg from conventional to AOBP measurements in 22 patients (23%) and a DBP reduction of > 10 mm Hg in 21 patients (22%). The percentage of patients with controlled BP (< 130/80 mm Hg) was higher in the AOBP group than in the conventional measurement group (22% vs 7%, respectively; P = .001).

This analysis suggests that the use of AOBP may reduce misclassification of patients with hypertension, prevent unnecessary therapeutic interventions, and mitigate the white coat effect.