Comparison of Automated Office Blood Pressure With Office and Out-Off-Office Measurement Techniques

Abstract

Automated office blood pressure (AOBP) has emerged as valuable tool to assess patient's blood pressure (BP) status, but the lack of strong evidences to establish a threshold value for hypertension diagnosis limits its use in clinical practice. We aimed at synthesizing the published literature through a meta-analysis of studies comparing AOBP with other BP measurement techniques and at analysing the differences between AOBP and physician's office BP, non-physician's office BP, daytime ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). We searched PubMed database for articles published up to April 2018; eligible studies compared AOBP with office and/or out-of-office measurement techniques and reported the BP differences or BP values obtained. Twenty-six studies, for a total of 7,116 patients were included in the analysis. AOBP values were lower than physician (systolic blood pressure, SBP-10.48 mmHg [95% CI-13.15 to-7.81] / diastolic blood pressure, DBP-4.44 mmHg [95% CI-6.07 to-2.80]) and non-physician office ones (SBP-6.89 mmHg [95% CI-8.75 to-5.04] / DBP-3.82 mmHg [95% CI-4.86 to-2.78]). No significant differences were detected between AOBP and daytime ABPM (SBP-1.85 mmHg [95% CI-4.50 to 0.79] / DBP 0.12 mmHg [95% CI-1.42 to 1.66]) and HBPM (SBP-2.65 mmHg [95% CI-8.42 to 3.12]) / DBP-1.67 mmHg [95% CI-4.20 to 0.87]). AOBP readings did not differ significantly from out-of-office blood pressure, still remaining an office technique; it may improve hypertension diagnosis by overcoming some of office BP limitations, including the white-coat effect.

Short-term reproducibility of ambulatory blood pressure measurements: a systematic review and meta-analysis of 35 observational studies

“…Conversely, another commonly used outcome measure, office BP measurements, had higher variability in interventional trials on repeated measurements than ABPM [ 34 ]; and it was reported that SBP could drop more than 10 mmHg without intervention on repeated office BP measurements [ 35 ]. Recently, two published meta-analyses reported that a newer office BP measurement method, called the automated office BP measurement (AOBP), could provide similar mean SBP readings to daytime ABPM [ 15 , 36 ]. However, more data is needed to confirm if AOBP can be as reproducible as ABPM.…”

Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta-analysis

“…An automated office blood pressure measurement (AOBPM), in which clinic BP is measured when patient is unattended sitting in a quiet room, might be an alternative if ABPM cannot be applied as for evidences from the recent meta-analyses (78,79) . These evidences showed that BP measured by AOBPM was not different from BP measured by awake/daytime ABPM, but it was significantly different when compared to CBPM which was measured by physicians or nurses.…”

Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta-analysis

“…An automated office blood pressure measurement (AOBPM), in which clinic BP is measured when patient is unattended sitting in a quiet room, might be alternative if ABPM cannot be applied as for evidences from the recent meta-analyses (65,66). These evidences showed that BP measured by AOBPM was not different from BP measured by awake/daytime ABPM but it was significant different when compared to CBPM that measured by physicians or nurses.…”