Office blood pressure measurement in the 21st century

Abstract

Measurement of blood pressure (BP) using the auscultatory method must follow specific rules and conditions to be reliable. Nonetheless, these requirements are often not followed in clinical practice, resulting in inaccurate BP readings. Simply replacing manual sphygmomanometers with an oscillometric device may still produce readings that are associated with a white coat effect. These limitations can be overcome by using an oscillometric sphygmomanometer that automatically records multiple readings with the patient resting quietly and alone, called automated office (AO)BP. AOBP produces office readings with a reduced white coat effect, which are also similar to the awake ambulatory BP. There is also evidence that AOBP is a better predictor of target organ damage than attended office BP. Furthermore, clinical outcome data support AOBP as having both a similar diagnostic threshold as awake ambulatory BP and a lower treatment target. Using AOBP in clinical practice simplifies recording office BP by not requiring an additional period of rest before activation of the device and by not having staff present during the actual measurements. Recent studies have reported that automatic BP measurements taken by staff in research studies with close adherence to guidelines using AOBP devices may produce similar readings to AOBP. Further research is needed to determine the best method for recording BP at systolic targets < 130 mm Hg and the relationship of office BP to ambulatory BP and home BP.

Arterial Blood Pressure at Liver Transplant Evaluation Predicts Renal Histology in Candidates With Renal Dysfunction

“…Our study is limited by the fact that the laboratory data and BP readings used in the analysis were obtained at a single time point during the LT evaluation. We also used office BP measurements, which have their own flaws . Prospective studies with serial pre‐LT BP readings will provide additional information.…”

Achieving reliable blood pressure measurements in clinical practice: It's time to meet the challenge

“…There is agreement that office blood pressure measurement (OBPM) will remain the commonest method of BP measurement in general use. However, although in the past it was used for the initiation of treatment and to guide the titration of therapy, it is now stipulated that it should be used only as a screening technique, with out‐of‐office measurements being required before diagnostic or therapeutic decisions are made . There is general acceptance that in the past the term “office blood pressure measurement” has been used indiscriminately and loosely to describe an unstandardized measurement.…”

“…Whereas more evidence is required on the threshold levels of BP for AOBP, the methodology (either physician attended or unattended) does standardize methodology and is recommended for future OBPM. The usual recommendations for accurate measurement of BP apply to AOBP; these include using only validated upper‐arm cuff devices, having the patient seated in silence with legs uncrossed, and using the appropriate cuff size …”

“…Devices for OBPM should be capable of automatically recording and storing on memory 3 (or more) measurements with single activation, averaging these, and giving a mean value . Devices for HBPM should have an automated memory capacity to store measurements and automated averaging, and preferably they should be capable of teletransmission .…”

“…However, although in the past it was used for the initiation of treatment and to guide the titration of therapy, it is now stipulated that it should be used only as a screening technique, with out-of-office measurements being required before diagnostic or therapeutic decisions are made. [12][13][14][15] There is general acceptance that in the past the term "office blood pressure measurement" has been used indiscriminately and loosely to describe an unstandardized measurement. Apart from the failure to standardize OBPM, the technique is subject to 2 major environmental influences that make it unrepresentative of the true BP, namely the white coat response (giving misleadingly high office measurements in the face of normal daytime average pressures), and masked hypertension (giving misleadingly low office measurements in the face of elevated daytime average pressures).…”