Automated office BP readings superior to other methods

Automated office BP readings provided similar results to awake ambulatory BP readings, which was previously the preferred method for predicting cardiovascular risk, and did not appear to induce the “white coat effect,” according to findings published in JAMA Internal Medicine.

Perspective from John A. Osborne, MD, PhD, FACC

“Automated office BP measurement involves recording several BP readings using a fully automated oscillometric sphygmomanometer with the patient resting alone in a quiet place,” Michael Roerecke, PhD, from the Institute for Mental Health Policy Research at the University of Toronto, and colleagues wrote. “Although several studies have shown automated office BP measurement to be more accurate than routine office BP measurement and not subject to a ‘white coat effect,’ the cumulative evidence has not yet been systematically reviewed.”

Roerecke and colleagues performed a systematic review and meta-analysis of 31 studies comprising 9,279 patients (mean age, 55.9 years) to investigate the effectiveness of automated office BP compared with routine office BP, awake ambulatory BP and research BP readings. Mean differences of systolic and diastolic BP between types of BP measurement were pooled.

In about half of the studies, the mean systolic automated office BP was 130 mm Hg or more. In these studies, systolic BP measurements performed routinely in an office or for research were substantially higher than automated office BP measurements, according to the researchers. The pooled mean difference was 14.5 mm Hg (95% CI, 11.8-17.2 mm Hg; n = 9; I² = 94.3%) for routine office systolic BP measurements and 7 mm Hg (95% CI, 4.9-9.1 mm Hg; n = 9; I² = 85.7%) for research systolic BP measurements.

There was no significant difference between systolic awake ambulatory BP and automatic office BP readings. The pooled mean difference was 0.3 mm Hg (95%CI, –1.1 to 1.7 mm Hg; n = 19; I² = 90%).

“Automated office BP readings, only when recorded properly with the patient sitting alone in a quiet place, are more accurate than office BP readings in routine clinical practice and are similar to awake ambulatory BP readings, with mean automated office BP being devoid of any white coat effect,” Roerecke and colleagues concluded. “There has been some reluctance among physicians to adopt this technique because of uncertainty about its advantages compared with more traditional methods of recording BP during an office visit. Based on the evidence, automated office BP should now be the preferred method for recording BP in routine clinical practice.” – by Alaina Tedesco

Disclosures: The authors report no relevant financial disclosures.

Perspective

John A. Osborne, MD, PhD, FACC

This careful systemic review and meta-analysis is extremely important in that it very impressively adds another “Brick in the Wall” in the argument of the superiority of automated office BP versus routine clinical BP measures obtained in the office.

Not only does this paper demonstrate the marked inaccuracy of routine office BPs (on average 14.5 mm Hg higher than automated office BP), but also persuasively shows that automated office BP results are nearly identical to the much more expensive and tedious, but “Gold-Standard,” systolic ambulatory BP measurements with an average difference of a mere 0.3 mm Hg.

This automated office BP technology that was used in the NIH SPRINT BP trial which demonstrated a 27% lower risk of all-cause mortality with more aggressive (<120 systolic) versus less aggressive (<140 systolic) BP control.

This equipment is not expensive, can easily be implemented into the clinic, and is automated so that these measurements don’t require a staff member to obtain. The automated office BP can be started once the patient is roomed or even done in the waiting area.

Arguments that it is too difficult to implement automated office BP in a routine clinical setting are moot given that an estimated 50% Canadian primary care physicians are using this superior technique already. Nearly no U.S. physicians are using this method, but if we were to adopt it, we would instantly be ahead of the game with an evidence-based, far more accurate approach.

John A. Osborne, MD, PhD, FACC

Preventive Cardiologist in Dallas, Texas

Volunteer for the National HQ of the American Heart Association

Disclosures: Osborne reports no relevant financial disclosures.

Sources/Disclosures

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Source:

Roerecke M, et al. JAMA Intern Med. 2019;doi:10.1001/jamainternmed.2018.6551.