Comparing Automated Office Blood Pressure Readings With Other Methods of Blood Pressure Measurement for Identifying Patients With Possible Hypertension: A Systematic Review and Meta-analysis

Abstract

Importance: Automated office blood pressure (AOBP) measurement involves recording several blood pressure (BP) readings using a fully automated oscillometric sphygmomanometer with the patient resting alone in a quiet place. Although several studies have shown AOBP 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.

Objective: To perform a systematic review and meta-analysis to examine the association between AOBP and office BP readings measured in routine clinical practice and in research studies, and ambulatory BP recorded during awake hours, as the latter is a standard for predicting future cardiovascular events.

Data sources: The MEDLINE, Embase, and Cochrane Library were searched from 2003 to April 25, 2018.

Study selection: Studies on systolic and diastolic BP measurement by AOBP in comparison with awake ambulatory BP, routine office BP, and research BP measurements were included if they contained 30 patients or more.

Data extraction and synthesis: Study characteristics were abstracted independently and random effects meta-analyses and meta-regressions were conducted.

Main outcomes and measures: Pooled mean differences (95% CI) of systolic and diastolic BP between types of BP measurement.

Results: Data were compiled from 31 articles comprising 9279 participants (4736 men and 4543 women). In samples with systolic AOBP of 130 mm Hg or more, routine office and research systolic BP readings were substantially higher than AOBP readings, with a pooled mean difference of 14.5 mm Hg (95% CI, 11.8-17.2 mm Hg; n = 9; I2 = 94.3%; P < .001) for routine office systolic BP readings and 7.0 mm Hg (95% CI, 4.9-9.1 mm Hg; n = 9; I2 = 85.7%; P < .001) for research systolic BP readings. Systolic awake ambulatory BP and AOBP readings were similar, with a pooled mean difference of 0.3 mm Hg (95% CI, -1.1 to 1.7 mm Hg; n = 19; I2 = 90%; P < .001).

Conclusions and relevance: Automated office blood pressure 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 AOBP being devoid of any white coat effect. 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, AOBP should now be the preferred method for recording BP in routine clinical practice.

Figure 1.. Mean Difference (MD) in Systolic Blood Pressure Between Automated Office Blood Pressure (AOBP) (Reference) and Awake Ambulatory Blood Pressure (ABP) Measurement in Samples With Systolic AOBP of 130 mm Hg or Higher

Weights are from random-effects analysis. TRUE-HTA is a study name.

Figure 2.. Mean Difference (MD) in Systolic Blood Pressure (BP) Between Automated Office Blood Pressure (AOBP) (Reference) and Research BP Measurement in Samples With Systolic AOBP of 130 mm Hg or Higher

Weights are from random-effects analysis. TRUE-ESP and TRUE-HTA are study names.

Figure 3.. Mean Difference (MD) in Systolic Blood Pressure (BP) Between Automated Office Blood Pressure (AOBP) (Reference) and Routine Office BP Measurement in Samples With Systolic AOBP of 130 mm Hg or Higher

Weights are from random-effects analysis.