Impact of the Number of Office Blood Pressure Measurements on the Classification of Blood Pressure in Patients With Atrial Fibrillation

Objective: To investigate the impact of the number of auscultatory or oscillometric blood pressure (BP) measurements taken in the office on the classification of BP in patients with atrial fibrillation (AF). Design and method: Patients with permanent AF were evaluated in a single office visit with consecutive alternating BP measurements using a mercury sphygmomanometer (5 measurements, 2 observers simultaneously) and an automated oscillometric upper-arm cuff BP monitor (4 measurements; Microlife BP B3 AFIB). BP was stratified according to the 2023 European Society of Hypertension (ESH) guidelines. Results: 53 participants were analyzed (mean age [SD] 76±9.8 years, 62% men, 91% with treated hypertension). The mean±SD of systolic/diastolic BP with the auscultatory and oscillometric method were 118.2±20.4/69.2±10.4 and 122.3±19.2/73.1±11.7 mmHg respectively (p<0.05/0.05). Systolic office BP based on the increasing number of measurements is shown in the graph. The prevalence of individuals with optimal, normal, high-normal BP, grade 1, and grade 2 hypertension based on the auscultatory technique was: 51/17/8/17/8% (1 measurement), 59/8/15/11/8% (average of 2 measurements), 59/13/9/11/8% (3 measurements), 62/9/6/15/8% (4 measurements), and 59/13/8/15/6% (5 measurements) (p=NS for all comparisons with the single measurement). Correspondingly, with the oscillometric method: 40/21/11/19/9% (1 measurement), 43/17/15/17/8% (2 measurements), 49/15/15/13/8% (3 measurements), and 53/11/15/15/6% (4 measurements) (p=NS for all comparisons with the single measurement). The agreement in diagnosing individuals with BP >120/80 mmHg between the 1st and the average of 1st-3rd measurements was 92/91% (kappa=0.85/0.81) with the auscultatory and the oscillometric method respectively. Conclusions: These preliminary results indicate that the standard ESH recommendation to perform triplicate office BP measurements is also applicable in patients with AF.