Impact of automated office blood pressure monitoring and staff education on accurate hypertension measurement at a university-affiliated comprehensive care clinic: a prospective quality improvement study

Hypertension is a global challenge and a leading risk factor for cardiovascular disease, stroke, and kidney failure. Accurate blood pressure (BP) measurement is essential for effective management, yet conventional methods are prone to inaccuracies. Automated Office Blood Pressure (AOBP) monitoring, which records multiple readings in an unattended setting, mitigates issues like observer bias and white coat effect. This study evaluates the impact of AOBP implementation and structured staff education on BP control and recheck adherence in a diverse clinical population. This 12-month prospective study used a pre-and post-intervention design in a comprehensive care clinic, including adult patients (≥ 18 years) with a diagnosis of hypertension, cared for in a racially and socioeconomically diverse population. Hillrom Spot Vital Signs 4400 AOBP devices were introduced alongside staff education on proper BP measurement techniques. BP control (< 140/90 mmHg) and recheck adherence were tracked biweekly using unattended AOBP readings based on the average of three measurements. Paired t-tests and stratified analyses by race/ethnicity and age were conducted. Among 2803 hypertensive patients, BP control improved significantly from 74.2% pre-intervention to 79.3% post-intervention (p = 0.022). BP control (< 140/90 mmHg) was defined using the average of three unattended AOBP measurements per visit. Recheck adherence referred to documentation of a repeat BP reading during the same visit. Recheck adherence increased from 59.1% to 96.0% (p < 0.001). Significant gains were among non-Hispanic Black and White patients, while Hispanic patients experienced a decline. Both younger (< 65 years) and older (≥ 65 years) patients showed improvements. Unattended AOBP monitoring and structured staff education significantly improved BP control and recheck adherence. These findings support AOBP integration into routine hypertension management, particularly in underserved populations. Future research should address disparities and explore long-term impacts. Studies should explore cost-effectiveness and external validation of AOBP protocols to enhance their adoption in diverse clinical settings.