Key result
Attended automated office BP measurement shows no difference in systolic BP versus unattended measurement.
Why the study?
Automated office blood pressure may decrease the white coat effect, but the impact of attendant presence and rest duration on BP and hypertension diagnosis remained to be evaluated.
Does the presence of a clinic attendant or extended rest time affect automated office blood pressure measurements and diagnostic accuracy in adults with suspected hypertension?
RCT (n=133)
Does the presence of a clinic attendant or extended rest time affect automated office blood pressure measurements and diagnostic accuracy in adults with suspected hypertension?
The presence of a clinic attendant and the duration of rest time do not significantly affect automated office blood pressure readings, which overall showed low sensitivity and specificity for diagnosing hypertension compared to daytime ambulatory monitoring.
Attended and unattended automated office BP yield equivalent readings; confirms attendant presence does not bias measurements but leaves diagnostic accuracy versus ambulatory monitoring unresolved.
BACKGROUND: Automated office blood pressure (AOBP) using 3-5 measurements taken with an oscillometric device with or without an attendant in the room may decrease "white coat" effect. We evaluated the impact of the presence or absence of the attendant and rest on BP and diagnosis of hypertension. METHODS: We randomly assigned 133 adults aged 18-85 with high BP at baseline (≥140/90 mm Hg), no hypertensive diagnosis and no antihypertensive medications to either attended AOBP first, unattended second, or unattended AOBP first, attended second. Outcomes included within-person BP difference for attended vs. unattended measurements; 5 vs. 15 minutes of rest; and the diagnostic performance of AOBP compared with daytime automated blood pressure measurement (ABPM). RESULTS: We found no significant differences between attended and unattended AOBP (mean difference attended - unattended [95% confidence interval, CI], systolic 0.14 mm Hg [-0.78, 1.06]; diastolic 0.16 mm Hg [-0.45, 0.78]) or by rest time (mean difference 15 - 5 minutes [95% CI], systolic -0.45 mm Hg [-1.36, 0.47]; diastolic 0.61 mm Hg [-1.23, 0.003]). AOBP was lower than mean daytime ABPM, regardless of attendance or rest (after 5 minutes rest systolic -3.6 and diastolic -2.55 mm Hg, P = 0.001 for both comparisons). Using daytime ABPM of ≥135/85 mm Hg as the diagnostic threshold, AOBP sensitivity and specificity after 5 minutes of rest were 71.0% and 54.1%, respectively. CONCLUSIONS: The presence or absence of a clinic attendant during AOBP measurement and the amount of rest time before AOBP measurements had no effects on BP. AOBP measurements have low sensitivity and specificity for making a new diagnosis of hypertension.
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Green et al. (2022) conducted an RCT in High blood pressure (n=133). Attended automated office blood pressure (AOBP) measurement vs. Unattended AOBP measurement was evaluated on Within-person systolic BP difference for attended vs. unattended measurements (MD 0.14, 95% CI -0.78 to 1.06). The presence of a clinic attendant during automated office blood pressure measurement did not significantly affect systolic BP compared to unattended measurement (MD 0.14 mm Hg; 95% CI -0.78 to 1.06).
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