Key result
Averaging the third to seventh office BP readings shows higher diagnostic accuracy than standard measurements.
Why the study?
Outpatient office blood pressure measurements are often inaccurate due to white coat effect and improper technique, necessitating evaluation of successive measurements for improved accuracy.
Do successive office blood pressure measurements improve accuracy compared to standard office measurements when using 24-hour ambulatory monitoring as the gold standard in patients with suspected or treated hypertension?
Cross-Sectional (n=834)
Do successive office blood pressure measurements improve accuracy compared to standard office measurements when using 24-hour ambulatory monitoring as the gold standard in patients with suspected or treated hypertension?
Successive automated office blood pressure measurements, particularly the average of the 3rd to 7th readings, provide significantly better accuracy and agreement with ambulatory blood pressure monitoring than standard office measurements.
Answers are grounded in this paper and cite their sources.
Successive nurse measurements yield closer agreement with ABPa than standard office readings; leaves open whether this supports routine adoption pending prospective validation.
INTRODUCTION: According to the published literature, blood pressure (BP) measurements performed in the outpatient clinical setting are often inaccurate. The white coat effect and improper technique are the main causes of this imprecision. Construction of a set of readings without them could improve the accuracy of BP measurement. OBJECTIVE: To evaluate the accuracy and agreement of successive office BP measurements using the awake blood pressure average (ABPa) as the gold standard. METHODS: BP was measured in 852 patients using three techniques: in office (OBPa); seven successive measurements performed by a nurse using an automatic device; and 24 h of ambulatory BP monitoring. BP averages (BPa) were obtained from the nurse's measurements: 1-2BPa (first and second), 3-7BPa (third to seventh), and 1-7BPa (first to seventh). OBPa and successive measurements were tested against ABPa by calculating the following: average difference in BP of 1-2BPa, 3-7BPa and OBPa, and the area under the curve. RESULTS: Among the 834 patients eligible, 374 (43.9%) were considered to be hypertensive on the basis of the ABPa (≥135/85 mmHg). 3-7BPa showed the lowest average difference (4/3 mmHg). By contrast, OBPa showed the highest result (21/11 mmHg). The mean difference with 1-2BPa was 8/4 mmHg. The areas under the curve were better with 3-7BPa (0.82-0.85) and 1-2BPa (0.82-0.83) than OBPa (0.67-0.71) for both systolic and diastolic BP. CONCLUSION: All means from successive measurements showed a better precision than OBPa, even the two first readings. However, more research needs to be carried out before recommendation of the use of this technique in routine practice.
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Silva et al. (2015) conducted a cross-sectional in Suspected and treated hypertension (n=834). Successive office blood pressure measurements vs. Standard office blood pressure (OBPa) was evaluated on Average difference in BP and area under the curve compared to awake blood pressure average (ABPa). Successive office blood pressure measurements (3rd to 7th readings) demonstrated higher diagnostic accuracy (AUC 0.82-0.85) and lower average difference (4/3 mmHg) than standard office BP.
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