Automated Office BP Beats Routine Readings: Meta-Analysis

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Automated office blood pressure (AOBP) readings are more accurate than office measurements and should be the “preferred method” for recording BP in clinical practice, concludes a meta-analysis in JAMA Internal Medicine.

A systematic review of the literature identified 31 articles related to AOBP including a total of 9279 patients. All of the studies included at least 30 patients with properly recorded AOBP measurements: patient unattended and sitting in a quiet place. The studies provided data enabling comparison of AOBP with awake ambulatory BP, research-quality office BP, or routine office BP measurements.

Mean systolic AOBP was 130 mm Hg or higher in about half of the studies, totaling 4892 patients. In these studies, the routine and research office systolic BP readings were significantly higher than the AOBP readings: pooled mean differences were 14.5 and 7.0 mm Hg, respectively.

In contrast, there was little or no difference in systolic awake ambulatory BP or AOBP measurements: pooled mean difference 0.3 mm Hg. The results were consistent for studies using different devices, and in studies including specialist/referral versus unselected patient populations.

Previous studies have reported that AOBP is more accurate than routine office BP measurement, with no “white coat effect.” The new report is the first comprehensive systematic review and meta-analysis of the evidence comparing AOBP with other measurement techniques.

Recorded properly, AOBP is more accurate than routine or even research-quality office BP measurements, and similar to awake ambulatory BP readings. The investigators conclude: “Automated office BP should now be the preferred method for recording BP in routine clinical practice to identify patients with possible hypertension, with the diagnosis to be confirmed by 24-hour ABPM or home BP” [Roerecke M, et al. 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. JAMA Intern Med 2019; DOI:10.1001/jamainternmed.2018.6551].