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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
Open accessAbstract
Importance: Automated office blood pressure (AOBP) measurement involves recording several blood pressure (BP) readings using a fully automated oscillometric sphygmomanometer with the patient resting alone in a quiet place. Although several studies have shown AOBP measurement to be more accurate than routine office BP measurement and not subject to a "white coat effect," the cumulative evidence has not yet been systematically reviewed. Objective: To perform a systematic review and meta-analysis to examine the association between AOBP and office BP readings measured in routine clinical practice and in research studies, and ambulatory BP recorded during awake hours, as the latter is a standard for predicting future cardiovascular events. Data Sources: The MEDLINE, Embase, and Cochrane Library were searched from 2003 to April 25, 2018. Study Selection: Studies on systolic and diastolic BP measurement by AOBP in comparison with awake ambulatory BP, routine office BP, and research BP measurements were included if they contained 30 patients or more. Data Extraction and Synthesis: Study characteristics were abstracted independently and random effects meta-analyses and meta-regressions were conducted. Main Outcomes and Measures: Pooled mean differences (95% CI) of systolic and diastolic BP between types of BP measurement. Results: Data were compiled from 31 articles comprising 9279 participants (4736 men and 4543 women). In samples with systolic AOBP of 130 mm Hg or more, routine office and research systolic BP readings were substantially higher than AOBP readings, with a pooled mean difference of 14.5 mm Hg (95% CI, 11.8-17.2 mm Hg; n = 9; I2 = 94.3%; P < .001) for routine office systolic BP readings and 7.0 mm Hg (95% CI, 4.9-9.1 mm Hg; n = 9; I2 = 85.7%; P < .001) for research systolic BP readings. Systolic awake ambulatory BP and AOBP readings were similar, with a pooled mean difference of 0.3 mm Hg (95% CI, -1.1 to 1.7 mm Hg; n = 19; I2 = 90%; P < .001). Conclusions and Relevance: Automated office blood pressure readings, only when recorded properly with the patient sitting alone in a quiet place, are more accurate than office BP readings in routine clinical practice and are similar to awake ambulatory BP readings, with mean AOBP being devoid of any white coat effect. There has been some reluctance among physicians to adopt this technique because of uncertainty about its advantages compared with more traditional methods of recording BP during an office visit. Based on the evidence, AOBP should now be the preferred method for recording BP in routine clinical practice.
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“Measurement bias on office BP may be overcome by the use of AOBP, which automatically measures BP a few times in the absence of health care professionals and may eliminate white-coat effects. 32”
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Metadata
- Authors
- Roerecke, M., Kaczorowski, J., & Myers, M. G.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- Université de Montréal (CA)
- Sunnybrook Health Science Centre (CA)
- Corresponding author
- Myers, Martin G.
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2019-03-01
- Volume
- 179
- Issue
- 3
- Pages
- 351
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC6439707
- OpenAlex
- W2913206674
- Cited by
- 216
- References
- 56
- Citations by year
- 2026: 19 · 2025: 21 · 2024: 19 · 2023: 22 · 2022: 38 · 2021: 32 · 2020: 34 · 2019: 31
- FWCI
- 24.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- automated office blood pressure, hypertension detection, white coat effect, ambulatory blood pressure monitoring, office blood pressure measurement, automated sphygmomanometer, systolic blood pressure, diastolic blood pressure, measurement agreement, cardiovascular risk prediction, hypertension screening, blood pressure measurement accuracy, cardiovascular event prediction, cardiovascular risk stratification, cardiovascular risk reduction, cardiovascular risk
- MeSH terms
- Automation, Blood Pressure Determination, Humans, Hypertension, Office Visits, Sphygmomanometers, White Coat Hypertension
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