Automated office blood pressure readings may avoid ‘white coat effect’

Physicians may be reluctant to adopt automated readings because of uncertainty about their advantages, study authors noted.


Properly done automated office blood pressure readings are more accurate than office readings done in routine clinical practice, a study concluded.

Automated office blood pressure measurement involves recording several blood pressure readings by using a fully automated oscillometric sphygmomanometer while the patient rests alone in a quiet place, with no staff present. Researchers conducted a meta-analysis of studies that compared automated office measurement of systolic and diastolic blood pressure with awake ambulatory blood pressure, routine office blood pressure, and measurements taken during clinical research. A research-quality office blood pressure measurement was defined as one performed according to standard guidelines, such as those of the American Heart Association. A routine office measurement was defined as a manual or electronic reading taken in usual clinical practice and not as part of a research study. Study results were published Feb. 4 by JAMA Internal Medicine.

Data were compiled from 31 articles that included 9,279 participants. In samples with systolic automated office blood pressure values of 130 mm Hg or more, routine office and research systolic blood pressure readings were substantially higher in comparison. The pooled mean difference was 4.5 mm Hg (95% CI, 11.8 to 17.2 mm Hg; P<0.001) for routine office systolic blood pressure readings and 7.0 mm Hg (95% CI, 4.9 to 9.1 mm Hg; P<0.001) for research systolic blood pressure readings. Automated office blood pressure readings were also similar to those obtained with systolic awake ambulatory blood pressure monitoring, with a pooled mean difference of 0.3 mm Hg (95% CI, −1.1 to 1.7 mm Hg; P<0.001).

The authors noted that while physicians may be reluctant to adopt automated readings because of uncertainty about their advantages, it should now be the preferred method for evaluating possible hypertension in routine clinical practice, with confirmation by 24-hour ambulatory blood pressure monitoring or home blood pressure measurements.

“If [automated office blood pressure] is to be used in clinical practice, readings must closely adhere to the procedures used in the [automated office blood pressure] studies in this meta-analysis, including multiple [blood pressure] readings recorded with a fully automated oscillometric sphygmomanometer while the patient rests alone in a quiet place,” the authors wrote.