Fully automated oscillometric devices may be more accurate than auscultation for measurement of blood pressure in an office setting, according to a recent statement on the topic from the American Heart Association (AHA).
The statement, which updates the AHA statement from 2005, notes that a validated automated office blood pressure device that can be programmed to take an average of at least three readings should be considered the preferred approach for evaluating blood pressure in the office. The initial step in measuring blood pressure involves determining the appropriate cuff size to be used, as a cuff that is too small will lead to an artificially elevated reading and one that is too large will result in an artificially low reading, according to the statement. Seated versus supine positioning is preferred based on available data, the statement said.
Blood pressure can differ substantially when measured outside the office versus inside the office, and ambulatory blood pressure monitoring should be considered the reference standard among outside measurement options, the statement said. It noted that home blood pressure monitoring can be used when ambulatory blood pressure monitoring is not available or the patient cannot tolerate it. Clinicians should advise patients to use only validated upper-arm cuff oscillometric devices for home blood pressure monitoring, the statement said.
It is not clear whether patients with white-coat hypertension are at higher cardiovascular risk or whether antihypertensive drug treatment lowers risk in this group, the statement said. Patients with untreated white-coat hypertension should receive annual follow-up with ambulatory blood pressure monitoring or home blood pressure monitoring to evaluate whether sustained hypertension has developed, according to the statement. Patients with masked hypertension (i.e., those with normal blood pressure in the clinic but with elevated readings outside of the clinical setting) and high nighttime blood pressure on ambulatory monitoring are at higher cardiovascular risk, the statement said.
The full statement, which also includes tables outlining proper procedures for blood pressure measurement and recommendations for children, pregnant women, obese patients, older patients, and those with pseudohypertension, arrhythmias, pulseless syndromes, and left ventricular assist devices, was published March 4 by Hypertension and is available online.