CAN PATIENT-ACTIVATED HOME BLOOD PRESSURE RECORDERS ELIMINATE THE WHITE COAT RESPONSE IF USED IN A CLINICAL SETTING?: PP.3.115

Abstract

Objective: Automated office (AO) BP obtained using fully automated devices which record multiple readings with the patient resting alone in a quiet room has been shown to virtually eliminate the white coat response with readings similar to the awake ambulatory (AA) BP. This study examined the possibility of replacing fully automated devices such as the BpTRU with relatively inexpensive, validated, patient-activated home (H) BP recorders. Methods: AABP was compared with AOBP readings in patients with predominantly systolic hypertension referred for 24-hour ambulatory BP monitoring. AOBP was obtained using the fully automated BpTRU device (mean of five readings) and using one of three different HBP recorders (A&D UA787, Microlife A 100 plus and Omron HEM 780E) to obtain a mean of five patient-activated readings (HBP-O). Each patient also used the same HBP recorder to obtain 28 readings in the home (HBP-28) and had 24-hour ambulatory BP monitoring performed using a Spacelabs 90207 device. Results: One hundred and thirty-nine patients (mean age 63, range 18–86 years; 61 M, 78 F; 58 untreated) with a manual systolic BP (mmHg) >/ = 140 (mean ± SD BP 152 ± 9/84 ± 12) were studied. Mean values for AABP, fully automated BpTRU, patient-activated HBP-O and HBP-28 home readings were as follows: 142 ± 11/81 ± 12, 141 ± 14/82 ± 12, 146 ± 14/86 ± 12 and 142 ± 14/85 ± 10, respectively. Patient-activated readings using an HBP recorder under similar conditions to readings taken with the BpTRU gave systolic BP readings which were 4–5 mmHg higher (p < 0.001) than the AABP, BpTRU and HBP-28. AABP correlated significantly (p< 0.001) with AOBP readings taken with the BpTRU (r = 0.40 / r = 0.83), HBP-O (r = 0.44 / r = 0.79), and HBP-28 (r = 0.57 / r = 0.87). Conclusion: AOBP recorded with a fully automated device (BpTRU) eliminates the white coat response with readings similar to the AABP. Patient-activated AOBP taken with a standard HBP recorder reduces but does not eliminate the white coat response since the systolic BP was still significantly higher than with the AABP, home BP and fully automated AOBP using the BpTRU.