UNATTENDED AUTOMATIC BLOOD PRESSURE MEASUREMENTS VS. CONVENTIONAL OFFICE READINGS IN PREDICTING HYPERTENSION-MEDIATED ORGAN DAMAGE

Abstract

Objective: Hypertension, a major cardiovascular risk, requires accurate blood pressure measurement. Conventional office measurements (OBPM) are error-prone and systematically biased by the white coat effect. Unattended office blood pressure measurement (UOBPM) is emerging as an alternative to mitigate this bias. However, its ability to predict hypertension-mediated organ damage (HMOD), indicating disease progression, remains debated. This study compares UOBPM with OBPM in terms of their association with various HMODs, including left ventricular hypertrophy (LVH), left atrial enlargement (LAE), left ventricular systolic and diastolic dysfunction, intima-media complex (IMT) thickening, microalbuminuria and abnormal pulse wave velocity (PWV). Design and method: Hypertensive patients without overt cardiovascular disease were recruited, interviewed, and examined. Subsequently, blood pressure measurements were conducted in standard conditions in a randomized sequence in each patient: 1) UOBPM: After 5 minutes of solitary rest in the examination room, blood pressure was automatically measured three times at 1-minute intervals with OMRON HEM 907 device. 2) OBPM: After 5 minutes of rest, a physician performed three automated measurements at 1-minute intervals with the same device. Subsequent evaluations aimed to detect HMODs, including echocardiography, carotid artery ultrasound, PWV assessment, and laboratory tests. Receiver operating characteristic (ROC) analysis was performed for each HMOD in both measurement groups, and the areas under the ROC curves were compared. Results: The study enrolled 219 patients(55% females, mean age 55 ±14 years). The average systolic blood pressure in UOBPM was lower by 4,2 mmHg (p<0,001) compared to OBP while the difference in diastolic pressure was 1,9 mmHg (p<0,001). Both measurement methods were associated with the presence of the following HMODs: LAE, IMT thickening, and abnormal PWV. Neither method allowed for the prediction of LVH, systolic and diastolic dysfunction of the left ventricle, elevated ACR, or the presence of atherosclerotic plaques in the carotid arteries. Furthermore, ROC curve analyses revealed no difference between the two methods in predicting HMOD (Table 1). Conclusions: Both measurement techniques exhibited satisfactory predictive ability for the presence of certain HMOD. However, based on the study results, no significant differences could be inferred between the two methods with respect to their predictive performance.