Conventional Office Blood Pressure Research Articles

Intelligent Assist Office Blood Pressures (IOBP) versus awake ambulatory monitoring and conventional auscultatory office readings in Chinese primary medical institutions.

To practice standardized office blood pressure (OBP) measurement guidelines pragmatically, we developed an intelligent assisted OBP (IOBP) measurement system in the Chinese community, which can automatically obtain two or three BP values after a 5-min rest before the patients visit the doctor and transfer values to the community medical network in real time. We conducted a comparative study to investigate the agreement among IOBP, awake ambulatory BP (ABP), and conventional auscultatory OBP at different BP levels. Participants were divided into three groups according to BP, with 120/80 mmHg and 160/100 mmHg as the cut-off points. Attended IOBP, unattended IOBP, and auscultatory OBP were randomly measured before ABP monitoring. In total, 245 participants were included in the analysis. The mean systolic attended/unattended IOBP, auscultatory OBP, and awake ABP were 135.0, 136.7, 135.6, and 136.2 mmHg, respectively. Bland-Altman analysis revealed a bias of -1.1 and 0.5 mmHg for systolic attended/unattended IOBP compared with awake ABP in the overall sample. For auscultatory OBP, the bias was -0.4 (attended) and 1.2 mmHg (unattended). The discrepancy between the systolic attended/unattended IOBP and awake ABP was inconsistent at different BP levels. In Group 1 the values were -8.4 and -6.9 mmHg, whereas in Group 3, the values were 9.4 and 10.0 mmHg. BP measured using the IOBP measurement system was in accordance with awake ABP and conventional OBP, and can be a good choice in the Chinese community.

Unattended automatic blood pressure measurements vs conventional office readings in predicting hypertension-mediated organ damage.

Hypertension is a leading cardiovascular risk factor. Accurate blood pressure (BP) measurement is pivotal in hypertension diagnosis and management. Conventional office blood pressure measurements (OBPMs) are error‑prone, exacerbated by the white‑coat effect. Unattended automated office blood pressure measurement (UAOBPM) is emerging as an alternative, mitigating the white‑coat effect. However, its ability to predict hypertension‑mediated organ damage (HMOD) remains disputable. This study compares UAOBPM with OBPM in terms of their association with various types of HMOD, including left ventricular hypertrophy, left atrial enlargement, left ventricular systolic and diastolic dysfunction, intima‑media complex thickening, microalbuminuria, and abnormal pulse wave velocity. A total of 219 hypertensive patients were recruited, interviewed, and examined. Subsequently, BP measurements were conducted in a randomized manner: 1) UAOBPM, after 5 minutes of solitary rest in an examination room, BP was automatically measured 3 times at 1‑minute intervals; 2) OBPM, after 5 minutes of rest, a physician performed 3 consecutive BP measurements at 1‑minute intervals. Subsequent evaluations aimed to detect HMOD and included echocardiography, carotid artery ultrasound, pulse wave velocity assessment, and laboratory tests. UAOBP values were lower than the OBP ones (mean [SD], 124.7 [14.4] vs 128.2 [14.2] mm Hg; P <0.001 for systolic BP, and 73.3 [10.2] vs 75.2 [10.6] mm Hg; P <0.001 for diastolic BP). Correlation and receiver operating characteristic curve analyses revealed no superiority of either method in predicting HMOD. The UAOBPM did not prove superior to OBPM in predicting HMOD. Further research is warranted to determine the role of UAOBPM in clinical practice.

S-04-1: CURRENT EVIDENCE AND ISSUES ON AOBP FROM JAPAN

The potential ability of unattended office blood pressure (AOBP) has been acknowledged worldwide, including Japan, although much resource consumption makes it less feasible to use AOBP in clinical practice. We reported that the three consecutive AOBP measurement values in each patient were almost identical, with high correlations (r ≥ 0.90), and the AOBP and conventional attended office blood pressure were moderate to highly correlated. We therefore interpret that AOBP can be an alternative that is more stable than the conventional attended blood pressure value despite with the average shifted to some extent, e.g., 10.4/4.2 mmHg based on the same study. In contrast, there is a fundamental discrepancy between the similarity in average values and the poor agreement in individuals when we compare AOBP versus self-measured home blood pressure, as the systolic blood pressure difference was 0.9 mmHg with a 95% agreement limit was -34.0 to + 35.8 mmHg. The vast wide range of difference indicates that we cannot estimate home as well as ambulatory blood pressure values by AOBP measurements in each patient, and vice versa. AOBP has another advantage regarding the elimination of white-coat effect by the presence of medical staff. Nevertheless, because AOBP measurement is performed at a clinic or in a screening setting where participants cannot be relaxed like at their own home, such a clinic effect still affects AOBP readings. In this session, the current evidence on AOBP based on our Japanese studies and others will be summarized and issues which remain to be investigated for the assessment of a variety of blood pressure conditions, unattended and attended office, and out-of-office blood pressures will be discussed.

Conventional office blood pressure measurements and unattended automated office blood pressure compared with home self-measurement and 24-h ambulatory blood pressure monitoring.

To assess whether automated office blood pressure (BP) (AOBP) measurement is a better method for measuring BP in the office than conventional techniques and an alternative to out-of-office BP measurements: home-self BP (HSBP) or ambulatory BP monitoring (ABPM). We conducted a cross-sectional study of 74 patients and compared AOBP with the conventional technique using a mercury sphygmomanometer and with both out-to-office BP measurements: HSBP of 7 days (three measurements in the morning, afternoon, and night) and daytime ABPM. In addition, we compared BP values obtained using HSBP and ABPM to determine their level of agreement. We used ANOVA to compare means, Bland-Altman, and intraclass correlation coefficients (ICC) for concordance. BP values obtained by the two office methods were similar: conventional 147.2/85.0 mmHg and AOBP 146.0/85.5 mmHg ( P > 0.05) with good agreement (ICC 0.85). The mean SBP differences between AOBP and HSBP ( P < 0.001) and between AOBP and ABPM ( P < 0.001) were 8.6/13.0 mmHg with limits of agreement of -21.2 to 38.5 and -18.4 to 44.3 mmHg, respectively. The average SBP values obtained by HSBP were 4.3 mmHg higher than those obtained by ABPM ( P < 0.01). Our study showed good agreement and concordance between the two office methods as well between the two out-to-office methods, although there was a significant difference in the mean SBP between the HSBP and ABPM. Moreover, AOBP was not comparable to either HSBP or ABPM; therefore, the estimation of out-to-office BP using AOBP is not supported.

A comprehensive risk score incorporating 24-hour ambulatory blood pressure.

Although ambulatory blood pressure (BP) monitoring is required for the proper diagnosis and management of hypertension, conventional office BP has not yet been replaced by ambulatory BP in the currently available risk charts. For the current analysis, we selected 9,024 participants from the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) aged ≥40 to <80 years with a baseline ambulatory BP recording including ≥6 daytime and ≥3 nighttime reading. Given the age range of the analyzed participants, we focused on systolic BP as a risk factor. Time-to-event analysis was conducted using the Cox model, and the 5-year risk was computed using the established formula used in the Heart “OMics” in AGEing (HOMAGE) study (J Am Heart Assoc 2017:e005231). Age at enrolment averaged 59.0 years, 48.2% women, and average 24 h systolic BP was 125.8 mmHg. The median number of ambulatory readings recorded over 24 h and the median follow-up of the cohort was 55 (ranging across cohorts from 37 to 80) and 13.9 years (from 4.0 to 23.3 years), respectively. All endpoints—composite cardiovascular endpoints, cardiovascular mortality, and total mortality—were positively associated with 24-h systolic BP, being on antihypertensive drug treatment at baseline, age, male sex, smoking, a history of cardiovascular disease, having diabetes, and non-drinking alcohol (P≤0.0032). Total mortality was inversely associated with body mass index and total cholesterol, whereas the composite cardiovascular endpoint and cardiovascular mortality were not. None of the endpoints was associated with Non-Asian versus Asian ethnicity (P≥0.31). Based on these findings, we constructed a risk score for each endpoint. The reference category was assigned to young (40–44 years old), women, no smoker, body mass index between 25–29 kg/m2, total serum cholesterol between 5.17–6.20 mmol/L, no diabetes, no history of cardiovascular disease, drinker, and 24-h ambulatory BP of <110 mmHg. The relative risk of cardiovascular events among the quintile of the scores in the participants was clearly separated, and estimated versus observed outcomes across the quintile groups demonstrated similar trends with showing good agreement. Although replication has not yet been fully achieved, the current risk calculator can be a valuable tool for healthcare providers as well as people for introducing ambulatory BP monitoring to the early detection and intervention for the general population and treatment naïve patients with high BP.

Office blood pressure: overcoming the problems of diagnosis and control of arterial hypertension treatment

Some national guidelines since 2017 considered the most common method for diagnosing and controlling hypertension (HTN) (office blood pressure (OBP) measurement) as screening only. Automated OBP (AOBP) measurement claims to be a unique method by obtaining a standardized result, even in primary health care. AOBP improves the reliability of data by reducing the influence of various errors on result. However, although the level of AOBP is on average lower than similar OBP in clinical and research practice and is comparable to the mean 24-hour BP monitoring, at present, all international guidelines emphasize the mandatory use of ambulatory BP measurements for diagnostic purposes. Whether the results of AOBP and the reference level ≥130/80 mm Hg are equivalent with the same OBP level, the use of which is associated with an increase in the prevalence of hypertension and insufficient control of antihypertensive therapy, is a question for research. Compared with conventional OBP, the use of AOBP in conjunction with outpatient measurement leads to a reduction in the proportion and timing of initiation of treatment in patients with masked HTN, whose cardiovascular risk is similar to that of patients with stable HTN. However, the widespread implementation of AOBP is hindered by the high cost and lack of accumulated data. The review analyzes in detail the limitations and advantages of various types of BP measurement, as well as the potential of using AOBP in modern clinical and research practice.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Unattended automated office blood pressure measurement — current evidence and the role in clinical practice

Arterial hypertension is a leading preventable cardiovascular risk factor. The definition and thresholds for the diagnosis of hypertension vary between European and American guidelines. That is mainly due to the widely known SPRINT trial in which unattended automated blood pressure measurements were used. This technique of blood pressure estimation requires a patient to be left alone in an office and then a programmed device measures blood pressure automatically. The absence of a health professional during the measurement helps to reduce or eliminate the “white coat” effect; therefore, values of blood pressure may be lower than in conventional office blood pressure measurements. There are premises that this technique can be a solid substitution for 24-hour ambulatory blood pressure measurements and that it can predict hypertension-mediated organ damage more accurately than standard techniques. However, due to the many methods in which measurement can be carried out, no universal protocol exists. More research is needed to evaluate the usefulness of unattended automated office blood pressure measurements in clinical practice.

Comparison of nurse attended and unattended automated office blood pressure with conventional measurement techniques in clinical practice.

Accuracy in blood pressure measurement is critical for proper hypertension diagnosis and treatment in clinical practice. Automated office blood pressure (AOBP) can simplify the measurement process, reducing human error and minimizing the white-coat effect in the unattended mode. The aim of this study was to compare AOBP, both unattended and nurse attended, with conventional office and out-of-office blood pressure measurement techniques. Four different methods of blood pressure measurement were performed in a cohort of hypertensive patients: conventional office blood pressure (OBP), unattended automated office blood pressure (uAOBP), nurse attended automated office blood pressure (nAOBP), and home blood pressure monitoring (HBPM). uAOBP and nAOBP were conducted with the same rigorous standardized procedure. We enrolled 118 consecutive patients. nAOBP values were slightly higher than uAOBP ones (respectively 132.8/73.3 ± 19.4/12.9 and 129.2/71.1 ± 19.0/12.3 mmHg), even if the difference was influenced by order of execution of AOBP measurement. nAOBP was significantly lower than HBPM and OBP (mean values 135.2/80.9 ± 16.6/8.1 and 140.9/84.6 ± 18.7/10.8 mmHg, respectively). AOBP, either attended or unattended, provides lower values than conventional OBP. uAOBP and nAOBP values showed small differences, even if they are not completely interchangeable. This evidence reflects a lower white-coat effect, even in nurse attended technique, but is also due to a lower measurement error through the application of a rigorous standardized protocol.

COMPARISON OF ATTENDED AND UNATTENDED CENTRAL AND PERIPHERAL OFFICE BLOOD PRESSURE MEASUREMENTS IN HYPERTENSIVE PATIENTS IN GENERAL PRACTICE

Objective: Central hemodynamic indices have been established as parameters of arterial health, but the prognostic value of central vs. conventional office blood pressure (OBP) measurements remains unclear. Furthermore, the use of attended vs. unattended automated OBP measurements is a current topic of controversy. Design and method: We conducted a prospective cohort study in general practice in Germany and included 42 consecutive patients with hypertension. The Mobil-O-Graph oscillometric device was used for the automated OBP recordings in all patients. Measurements were performed in a separate quiet room after five minutes rest in seated position. We compared in random order in each patient the attended vs. unattended automated central and peripheral systolic OBP (SOBP), diastolic OBP (DOBP), and pulse velocity wave (PVW). Results: The mean age of patients was 71 years (range 34–89 years, 54.8% females). Patients were treated on average with 1.95 antihypertensive drugs. The mean attended and unattended automated peripheral SOBP (131.7 and 131.6 mmHg, respectively) and DOBP (83.4 and 82.4 mmHg, respectively) values recorded by the device were not significantly different. In addition, there was no difference between the mean attended and unattended central aortic SOBP (120.1 and 120.2 mmHg, respectively) and DOBP (84.7 and 83.7 mmHg, respectively) values. Bland-Altman analysis revealed the small inter-individual differences between attended und unattended peripheral and central SOBP and DOBP values. There was no asymmetry and narrow limits of agreement between the two methods. Finally, no significant difference for PVW was found between attended and unattended measurements (10.1 and 10.2 m/sec, respectively). Conclusions: The attended versus unattended status of automated OBP measurements had no impact on derived peripheral OBP, central OBP and PVW values in general practice when using the Mobil-O-Graph oscillometric device.

Automated office blood pressure measurement by elderly patients in the waiting room.

Unattended automated office blood pressure (AOBP) may be a better estimate of true blood pressure (BP) than conventional office BP by physicians or nurses. However, measurement of AOBP is cumbersome in general clinical practice. We compared unattended AOBP by the patients themselves using the rigid cuff in the waiting room with attended AOBP and home BP (HBP) (N = 72). Unattended AOBP by patients was measured in the waiting room using a rigid cuff with the fully automated device (Omron, HEM-907, triple BP readings taken at 1-min intervals after 5 min of rest). Attended AOBP was measured using a soft cuff by a physician in an examination room without specific resting time. HBP was measured for 5 consecutive days. The mean age was 76.5 ± 8.6 years. The mean systolic unattended AOBP by patients, attended AOBP and HBP were 139.3 ± 16.6, 144.8 ± 17.1 and 139.1 ± 14.4 mmHg, respectively. Unattended AOBP by patients was significantly related to attended AOBP (r = 0.798; P < 0.01) and to HBP (r = 0.404; P < 0.001). It was significantly lower than attended AOBP (difference 5.5 ± 10.7 mmHg; P < 0.001) and comparable with HBP (difference 0.26 ± 17.0 mmHg; P = 0.90) in Bland-Altman plots. However, 22% of patients had a difference of over 20 mmHg between unattended AOBP by patients and HBP. Multivariate regression demonstrated older age (B = -0.73; P = 0.002) to be related to the difference between unattended AOBP by patients and HBP. The mean unattended AOBP by patients was lower than attended AOBP and comparable with HBP, but older age affected the difference between unattended AOBP by patients and HBP.

Office, central and ambulatory blood pressure for predicting incident atrial fibrillation in older adults.

Recently, more sophisticated blood pressure (BP) measurements, such as central and ambulatory BP (ABP), have proven to be stronger predictors of future cardiovascular disease than conventional office BP. Their predictive value for atrial fibrillation development is not established. We investigated the prognostic impact for incident atrial fibrillation of office, central and ambulatory BP measurements in a predominantly older population-based cohort. Of 1004 participants in the Cardiovascular Abnormalities and Brain Lesions (CABL) study, 769 in sinus rhythm with no history of atrial fibrillation or stroke (mean age 70.5 years) underwent ABP and arterial wave reflection analysis for central BP determination. Fine and Gray's proportional subdistribution hazards models were used to assess the association of BP parameters with incident atrial fibrillation. During 9.5 years, atrial fibrillation occurred in 83 participants. No office BP variable showed a significant association with incident atrial fibrillation. Central SBP and central pulse pressure were marginally associated with incident atrial fibrillation in multivariate analysis. Among ABP variables, 24-h SBP [adjusted hazard ratio per 10 mmHg, 1.24; 95% confidence interval (CI) 1.07--1.44; P = 0.004], daytime SBP (adjusted hazard ratio per 10 mmHg, 1.21; 95% CI 1.04--1.40; P = 0.011) and night-time SBP (adjusted hazard ratio per 10 mmHg, 1.22; 95% CI 1.07--1.39; P = 0.002) were significantly associated with incident atrial fibillation. In a predominantly older, stroke-free community-based cohort, ABP was a better independent predictor of incident atrial fibrillation than central BP, whereas office BP was inadequate for this purpose.

Effect of ambulatory blood pressure monitoring guided antihypertensive treatment on renal progression in patients with chronic kidney disease: a randomized comparative study.

Adequate blood pressure (BP) control is pivotal for managing chronic kidney disease (CKD). The optimal approach for monitoring BP to delay CKD progression is not yet clear. Patients with hypertension and CKD stage 3-4 were randomized into ambulatory blood pressure monitoring (ABPM) or office BP groups. All patients had ABPM at baseline and 18 months, and the ABPM group additionally underwent ABPM at 3 and 6 months. Each ABPM result was notified only for the ABPM group. The BP target was daytime ABP less than 135/85 mmHg for the ABPM group and office BP less than 140/90 mmHg for the office BP group. The primary outcome was decrease in estimated glomerular filtration rate (eGFR) during 18 months. A total of 146 patients were randomized into the ABPM (n = 69) and office BP groups (n = 77). Although office BP was comparable in the two groups at baseline, daytime ABP was higher in the ABPM group (median 140 vs. 132 mmHg). Initial eGFR was 35.7 ± 12.5 ml/min per 1.73 m2 in the ABPM group and 34.6 ± 12.0 ml/min per 1.73 m2 in the office BP group. eGFR change was -5.5 [95% confidence interval (95% CI) -7.7 to -3.4] ml/min per 1.73 m2 in the ABPM group and -5.0 (95% CI -6.9 to -3.0) ml/min per 1.73 m2 in the office BP group (P = 0.704). Renal events occurred in 10 patients (15.6%) from the ABPM group and five (7.1%) from the office BP group (P = 0.120). The present study did not show a beneficial effect of ABPM for controlling hypertension in CKD compared with conventional office BP monitoring in terms of renal outcomes.

Differences between home blood pressure and strictly measured office blood pressure and their determinants in Japanese men.

Conventional office blood pressure (OBP) and home blood pressure (HBP) measurements are often inconsistent. The purpose of this research was (1) to test whether strictly measured OBP values with sufficient rest time before measurement (st-OBP) is comparable to HBP at the population level and (2) to ascertain whether there are particular determinants for the difference between HBP and st-OBP at the individual level. Data from a population-based group of 1056 men aged 40-79 years were analyzed. After a five-min rest, st-OBP was measured twice. HBP was measured after a 2-min rest every morning for seven consecutive days. To determine factors related to ΔSBP (HBP minus st-OBP measurements), multiple linear regression analyses and analyses of covariance were performed. While st-OBP and HBP were comparable (136.5 vs. 137.2 mmHg) at the population level, ΔSBP varied with a standard deviation of 13.5 mmHg. Smoking was associated with a larger ΔSBP regardless of antihypertensive usage, and BMI was associated with a larger ΔSBP in participants using antihypertensive drugs. The adjusted mean ΔSBP in the highest BMI tertile category was 4.6 mmHg in participants taking antihypertensive drugs. st-OBP and HBP measurements were comparable at the population level, although the distribution of ΔSBP was considerably broad. Smokers and obese men taking antihypertensive drugs had higher HBP than st-OBP, indicating that their blood pressure levels are at risk of being underestimated. Therefore, this group would benefit from the addition of HBP measurements.

Comparison between unattended automated office blood pressure and conventional office blood pressure under the environment of health checkup among Japanese general population.

Unattended automated office blood pressure (AOBP) measurement has been endorsed as the preferred in-office measurement modality in recent Canadian and American clinical practice guidelines. However, the difference between AOBP and conventional office blood pressure (CBP) under the environment of a health checkup remains unclear. We aimed to identify the clinical significance of AOBP as compared to CBP under the environment of a health checkup. There were 491 participants (333 females, mean age of 62.5years) who were at least 20years old, including 179 participants who were previously diagnosed with hypertension. Mean AOBPs were 131.8±20.9/76.6±11.7mmHg, and CBPs were 135.6±21.6/77.3±11.5mmHg. There was a difference of 3.9mmHg in systolic blood pressure (SBP) and 0.8mmHg in diastolic BP between AOBP and CBP. In all participants, SBP and pulse pressure, as well as the white coat effect (WCE), increased with age. The cutoff value used was 140/90mmHg for CBP and 135/85mmHg for AOBP, and the prevalence of WCE and masked hypertension effect (MHE) was 12.4% and 14.1%, respectively. Even in a health checkup environment of the general population, there was a difference between the AOBP and CBP, and the WCE was observed more strongly in the elderly with a history of hypertension, suggesting that a combination of AOBP with CBP may be useful in detecting WCE and MHE in all clinical scenarios including health checkups, and help solve the "hypertension paradox" not only in Japan but in all over the world.

The optimal use of automated office blood pressure measurement in clinical practice.

This evidence-based article endorses the use of automated office blood pressure (AOBP). AOBP is the most favorable office blood pressure (BP) measuring technique as it provides accurate readings with 3-15mmHg lower values than the casual conventional office measurements with auscultatory or semi-automated oscillometric devices and relates closely to awake ABP readings. The AOBP technique seems to be superior to conventional office BP in predicting hypertension-mediated organ damage and appears to be equally reliable to awake ABP in the prediction of cardiovascular (CV) disease. AOBP readings should be obtained either unattended, with the patient alone in the examination room, or attended with the presence of personnel in the room but with no talking to the patient, although this recommendation is not frequently followed in routine clinical practice. To optimize office BP readings, the type of device, the rest period before AOBP measurements (preceding rest), and the time intervals between measurements were evaluated. As AOBP readings have the advantage of removing many confounding factors, the authors propose to perform measurements with a preceding rest in all patients at the initial visit; if AOBP readings remain <130mmHg in subsequent visits, measurements could be accepted, otherwise, if are higher, patients should be evaluated by out-of-office BP measurements.

Recommendations for home blood pressure monitoring in Latin American countries: A Latin American Society of Hypertension position paper.

Out-of-office blood pressure (BP) monitoring appears to be a very useful approach to hypertension management insofar it allows to obtain multiple measurements in the usual environment of each individual, allows the detection of hypertension phenotypes, such as white-coat and masked hypertension, and appears to have superior prognostic value than the conventional office BP measurements. Out-of-office BP can be obtained through either home or ambulatory monitoring, which provide complementary and not identical information. Home BP monitoring yields BP values self-measured in subjects' usual living environment; it is an essential method for the evaluation of almost all untreated and treated subjects with suspected or diagnosed hypertension, best if combined with telemonitoring facilities, also allowing long-term monitoring. There is also increasing evidence that home BP monitoring improves long-term hypertension control rates by improving patients' adherence to prescribed treatment. In Latin American Countries, it is widely available, being relatively inexpensive, and well accepted by patients. Current US, Canadian, Japanese, and European guidelines recommend out-of-office BP monitoring to confirm and refine the diagnosis of hypertension.

Evaluation of Unattended Automated Office, Conventional Office and Ambulatory Blood Pressure Measurements and Their Correlation with Target Organ Damage in an Outpatient Population of Hypertensives: Study Design and Methodological Aspects.

Accurate measurement of blood pressure (BP) has a pivotal role in the management of patients with arterial hypertension. Recently, introduction of unattended office BP measurement has been proposed as a method allowing more accurate management of hypertensive patients and prediction of hypertension-mediated target organ damage (HMOD). This approach to BP measurement has been in particular proposed to avoid the white coat effect (WCE), which can be easily assessed once both attended and unattended BP measurements are obtained. In spite of its interest, the role of WCE in predicting HMOD remains largely unexplored. To fill this gap the Young Investigator Group of the Italian Hypertension Society (SIIA) conceived the study "Evaluation of unattended automated office, conventional office and ambulatory blood pressure measurements and their correlation with target organ damage in an outpatient population of hypertensives". This is a no-profit multicenter observational study aiming to correlate attended and unattended BP measurements for quantification of WCE and to correlate WCE with markers of HMOD, such us left ventricular hypertrophy, left atrial dilatation, and peripheral atherosclerosis. The Ethical committee of the Federico II University hospital has approved the study.

UNATTENDED AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENT. DOES IT DIFFER FROM OFFICE BLOOD PRESSURE? INSIGHT FROM A RANDOM POPULATION SAMPLE

Objective: Currently, there is an ongoing controversy about the magnitude of the difference between unattended automated office blood pressure (AOBP) and conventional office blood pressure (BP) measurement. Thus, the aim of our study was to compare AOBP with both mercury sphygmomanometer and oscillometric BP measurements in a random population sample. Design and method: In 2588 subjects of the Czech post-MONICA study (a randomly selected 1% representative population sample aged 25–64 years, mean age 48 ± 11 years, 47.5% males), BP was measured using an AOBP device (BpTRU) unattended, and office BP using a manual mercury sphygmomanometer (Baumanometer) and a validated oscillometric device (Microlife). Results: On average, sphygmomanometer BP was 10.7/5.5 mmHg higher than AOBP. Similarly, oscillometric BP was 10.2/3.6 mmHg higher than AOBP (p < 0.001 for both differences), while the mean difference of 0.5/1.9 mmHg between sphygmomanometer and oscillometric BP was not significant. The difference between sphygmomanometer and AOBP systolic increased nonlinearly with increasing sphygmomanometer BP up to the value of 150 mmHg to remain stable afterwards, while the difference decreased with increasing age and male gender. AOBP systolic of 127 mmHg corresponded to sphygmomanometer systolic BP of 140 mmHg. Similarly, AOBP systolic of 128 mmHg corresponded to an oscillometric value of 140 mmHg. Conclusions: Unattended systolic BP measured using an AOBP device is on average 10 mmHg lower than the office sphygmomanometer or oscillometric value, but the difference is dependent on current BP. The implication is that AOBP values cannot be used interchangeably with other office measurements.

Nocturnal blood pressure measured by home devices: evidence and perspective for clinical application.

: Studies using ambulatory blood pressure (BP) monitoring have shown that BP during night-time sleep is a stronger predictor of cardiovascular outcomes than daytime ambulatory or conventional office BP. However, night-time ambulatory BP recordings may interfere with sleep quality because of the device cuff inflation and frequency of measurements. Hence, there is an unmet need for obtaining high quality BP values during sleep. In the last two decades, technological development of home BP devices enabled automated BP measurements during night-time. Preliminary data suggest that nocturnal home BP measurements yield similar BP values and show good agreement in detecting nondippers when compared with ambulatory BP monitoring. Thus, nocturnal home BP measurements might be a reliable and practical alternative to ambulatory BP monitoring to evaluate BP during sleep. As the use of home BP devices is widespread, well accepted by users and has relatively low cost, it may prove to be more feasible and widely available for routine clinical assessment of nocturnal BP. At present, however, data on the prognostic relevance of nocturnal BP measured by home devices, the optimal measurement schedule, and other methodological issues are lacking and await further investigation. This article offers a systematic review of the current evidence on nocturnal home BP, highlights the remaining research questions, and provides preliminary recommendations for application of this novel approach in BP management.