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Differences in the diagnosis of high blood pressure using unattended and attended automated office blood pressure

Journal of Human Hypertension volume 36, pages 370–372 (2022)Cite this article

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Automated office blood pressure (AOBP) is becoming an increasingly popular blood pressure (BP) measuring approach [1], and its derived values have been used to define BP targets and thresholds in some hypertension guidelines [2, 3]. However, AOBP may be at least 3–15 mmHg lower than conventional office BP (ConvOBP) [4], indicating that AOBP and ConvOBP are not interchangeable measures. Recent attention is also devoted to the possible equivalence between attended (AttAOBP) and unattended (UnattAOBP) AOBP measures. Data from the Systolic Blood Pressure Intervention Trial and clinical studies suggested that AttAOBP and UnattAOBP provide similar average BP values [5,6,7]. However, AttAOBP and UnattAOBP may vary at similar average values [7], and alternative evidence demonstrated that AttAOBP might be greater than UnattAOBP [1, 8], challenging the notion that AttAOBP and UnattAOBP are equivalent phenotypes. Yet, there are no established AOBP cutoffs to identify high BP levels, although AOBP values of 135/85 mmHg and UnattAOBP values of 130/85 mmHg were suggested to identify hypertension [9, 10]. This exploratory study aimed at comparing the agreement of AttAOBP and UnattAOBP, and determining AttAOBP and UnattAOBP values corresponding to high ConvOBP thresholds recommended by current European Society of Hypertension/European Society of Cardiology (140/90 mmHg) [11] and the 2017 American College of Cardiology/American Heart Association (2017-ACC/AHA) (130/80 mmHg) [2] hypertension guidelines.

This study was approved by the Cesmac University Center Ethics committee and all participants provided written informed consent. We evaluated clinical characteristics and UnattAOBP, AttAOBP, and ConvOBP of a convenience sample of 187 consecutive individuals with age >18 years enrolled from the Clinical Research Center of the Cesmac University Center from June 2018 to June 2019. All BP measures were performed during a single office visit using an Omron HEM-907 device (Omron Healthcare, Kyoto, Japan), with the participants in the sitting position and arm on the table, with the back supported and feet on the ground, using adequate arm cuffs according to arm circumference. The arm with greater BP reading, which was defined before AttAOBP and UnattAOBP evaluation, was used for all BP measures. UnattAOBP comprised the average of three readings obtained at 1-min intervals after 5 min of rest, with the participants alone in a separate and silent room during all the resting and measuring periods. AttAOBP was measured similarly to UnattAOBP, except for the presence of a medical student. No conversation or interaction between the medical student and the participant was allowed throughout the resting and measuring periods. In the first consecutive 141 patients, AttAOBP was measured before UnattAOBP, while AttAOBP was measured after UnattAOBP in the last consecutive 46 participants. ConvOBP comprised the average of three readings obtained at 1-min intervals after 5 min in the sitting position and were taken by a physician at the physician’s office with the HEM-907 device set at the oscillometric (AVG) mode after AttAOBP and UnattAOBP measures were performed. Patients were allowed to speak during the 5 min before ConvOBP measurements, but not during ConvOBP measurements. Continuous and categorical variables are presented as mean ± standard deviation and proportions. Paired t-test and unpaired t-test compared BP measures within the same individuals and between different individuals, respectively, while correlations between BP measures were assessed by Pearson’s method. Unadjusted linear regression models were built to determine AttAOBP and UnattAOBP values corresponding to ConvOBP values of 140/90 and 130/80 mmHg [12]. P values <0.05 were considered significant. Statistical analysis was performed using Stata software Version 14.1 (Stata Corp LP, College Station, TX, USA).

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Fig. 1: Differences between blood pressure measurements.

References

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Funding

The study was supported by the Brazilian National Council for Scientific and Technological Development (CNPq; grant 306154/2017-0) for WNJ.

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Authors and Affiliations

  1. Centro de Pesquisas Clínicas do Centro Universitário Cesmac/Hospital do Coração de Alagoas, Maceió, AL, Brazil

    Annelise M. G. Paiva, Marco A. Mota-Gomes, Thomás C. P. Azevedo & Natalia W. Amorim

  2. Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil

    Audes D. M. Feitosa & Wilson Nadruz Jr.

  3. Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil

    Audes D. M. Feitosa

  4. UNICAP Clinical Research Institute, Recife, PE, Brazil

    Audes D. M. Feitosa

  5. Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil

    Decio Mion Jr.

  6. Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, SP, Brazil

    Andrei C. Sposito & Wilson Nadruz Jr.

Authors
  1. Annelise M. G. Paiva
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  2. Marco A. Mota-Gomes
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  3. Audes D. M. Feitosa
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  4. Thomás C. P. Azevedo
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  6. Decio Mion Jr.
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  7. Andrei C. Sposito
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  8. Wilson Nadruz Jr.
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Contributions

AMGP, MAM-G, and WNJ contributed to the design of the work, the acquisition, analysis and interpretation of data, and drafted the manuscript. ADMF, TCPA, NWA, DMJ, and ACS contributed to the acquisition, analysis and/or interpretation of data, and revised the manuscript critically for important intellectual content. All authors gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

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Correspondence to Wilson Nadruz Jr..

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Paiva, A.M.G., Mota-Gomes, M.A., Feitosa, A.D.M. et al. Differences in the diagnosis of high blood pressure using unattended and attended automated office blood pressure. J Hum Hypertens 36, 370–372 (2022). https://doi.org/10.1038/s41371-021-00593-6

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