Automated office BP measurement: The new standard in HTN screening

,; ,; ,

doi:10.12788/jfp.0188

PURLs

Automated office BP measurement: The new standard in HTN screening

J Fam Pract. 2021 May;70(4):194-196 | 10.12788/jfp.0188

PDF Download

References

1. Roerecke M, Kaczorowski J, Myers MG. Comparing automated office blood pressure readings with other methods of blood pressure measurement for identifying patients with possible hypertension: a systematic review and meta-analysis. JAMA Intern Med. 2019;179:351-362.

2. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13-e115. Published correction appears in Hypertension. 2018;71:e140-e144.

3. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507-520. Published correction appears in JAMA. 2014;311:1809.

4. Fryar CD, Ostchega Y, Hales CM, et al. Hypertension prevalence and control among adults: United States, 2015-2016. NCHS Data Brief. 2017;(289):1-8.

5. GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1923-1994.

6. Kirkland EB, Heincelman M, Bishu KG, et al. Trends in healthcare expenditures among US adults with hypertension: national estimates, 2003-2014. J Am Heart Assoc. 2018;7:e008731.

7. Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111:697-716.

8. Ogedegbe G, Pickering T. Principles and techniques of blood pressure measurement. Cardiol Clin. 2010;28:571-586.

9. Pappaccogli M, Di Monaco S, Perlo E, et al. Comparison of automated office blood pressure with office and out-of-office measurement techniques. Hypertension. 2019;73:481-490.

10. Reeves RA. The rational clinical examination. Does this patient have hypertension? How to measure blood pressure. JAMA. 1995;273:1211-1218.

11. Myers MG, Valdivieso M, Kiss A. Use of automated office blood pressure measurement to reduce the white coat response. J Hypertens. 2009;27:280-286.

12. Centers for Medicare & Medicaid Services. Decision memo for ambulatory blood pressure monitoring (ABPM) (CAG-00067R2). July 2, 2019. Accessed September 29, 2020. www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=294

This meta-analysis emphasized the technique (see below) by which to obtain the best AOBP vs ABP results, whereas the other meta-analysis⁹ did not. Thus the study provides practice-based settings with the information they need to more closely replicate the results of the studies included in the meta-analysis.

Also, the equivalency comparison with the more expensive and intrusive ABP monitoring may save money, improve patient adherence, and increase patient satisfaction. Given these advantages, along with its demonstrated accuracy, AOBP should be adopted in routine clinical practice to screen patients for hypertension.

CAVEATS

Close adherence to measurementprocedures is a necessity

Effective use of AOBP in clinical practice requires close adherence to the AOBP study procedures described in this meta-analysis. These include taking multiple (at least 3) BP readings, 1 to 2 minutes apart, recorded with a fully automated oscillometric sphygmomanometer while the patient rests alone in a quiet place.

CHALLENGES TO IMPLEMENTATION

Adjusting workflows, addressing cost

Physicians may be reluctant to adopt this technique because they may not be convinced of its advantages compared with the traditional methods of recording BP and because of difficulties with implementing new rooming workflows.¹² The cost of AOBP devices used in this study (Omron 907 and BpTRU; BpTRU ceased operations in 2017) were not disclosed, which may be a hindrance, as devices may cost $1000 or more.

Effective use of automated office blood pressure requires that one take multiple (at least 3) BP readings, 1 to 2 minutes apart, while the patient rests alone in a quiet place.

An online search for “automated oscillometric BP monitor” by one of the PURL authors (RCM) found oscillometric AOBP devices ranging from $150 to > $1000, depending on whether the device was medical grade; a search for “Omron 907” found devices for ≤ $599 on multiple sites. However, none of the lower-cost devices indicated the ability to take multiple, unattended BP readings.

ACKNOWLEDGEMENT

The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.