Skip to main content
SpringerLink
Log in

The Impact of Measurement Methods on Office Blood Pressure and Management of Hypertension in General Practice

  • Original article
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

Introduction

The use of unattended automated office blood pressure (uAutoOBP) versus attended automated (aAutoOBP) and manual auscultatory office blood pressure (AuscOBP) measurements is a topic of current controversy.

Aim

To evaluate the differences between OBP measurements methods in the general practice (GP) setting.

Methods

We first compared aAutoOBP and uAutoOBP in 42 consecutive patients with hypertension (group 1). Secondly, we compared AuscOBP to uAutoOBP measurements in 133 consecutive patients with hypertension (group 2). In addition, we analyzed the achieved OBP targets as recommended in the 2018 European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) guidelines in group 2.

Results

The mean age of patients in group 1 was 71 years (range 34–89 years, 54.8% females). The aAutoOBP and uAutoOBP systolic (131.7 and 131.6 mmHg) and diastolic (83.4 and 82.4 mmHg) mean values were not significantly different. The patient characteristics in group 2 were similar to group 1. We observed a significant difference between AuscOBP and uAutoOBP measurement for both systolic (149.4 versus 129.5 mm Hg) and diastolic (85.4 versus 81.6 mm Hg, p < 0.0001, respectively). Accordingly, 20.3% and 45.9% of patients reached the overall 2018 ESC/ESH systolic and diastolic OBP targets of < 140/80 mmHg according to AuscOBP and uAutoOBP (p < 0.0001).

Conclusion

The attended versus unattended status of automated OBP measurements had no impact on OBP values in GP. However, significantly higher OBP values and lower rates of achieved target OBP were observed by using AuscOBP measurements by physicians in comparison to automated OBP recordings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Zhou B, Bentham J, Di Cesare M, Bixby H, Danaei G, Cowan MJ, et al. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. The Lancet. 2017;389(10064):37–55.

    Article  Google Scholar 

  2. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–104.

    Article  Google Scholar 

  3. Paini A, Salvetti M, Bertacchini F, Stassaldi D, Maruelli G, Arnoldi C, et al. Unattended vs attended Bp measurement: mean values and determinants of the difference. J Hypertens. 2018;36:e70.

    Article  Google Scholar 

  4. Group SR. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103–16.

    Article  Google Scholar 

  5. Lüscher TF, Kjeldsen SE, Mancia G, Papademetriou V. From ‘essential’ hypertension to intensive blood pressure lowering: the pros and cons of lower target values. Eur Heart J. 2017;38(44):3258–71. https://doi.org/10.1093/eurheartj/ehx643.

    Article  PubMed  Google Scholar 

  6. Stergiou GS, Kyriakoulis KG, Kollias A. Office blood pressure measurement types: different methodology—different clinical conclusions. J Clin Hypertens. 2018;20(12):1683–5.

    Article  Google Scholar 

  7. Kollias A, Stambolliu E, Kyriakoulis KG, Gravvani A, Stergiou GS. Unattended versus attended automated office blood pressure: systematic review and meta-analysis of studies using the same methodology for both methods. J Clin Hypertens. 2019;21(2):148–55.

    Article  Google Scholar 

  8. Nasothimiou EG, Tzamouranis D, Rarra V, Roussias LG, Stergiou GS. Diagnostic accuracy of home vs. ambulatory blood pressure monitoring in untreated and treated hypertension. Hypertens Res. 2012;35(7):750.

    Article  Google Scholar 

  9. Quer G, Nikzad N, Chieh A, Normand A, Vegreville M, Topol EJ, et al. Home monitoring of blood pressure: short-term changes during serial measurements for 56398 subjects. IEEE J Biomed Health Inf. 2017;22(5):1691–8.

    Article  Google Scholar 

  10. Kjeldsen SE, Mancia G. Unattended automated office vs. ambulatory blood pressure in people with high cardiovascular risk: implications for understanding the SPRINT results. J Hypertens. 2019;37(1):6–8.

    Article  CAS  Google Scholar 

  11. 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 Internal Med. 2019;179(3):351–62.

    Article  Google Scholar 

  12. Myers MG, Parati G. Self-measurement of blood pressure in the office and at home. J Hypertens. 2003;21(12):2223–5.

    Article  CAS  Google Scholar 

  13. Parati G, Pomidossi G, Casadei R, Mancia G. Lack of alerting reactions to intermittent cuff inflations during noninvasive blood pressure monitoring. Hypertension. 1985;7(4):597–601.

    Article  CAS  Google Scholar 

  14. Myers MG, Godwin M, Dawes M, Kiss A, Tobe SW, Grant FC, et al. Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial. BMJ. 2011;342:d286.

    Article  Google Scholar 

  15. Mancia G, Bombelli M, Cuspidi C, Facchetti R, Grassi G. Cardiovascular risk associated with white-coat hypertension: pro side of the argument. Hypertension. 2017;70(4):668–75.

    Article  CAS  Google Scholar 

  16. Mancia G, Parati G, Pomidossi G, Grassi G, Casadei R, Zanchetti A. Alerting reaction and rise in blood pressure during measurement by physician and nurse. Hypertension. 1987;9(2):209–15.

    Article  CAS  Google Scholar 

  17. Franklin SS, Thijs L, Asayama K, Li Y, Hansen TW, Boggia J, et al. The cardiovascular risk of white-coat hypertension. J Am Coll Cardiol. 2016;68(19):2033–43.

    Article  Google Scholar 

  18. Mancia G, Zanchetti A. Editors’ Corner: White-coat hypertension: misnomers, misconceptions and misunderstandings. What should we do. J Hypertens. 1996;14(9):1049–52.

  19. Parati G, Omboni S, Staessen J, Thijs L, Fagard R, Ulian L, et al. Limitations of the difference between clinic and daytime blood pressure as a surrogate measure of the ‘white-coat’effect. J Hypertens. 1998;16(1):23–9.

    Article  CAS  Google Scholar 

  20. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, 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. J Am Coll Cardiol. 2018;71(19):e127–248.

    Article  Google Scholar 

  21. Bauer F, Seibert FS, Rohn B, Bauer KA, Rolshoven E, Babel N, et al. Attended versus unattended blood pressure measurement in a real life setting. Hypertension. 2018;71(2):243–9.

    Article  CAS  Google Scholar 

  22. Filipovský J, Seidlerová J, Kratochvíl Z, Karnosová P, Hronová M, Mayer O Jr. Automated compared to manual office blood pressure and to home blood pressure in hypertensive patients. Blood Press. 2016;25(4):228–34.

    Article  Google Scholar 

  23. Filipovský J, Seidlerová J, Ceral J, Vysočanová P, Špác J, Souček M, et al. A multicentre study on unattended automated office blood pressure measurement in treated hypertensive patients. Blood Press. 2018;27(4):188–93.

    Article  Google Scholar 

  24. Wei W, Tölle M, Zidek W, van der Giet M. Validation of the mobil-O-Graph: 24 h-blood pressure measurement device. Blood Pressure Monit. 2010;15(4):225–8.

    Article  Google Scholar 

  25. Weiss W, Gohlisch C, Harsch-Gladisch C, Tölle M, Zidek W, van der Giet M. Oscillometric estimation of central blood pressure: validation of the Mobil-O-Graph in comparison with the SphygmoCor device. Blood Pressure Monit. 2012;17(3):128–31.

    Article  Google Scholar 

  26. Brinker S, Pandey A, Ayers C, Price A, Raheja P, Arbique D, et al. Therapeutic drug monitoring facilitates blood pressure control in resistant hypertension. J Am Coll Cardiol. 2014;63(8):834–5.

    Article  Google Scholar 

  27. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, 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(5):507–20.

    Article  CAS  Google Scholar 

  28. Handler J. The importance of accurate blood pressure measurement. Permanente J. 2009;13(3):51.

    Article  Google Scholar 

  29. Andreadis EA, Geladari CV, Angelopoulos ET, Savva FS, Georgantoni AI, Papademetriou V. Attended and unattended automated office blood pressure measurements have better agreement with ambulatory monitoring than conventional office readings. J Am Heart Assoc. 2018;7(8):e008994.

    Article  Google Scholar 

  30. Irving G, Neves AL, Dambha-Miller H, Oishi A, Tagashira H, Verho A, et al. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open. 2017;7(10):e017902. https://doi.org/10.1136/bmjopen-2017-017902.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We are very grateful for the outstanding support of the entire staff of the Audorfer Gemeinshaftspraxis.

Author information

Author notes

  1. Julia Höller and Linda Elizabeth Villagómez Fuentes contributed equally to the manuscript.

Authors and Affiliations

  1. Audorfer Gemeinschaftspraxis, General Medicine in Oberaudorf, Bavaria, Germany

    Julia Höller & Klaus Matthias

  2. Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, and Institute of Clinical Pharmacology and Toxicology, Charitéplatz 1, 10117, Berlin, Germany

    Linda Elizabeth Villagomez Fuentes & Reinhold Kreutz

Authors
  1. Julia Höller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda Elizabeth Villagomez Fuentes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Klaus Matthias
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Reinhold Kreutz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Linda Elizabeth Villagomez Fuentes.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The protocol was in accordance with the 1975 Helsinki Declaration and approved by the Charité ethics committee.

Informed consent

Informed consent was obtained from all participants before inclusion into the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Höller, J., Villagomez Fuentes, L.E., Matthias, K. et al. The Impact of Measurement Methods on Office Blood Pressure and Management of Hypertension in General Practice. High Blood Press Cardiovasc Prev 26, 483–491 (2019). https://doi.org/10.1007/s40292-019-00347-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40292-019-00347-z

Keywords

Search

Navigation