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Attended Versus Unattended Automated Office Blood Pressure: A Systematic Review and Meta-analysis

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Abstract

Introduction

Automated office blood pressure (AOBP) has been proposed for blood pressure (BP) assessment in the office because it shows a strong association with the awake ambulatory BP. However, it remains unknown whether the presence or absence of an observer modulates AOBP readings.

Aim

To determine the difference between unattended and attended AOBP measurements through systematic review and meta-analysis.

Methods

We searched the PubMed and the Cochrane Collaboration Library and we screened the references’ list of relevant reports to identify potentially eligible articles. For included studies, quality was assessed by using the Quality Assessment for Diagnostic Accuracy Studies 2. The weighted pooled BP difference with 95% confidence interval (CI) between unattended and attended AOBP was estimated under the random effects model.

Results

Twelve studies (1762 subjects) were included. The systolic and diastolic BP difference between unattended and attended AOBP measurements was − 3.66 (− 6.58 to − 0.75) and − 1.67 (− 2.78 to − 0.55) mmHg, respectively. Heterogeneity across studies was high (I2 = 97,1% for systolic and I2 = 89% for diastolic BP, P < 0.001) and was partially determined by the sequence of performing unattended and attended BP measurements, the device used for AOBP, the geographic region in which studies were performed and the presence of a resting period before unattended AOBP.

Conclusions

Due to the high heterogeneity, we cannot rely on the weighted pooled estimate. However, the available evidence suggests that attended AOBP yielded higher systolic and diastolic BP levels and it seems that the procedural methodology determines partially the statistical heterogeneity across studies.

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Acknowledgements

The corresponding author (E. A.) is responsible for the design of the study, the preparation of the first draft and the completion of the whole manuscript C. T. and C. G. have done the systematic review of the literature and extracted data. C. T. has conducted the meta-analysis. All four authors have substantially contributed to interpretation of data, critical revision of the article for important intellectual content and given final approval of the version to be published. We would like also to cordially thank Dr. Polonia and Dr. Martin for their valuable help in providing additional information of their studies.

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Authors and Affiliations

  1. Hypertension and Cardiovascular Disease Prevention Outpatient Center, Evangelismos General Hospital, 7 Dimocharous Street, Kolonaki, 11521, Athens, Greece

    Emmanuel A. Andreadis & Charalampia V. Geladari

  2. Department of Cardiology, Helena Venizelou Hospital, Athens, Greece

    Costas Thomopoulos

  3. Department of Cardiology, Veterans Affairs and Georgetown University Medical Centers, Washington, DC, USA

    Vasilios Papademetriou

Authors
  1. Emmanuel A. Andreadis
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  2. Costas Thomopoulos
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  3. Charalampia V. Geladari
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  4. Vasilios Papademetriou
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Corresponding author

Correspondence to Emmanuel A. Andreadis.

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Funding

We received no funding for this work.

Conflict of interest

CT declares consultancy fees from Astra Zeneca, Menarini and lecture honoraria from Sanofi, MSD, Menarini and Servier. The other authors declare no conflict of interest regarding this review and meta-analysis.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Andreadis, E.A., Thomopoulos, C., Geladari, C.V. et al. Attended Versus Unattended Automated Office Blood Pressure: A Systematic Review and Meta-analysis. High Blood Press Cardiovasc Prev 26, 293–303 (2019). https://doi.org/10.1007/s40292-019-00329-1

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  • DOI: https://doi.org/10.1007/s40292-019-00329-1

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