Why Use Automated Office Blood Pressure Measurements in Clinical Practice?
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Why Use Automated Office Blood Pressure Measurements in Clinical Practice? Emmanuel A. Andreadis, Epameinondas T. Angelopoulos, Gerasimos D. Agaliotis, Athanasios P. Tsakanikas and George P. Mousoulis 3rd Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
Abstract
Automated office blood pressure (AOBP) measurement with the patient resting alone in a quiet examining room can eliminate the white-coat effect associated with conventional readings taken by manual sphygmomanometer. The key to reducing the white-coat response appears to be multiple blood pressure (BP) readings taken in a non-observer office setting, thus eliminating any interaction that could provoke an office-induced increase in BP. Furthermore, AOBP readings have shown a higher correlation with the mean awake ambulatory BP compared with BP readings recorded in routine clinical practice. Although there is a paucity of studies connecting AOBP with organ damage, AOBP values were recently found to be equally associated with left ventricular mass index as those of ambulatory BP. This concludes that in contrast to routine manual office BP, AOBP readings compare favourably with 24-hour ambulatory BP measurements in the appraisal of cardiac remodelling and, as such, could be complementary to ambulatory readings in a way similar to home BP measurements. Received for publication 11 July 2011; accepted for publication 8 August 2011. Keywords: automated office blood pressure measurements (AOBP), manual blood pressure measurements, ambulatory blood pressure, home blood pressure.
Manual blood pressure (BP) recordings performed in the office, although regarded as the basis for diagnosing and treating hypertension,[1] are not without considerable limitations. Such limitations include the non-standardization of BP measurements, observer error/bias, an inappropriate environment, the white-coat and masked hypertension phenomena, and the placebo effect.[2] Moreover, manual sphygmomanometer readings cannot accurately predict target organ damage and cardiovascular events. Hence, it is not surprising the move towards either home BP measurements or 24-hour ambulatory BP monitoring (ABPM) as a more accurate assessment of the patient’s BP status. As a consequence of the drawbacks associated with conventional manual office readings, mounting evidence supports wider use of home and 24-hour ABPM. For instance, it has been shown that the values obtained with these two techniques are better predictors of cardiovascular events than manual BP readings, even when the latter are meticulously taken in accordance with detailed guidelines.[3,4] Still, it might be premature to conclude that this makes the practice of office BP measurement obsolete. Due to developments in automated
office BP technology, the use of validated, fully automated devices in clinical practice is gaining momentum. Many of the factors hitherto associated with conventional manual sphygmomanometers, such as the white-
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