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Identification of the optimal protocol for automated office blood pressure measurement among patients with treated hypertension


Moore, MN and Schultz, MG and Nelson, MR and Black, JA and Dwyer, NB and Hoban, E and Jose, MD and Kosmala, W and Przewlocka-Kosmala, M and Zachwyc, J and Otahal, P and Picone, DS and Roberts-Thomson, P and Veloudi, P and Sharman, JE, Identification of the optimal protocol for automated office blood pressure measurement among patients with treated hypertension, American Journal of Hypertension, 31, (3) pp. 299-304. ISSN 0895-7061 (2018) [Refereed Article]

Copyright Statement

American Journal of Hypertension, Ltd 2017. All rights reserved.

DOI: doi:10.1093/ajh/hpx180


Background: Automated office blood pressure (AOBP) involving repeated, unobserved blood pressure (BP) readings during one clinic visit is recommended for in-office diagnosis and assessment of hypertension. However, the optimal AOBP protocol to determine BP control in the least amount of time with the fewest BP readings is yet to be determined and was the aim of this study.

Methods: One hundred and eighty-nine patients (mean age 62.8 12.1 years; 50.3% female) with treated hypertension referred to specialist clinics at 2 sites underwent AOBP in a quiet room alone. Eight BP measurements were taken starting immediately after sitting and then at 2-minute intervals (15 minutes total). The optimal AOBP protocol was defined by the smallest mean difference and highest intraclass correlation coefficient (ICC) compared with daytime ambulatory BP (ABP). The same BP device (Mobil-o-graph, IEM) was used for both AOBP and daytime ABP.

Results: Average 15-minute AOBP and daytime ABP were 134 22/82 13 and 137 17/83 11 mm Hg, respectively. The optimal AOBP protocol was derived within a total duration of 6 minutes from the average of 2 measures started after 2 and 4 minutes of seated rest (systolic BP: mean difference (95% confidence interval) 0.004(-2.21, 2.21) mm Hg, P = 1.0; ICC = 0.81; diastolic BP: mean difference 0.37(-0.90, 1.63) mm Hg, P = 0.57; ICC = 0.86). AOBP measures taken after 8 minutes tended to underestimate daytime ABP (whether as a single BP or the average of more than 1 BP reading).

Conclusions: Only 2 AOBP readings taken over 6 minutes (excluding an initial reading immediately after sitting) may be needed to be comparable with daytime ABP.

Item Details

Item Type:Refereed Article
Keywords:blood pressure, blood pressure monitoring, clinical decision making, diagnostic errors, hypertension
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Moore, MN (Mr Myles Moore)
UTAS Author:Schultz, MG (Dr Martin Schultz)
UTAS Author:Nelson, MR (Professor Mark Nelson)
UTAS Author:Black, JA (Professor John Black)
UTAS Author:Dwyer, NB (Dr Nathan Dwyer)
UTAS Author:Hoban, E (Ms Ella Hoban)
UTAS Author:Jose, MD (Professor Matthew Jose)
UTAS Author:Kosmala, W (Professor Wojciech Kosmala)
UTAS Author:Otahal, P (Mr Petr Otahal)
UTAS Author:Picone, DS (Dr Dean Picone)
UTAS Author:Roberts-Thomson, P (Dr Philip Roberts-Thomson)
UTAS Author:Veloudi, P (Mrs Penny Veloudi)
UTAS Author:Sharman, JE (Professor James Sharman)
ID Code:124268
Year Published:2018 (online first 2017)
Web of Science® Times Cited:10
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-02-15
Last Modified:2018-07-23

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