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Fully automated blood pressure measurement is the way to go in the office
Clinical Question
Is fully automated blood pressure measurement more accurate than manual sphygmomanometry?
Bottom line
There are 2 takeaways and a recommendation from this analysis of in-office automated blood pressure measurement. The takeaways: (1) Automated measurement aligns better with ambulatory blood pressure monitoring, the best predictor of cardiovascular events, than manual measurement; and (2) manual readings are an average 13.4 to 14.5 mm Hg (systolic) higher than daytime ambulatory or automated readings in patients with hypertension. The recommendation: Since the recent guidelines from the American College of Cardiology/American Heart Association are based on automated readings, follow them only if you switch from the squeeze bulb to the machine. 1b
Reference
Study design: Meta-analysis (other)
Funding: Self-funded or unfunded
Setting: Various (meta-analysis)
Synopsis
The authors searched 3 databases, including the Cochrane Central Register of Controlled Trials, to identify studies that compared automated office blood pressure readings with standard or research-based manual measurement or ambulatory automated recording during awake hours (the latter used as the reference standard). The authors also searched reference lists of identified articles. They included papers in any language, 2 authors independently selected articles for inclusion, and a single investigator extracted data. Automated measurement had be performed without anyone activating the machine and used 3 to 5 readings separated by 1-minute to 2-minute intervals. In 31 studies of 9279 participants, the pooled mean differences between routine measurement and awake ambulatory measurements were 13.4 mm Hg systolic and 5.9 mm Hg diastolic. There was no difference between ambulatory and automated blood pressure. The difference between manual and automated blood pressures was 14.5 mm Hg systolic in patients with hypertension. There was a great deal of heterogeneity among studies for all outcomes that could not be explained by any of the variables available to the researchers. There was no evidence of publication bias.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Machines used
Any mention about which machines are best for this purpose? The experience at my clinic has been different I.e. the automated machines often give error codes or are are inaccurate despite multiple readings. This is despite having the machines changed, replaced, using different cuffs etc.
I often find the automatic…
I often find the automatic cuffs cope poorly with irregular heart rates. So if your patient has ongoing atrial fibrillation, you may find the cuff takes much much longer to identify the BP, which means the cuff is inflated longer and may give an elevated reading due to venous congestion.