Automated Office Blood Pressure Measurements in Waiting Room or Isolated Room for Diagnosis and Phenotyping of Hypertension

Abstract

BACKGROUND: Automatic office blood pressure measurement (AOBPM) in the waiting room could improve the performance of diagnosing hypertension without requiring an isolated room to carry out exploration. METHODS: In a cross-sectional study, we compared the performance to diagnose and phenotyping hypertension by 3 methods of blood pressure measurements, standard office blood pressure, unattended AOBPM in an isolated room or in an office waiting room AOBPM, compared with daytime ambulatory blood pressure measurement (daytime ambulatory blood pressure monitoring) from a 24-hour ambulatory blood pressure monitoring as a reference. The cutoff values for hypertension and validation for waiting room or isolated room AOBPM were performed by receiver operating characteristic curves and Bland-Altman plots compared with daytime ambulatory blood pressure monitoring. RESULTS: Out of the 548 participants recruited, 349 (64%) had hypertension, while 199 (36%) were being studied for a diagnosis of hypertension. Waiting room AOBPM and unattended AOBPM stratified hypertension status in a comparable way (n=398; 73% [95% CI, 69%-76%; and n=417; 75% [95% CI, 72%-79%] participants, respectively), and both methods stratified better hypertension status than standard office blood pressure measurement did (n=338; 62% [95% CI, 57%-65%]). Overall, the diagnostic accuracy for white coat syndrome was better for waiting room AOBPM, while for masked hypertension it was by unattended AOBPM (80% [95% CI, 77%-83%] versus 87% [95% CI, 83%-89%] and 88% 95% CI, 85%-90%] versus 73% [95% CI, 69%-76%], respectively). CONCLUSIONS: To assess hypertension status, waiting room AOBPM is equivalent to unattended AOBPM in an isolated room and both better than standard office blood pressure measurement. The detection of hypertension phenotypes differs depending on the site of the measurement, waiting room or isolated room. REGISTRATION: URL: https://clinicaltrials.gov; unique identifier: NCT06198855.