Félix Rinfret1, Lyne Cloutier2, Hélène L'Archevêque3, Martine Gauthier3, Mikhael Laskine4, Pierre Larochelle3, Monica Ilinca3, Leora Birnbaum3, Nathalie Ng Cheong3, Robert Wistaff3, Paul Van Nguyen3, Ghislaine Roederer3, Michel Bertrand3, Maxime Lamarre-Cliche5. 1. Département des sciences biomédicales, Université de Montréal, Montréal, Québec, Canada; Institut de recherches cliniques de Montréal (IRCM), Montréal, Québec, Canada. 2. Département des sciences infirmières, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Québec, Canada. 3. Institut de recherches cliniques de Montréal (IRCM), Montréal, Québec, Canada. 4. Institut de recherches cliniques de Montréal (IRCM), Montréal, Québec, Canada; Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada. 5. Institut de recherches cliniques de Montréal (IRCM), Montréal, Québec, Canada. Electronic address: lamarrm@ircm.qc.ca.
Abstract
BACKGROUND: Blood pressure (BP) readings taken in clinics are often higher than BP readings taken in a research setting. Recent guidelines and clinical trials have highlighted the necessity of using automated office blood pressure (AOBP) devices and standardizing measurement procedures. The goal of the present study was to compare AOBP vs manual BP measurement in both research and clinical environments in which operators and devices were the same and measurement procedures were standardized and optimal. METHODS: Clinical manual BP and AOBP measurement estimates were gathered from a retrospective cohort of patients followed in a hypertension clinic. Research AOBP and manual BP measurement data were obtained from past research studies. Descriptive statistics and agreement analyses with Cohen kappa coefficients were developed. The AOBP/manual BP measurement gap between clinical and research follow-up was compared using an unpaired t test. RESULTS: Two hundred eighty-eight patients were included in the clinical cohort, and 195 patients contributed to research-grade BP data. All patients had hypertension. AOBP averages were lower than manual measurement averages in both clinical (-3.6 ± 14.9 mm Hg / -3.0 ± 8.8 mm Hg) and research (-2.7 ± 10.0 / -2.4 ± 6.3 mm Hg) environments. The gap between measurement methods did not differ between research and clinical data. Cohen kappa coefficient was lower in the clinical context because of greater variability and more time between BP measurements (5.5 ± 2.9 months). CONCLUSIONS: Manual BP readings were slightly higher than AOBP estimates. The difference was not influenced by the real-world context of clinical practice. Office nonautomated BP measurements may still be valuable if measurement procedures are well standardized and performed by trained nurses.
BACKGROUND: Blood pressure (BP) readings taken in clinics are often higher than BP readings taken in a research setting. Recent guidelines and clinical trials have highlighted the necessity of using automated office blood pressure (AOBP) devices and standardizing measurement procedures. The goal of the present study was to compare AOBP vs manual BP measurement in both research and clinical environments in which operators and devices were the same and measurement procedures were standardized and optimal. METHODS: Clinical manual BP and AOBP measurement estimates were gathered from a retrospective cohort of patients followed in a hypertension clinic. Research AOBP and manual BP measurement data were obtained from past research studies. Descriptive statistics and agreement analyses with Cohen kappa coefficients were developed. The AOBP/manual BP measurement gap between clinical and research follow-up was compared using an unpaired t test. RESULTS: Two hundred eighty-eight patients were included in the clinical cohort, and 195 patients contributed to research-grade BP data. All patients had hypertension. AOBP averages were lower than manual measurement averages in both clinical (-3.6 ± 14.9 mm Hg / -3.0 ± 8.8 mm Hg) and research (-2.7 ± 10.0 / -2.4 ± 6.3 mm Hg) environments. The gap between measurement methods did not differ between research and clinical data. Cohen kappa coefficient was lower in the clinical context because of greater variability and more time between BP measurements (5.5 ± 2.9 months). CONCLUSIONS: Manual BP readings were slightly higher than AOBP estimates. The difference was not influenced by the real-world context of clinical practice. Office nonautomated BP measurements may still be valuable if measurement procedures are well standardized and performed by trained nurses.
Authors: Piotr Sobieraj; Jacek Lewandowski; Maciej Siński; Zbigniew Gaciong Journal: J Clin Hypertens (Greenwich) Date: 2019-06-06 Impact factor: 3.738