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Original research article
Reliability of single office blood pressure measurements
  1. Thilo Burkard1,2,
  2. Michael Mayr1,
  3. Clemens Winterhalder3,
  4. Licia Leonardi3,
  5. Jens Eckstein3,
  6. Annina Salome Vischer1
  1. 1Hypertension Clinic, ESH Hypertension Centre of Excellence, Medical Outpatient Department, University Hospital Basel, Basel, Switzerland
  2. 2Department of Cardiology, University Hospital Basel, Basel, Switzerland
  3. 3Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
  1. Correspondence to Dr Annina Salome Vischer, Hypertension Clinic, ESH Hypertension Centre of Excellence, Medical Outpatient Department, University Hospital Basel, 4031 Basel, Switzerland; annina.vischer{at}usb.ch

Abstract

Objectives Standard operating procedures for office blood pressure measurement (OBPM) vary greatly between guidelines and studies. We aimed to compare the difference between a single OBPM and the mean of the three following measurements. Further, we studied how many patients with possible hypertension may be missed due to short-term masked hypertension (STMH) and how many might be overdiagnosed due to short-term white coat hypertension (STWCH).

Design and setting In this cross-sectional, single-centre trial, 1000 adult subjects were enrolled. After 5 min of rest, four sequential standard OBPMs were performed at 2 min intervals in a quiet room in sitting position. We compared the first (fBPM) to the mean of the second to fourth measurement (mBPM). STMH was defined as fBPM <140 mm Hg systolic and <90 mm Hg diastolic and mBPM systolic ≥140 mm Hg or diastolic ≥90 mm Hg. STWCH was defined as fBPM systolic ≥140 mm Hg or diastolic ≥90 mm Hg and mBPM <140 mm Hg systolic and <90 mm Hg diastolic.

Results Complete measurements were available in 802 subjects. Between fBPM and mBPM, 662 (82.5%), 441 (55%) and 208 (25.9%) subjects showed a difference in systolic and 531 (66.2%), 247 (30.8%) and 51 (6.4%) in diastolic blood pressure (BP) values of >2 mm Hg, >5 mm Hg and >10 mm Hg, respectively. In 3.4% of initially normotensives STMH and in 34.3% of initially hypertensives, STWCH was apparent.

Conclusions There are significant differences between a single OBPM and the mean of consecutive BP measurements. Our study provides evidence that a single OBPM should not be the preferred method and should be discouraged in future guidelines.

Trial registration number NCT02552030;Results.

  • hypertension
  • cardiac risk factors and prevention

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Footnotes

  • Contributors TB: conception and design of the work, analysis and interpretation of data, drafting the work, revising, final approval. MM: critical revision of intellectual content, final approval. CW: conception and design of the work, critical revision of intellectual content, final approval. LL: conception and design of the work, data collection, critical revision of intellectual content, final approval. JE: conception and design of the work, critical revision of intellectual content, final approval. ASV: conception and design of the analysis and interpretation of data, drafting the work, revising, final approval.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical committee northwestern and central Switzerland (EKNZ 2015-287).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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