Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
University of Montreal Hospital Research Centre, Department of Family and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada.
JAMA Intern Med. 2019 Mar 1;179(3):351-362. doi: 10.1001/jamainternmed.2018.6551.
Automated office blood pressure (AOBP) measurement involves recording several blood pressure (BP) readings using a fully automated oscillometric sphygmomanometer with the patient resting alone in a quiet place. Although several studies have shown AOBP measurement to be more accurate than routine office BP measurement and not subject to a "white coat effect," the cumulative evidence has not yet been systematically reviewed.
To perform a systematic review and meta-analysis to examine the association between AOBP and office BP readings measured in routine clinical practice and in research studies, and ambulatory BP recorded during awake hours, as the latter is a standard for predicting future cardiovascular events.
The MEDLINE, Embase, and Cochrane Library were searched from 2003 to April 25, 2018.
Studies on systolic and diastolic BP measurement by AOBP in comparison with awake ambulatory BP, routine office BP, and research BP measurements were included if they contained 30 patients or more.
Study characteristics were abstracted independently and random effects meta-analyses and meta-regressions were conducted.
Pooled mean differences (95% CI) of systolic and diastolic BP between types of BP measurement.
Data were compiled from 31 articles comprising 9279 participants (4736 men and 4543 women). In samples with systolic AOBP of 130 mm Hg or more, routine office and research systolic BP readings were substantially higher than AOBP readings, with a pooled mean difference of 14.5 mm Hg (95% CI, 11.8-17.2 mm Hg; n = 9; I2 = 94.3%; P < .001) for routine office systolic BP readings and 7.0 mm Hg (95% CI, 4.9-9.1 mm Hg; n = 9; I2 = 85.7%; P < .001) for research systolic BP readings. Systolic awake ambulatory BP and AOBP readings were similar, with a pooled mean difference of 0.3 mm Hg (95% CI, -1.1 to 1.7 mm Hg; n = 19; I2 = 90%; P < .001).
Automated office blood pressure readings, only when recorded properly with the patient sitting alone in a quiet place, are more accurate than office BP readings in routine clinical practice and are similar to awake ambulatory BP readings, with mean AOBP being devoid of any white coat effect. There has been some reluctance among physicians to adopt this technique because of uncertainty about its advantages compared with more traditional methods of recording BP during an office visit. Based on the evidence, AOBP should now be the preferred method for recording BP in routine clinical practice.
自动化诊室血压（AOBP）测量涉及使用全自动示波法血压计记录多次血压（BP）读数，患者独自在安静的地方休息。尽管有几项研究表明 AOBP 测量比常规诊室 BP 测量更准确，且不受“白大衣效应”的影响，但累积证据尚未得到系统审查。
进行系统评价和荟萃分析，以检查 AOBP 与常规临床实践和研究研究中测量的诊室 BP 读数以及清醒时记录的动态血压之间的关联，因为后者是预测未来心血管事件的标准。
从 2003 年到 2018 年 4 月 25 日，检索了 MEDLINE、Embase 和 Cochrane 图书馆。
如果研究包含 30 名或以上患者，并且对 AOBP 进行收缩压和舒张压测量，与清醒时动态血压、常规诊室 BP 和研究 BP 测量进行比较，则纳入研究。
独立提取研究特征，并进行了随机效应荟萃分析和荟萃回归分析。
各类型 BP 测量之间的收缩压和舒张压的汇总平均差异（95%CI）。
从 31 篇文章中汇总了 9279 名参与者的数据（4736 名男性和 4543 名女性）。在收缩压 AOBP 为 130mmHg 或更高的样本中，常规诊室和研究收缩压读数明显高于 AOBP 读数，汇总平均差异为 14.5mmHg（95%CI，11.8-17.2mmHg；n=9；I2=94.3%；P<0.001）用于常规诊室收缩压读数，以及 7.0mmHg（95%CI，4.9-9.1mmHg；n=9；I2=85.7%；P<0.001）用于研究收缩压读数。收缩压清醒时动态血压和 AOBP 读数相似，汇总平均差异为 0.3mmHg（95%CI，-1.1 至 1.7mmHg；n=19；I2=90%；P<0.001）。
仅当患者独自安静地坐在座位上正确记录时，自动化诊室血压读数才比常规临床实践中的诊室 BP 读数更准确，并且与清醒时动态血压读数相似，平均 AOBP 没有任何白大衣效应。由于对与在诊室就诊期间记录 BP 相比，该技术的优势存在不确定性，因此医生在采用该技术方面一直存在一些犹豫。基于证据，AOBP 现在应该是常规临床实践中记录 BP 的首选方法。
