Lynn-Green Erika E, Cluett Jennifer L, Turkson-Ocran Ruth-Alma N, Mukamal Kenneth J, Li Jonathan X, Juraschek Stephen P
Harvard Medical School, Boston, Massachusetts, USA.
Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Am J Hypertens. 2025 Feb 18;38(3):168-177. doi: 10.1093/ajh/hpae135.
Guidelines advise automated office blood pressure (AOBP) with an initial 5-minute delay and multiple measurements at least 60 seconds apart. Recent studies suggest that AOBP may be accurate with shorter delays or intervals, but evidence in clinical settings is limited.
Patients referred to 1 hypertension (HTN) center underwent 24-hour ambulatory blood pressure monitoring (ABPM) and 1 of 4 nonrandomized, unattended AOBP protocols: a 3- or 5-minute delay with a 30- or 60-second interval, i.e., 3 min/30 s/30 s, 3/60/60, 5/30/30 and 5/60/60 protocols. HTN was defined as systolic blood pressure (SBP) ≥140 or diastolic blood pressure ≥90 mm Hg.
We compared differences in mean blood pressure and HTN classification between average AOBP and awake-time ABPM by t-tests and Fisher's exact test. Among 212 participants (mean 58.9 years, 61% women, 25% Black), there was substantial overlap in the probability distributions of awake-time ABPM and each of the 3 AOBP measures. SBP means were similar between the 5/60/60 and 3/30/30 protocols and 5/30/30 and 3/60/60 protocols. The 5/30/30 was associated with a higher proportion of systolic HTN, while the 3/60/60 protocol was associated with a higher proportion of diastolic HTN. There were no significant differences in systolic or diastolic HTN between 5/60/60 and 3/30/30 protocols with respect to awake-time ABPM.
In this quality improvement study, the shortest AOBP protocol did not differ significantly from the longest protocol. The time savings of shorter protocols may improve AOBP adoption in clinical practice without meaningfully compromising accuracy.
指南建议采用自动诊室血压（AOBP）测量，初始延迟5分钟，并进行多次测量，每次测量间隔至少60秒。近期研究表明，较短的延迟时间或测量间隔可能使AOBP测量结果准确，但临床环境中的证据有限。
转诊至1家高血压（HTN）中心的患者接受了24小时动态血压监测（ABPM）以及4种非随机、无人值守的AOBP方案中的1种：延迟3或5分钟，间隔30或60秒，即3分钟/30秒/30秒、3/60/60、5/30/30和5/60/60方案。高血压定义为收缩压（SBP）≥140或舒张压≥90 mmHg。
我们通过t检验和费舍尔精确检验比较了平均AOBP与清醒时段ABPM之间的平均血压差异和高血压分类情况。在212名参与者（平均年龄58.9岁，61%为女性，25%为黑人）中，清醒时段ABPM与3种AOBP测量结果的概率分布有很大重叠。5/60/60与3/30/30方案以及5/30/30与3/60/60方案之间的SBP均值相似。5/30/30方案与较高比例的收缩期高血压相关，而3/60/60方案与较高比例的舒张期高血压相关。就清醒时段ABPM而言，5/60/60与3/30/30方案之间的收缩期或舒张期高血压无显著差异。
在这项质量改进研究中，最短的AOBP方案与最长的方案相比无显著差异。较短方案节省的时间可能会提高AOBP在临床实践中的采用率，且不会对准确性造成显著影响。
