P-56 MP-19: Repeated office blood pressure (ROBP) measurement for the diagnosis of white-coat or sustained hypertension

• Published in: American journal of hypertension 2005-05, Vol.18 (S4), p.28A-28A
• Main Authors: Crippa, Giuseppe, Ragni, Giorgio, Venturi, Claudio, Arrigoni, Eugenio, Pancotti, Daniela
• Format: Article
• Language: English
• Subjects: Repeated Office Blood Pressure Measurement; Sustained Hypertension; White Coat Hypertension
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/j.amjhyper.2005.03.074

Conventional sphygmomanometric blood pressure (BP) measurements performed in the medical environment by the physician are often inaccurate as a result of variable alert reactions of the subject (white-coat phenomenon) and systematic errors in the observer technique. These sources of bias may often lead to an overestimation of the real BP status and therefore, to incorrect diagnosis of hypertension in normotensive subjects. Aim of the present study was to investigate the influence of the way in which BP measurements were taken on the diagnosis of white-coat or sustained hypertension. We considered 122 subjects consecutively referred to our Hypertension Unit to confirm or deny the clinical diagnosis of hypertension through an ambulatory BP monitoring (ABPM). All subjects were untreated and had clinic BP constantly >140/90 mmHg but home (self-measured) BP persistently < 140/90 mmHg. Before setting the device, BP was measured, in random order, by the physician, by the nurse and by using repeated office blood pressure (ROBP) measurement with automated device. After 20-minute resting, the doctor and the nurse each took 3 BP readings (phase V of the Korotkoff sounds). ROBP was performed by automated oscillometric device, set to obtain 10 valid readings at 2.5-minute intervals, with the patients sitting alone in the office. The average of the last 2 measurements obtained by the doctor and the nurse, the average of the last 5 measurements obtained with ROBP were compared with mean daytime ABP. Out of the 122 subjects, 41 presented with normal ABP values (daytime BP ≤ 132/85 mmHg) suggesting white-coat hypertension. ROBP measurements correctly diagnosed white-coat hypertension in all but one the subjects. The average of the last 5 value (122.5/74.8 ± 7.1/7.7 mmHg) practically overlapped with daytime ABP values (121.1/73.4 ± 4.4/6.1 mmHg) in those patients and the correlation was high and significant (p