Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial

• Published in: BMJ 2011-02, Vol.342 (7793), p.372-372
• Main Authors: Myers, Martin G, Godwin, Marshall, Dawes, Martin, Kiss, Alexander, Tobe, Sheldon W, Grant, F Curry, Kaczorowski, Janusz
• Format: Article
• Language: English
• Subjects: Accuracy; Aged; Aged, 80 and over; Ambulatory blood pressure; Automation; Blood pressure; Blood Pressure - physiology; Blood Pressure Determination - methods; Clinical medicine; Clinical trials; Clinical Trials (Epidemiology); Control groups; Female; General Practice / Family Medicine; Humans; Hypertension; Hypertension - diagnosis; Hypertension - physiopathology; Induced; Inpatient care; Male; Measurement; Measurement techniques; Medical equipment; Middle Aged; Patients; Physicians; Pressure measurement; Primary care; Primary Health Care; Recording
• ISSN: 0959-8138; 0959-8146; 0959-535X; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.d286

Objective To compare the quality and accuracy of manual office blood pressure and automated office blood pressure using the awake ambulatory blood pressure as a gold standard.Design Multi-site cluster randomised controlled trial.Setting Primary care practices in five cities in eastern Canada.Participants 555 patients with systolic hypertension and no serious comorbidities under the care of 88 primary care physicians in 67 practices in the community.Interventions Practices were randomly allocated to either ongoing use of manual office blood pressure (control group) or automated office blood pressure (intervention group) using the BpTRU device. The last routine manual office blood pressure (mm Hg) was obtained from each patient’s medical record before enrolment. Office blood pressure readings were compared before and after enrolment in the intervention and control groups; all readings were also compared with the awake ambulatory blood pressure.Main outcome measure Difference in systolic blood pressure between awake ambulatory blood pressure minus automated office blood pressure and awake ambulatory blood pressure minus manual office blood pressure.Results Cluster randomisation allocated 31 practices (252 patients) to manual office blood pressure and 36 practices (303 patients) to automated office blood pressure measurement. The most recent routine manual office blood pressure (149.5 (SD 10.8)/81.4 (8.3)) was higher than automated office blood pressure (135.6 (17.3)/77.7 (10.9)) (P