J Korean Med Sci.  2023 Dec;38(48):e406. 10.3346/jkms.2023.38.e406.

Comparison of Office Blood Pressure, Automated Unattended Office Blood Pressure, Home Blood Pressure, and 24-Hour Ambulatory Blood Pressure Measurements

• Kim BJ
• Lee SH
• Lee MY
• Lee SJ
• Choi HI

• KMID: 2549168
• DOI: http://doi.org/10.3346/jkms.2023.38.e406

Abstract

Background
Although previous studies have reported differences of blood pressure (BP) according to BP measurement methods, studies in Korean population were scarce. This study aimed to compare BP differences according to different BP measurement methods and assess hypertension phenotype.
Methods
This prospective study recruited 183 individuals (mean 55.9 years; 51.4% males). The BP measurements included office BP (auscultatory attended office BP [ausAOBP], automated attended office BP [aAOBP], and automated unattended office BP [aUAOBP]) and out-of-office BP (home BP [HBP] and ambulatory BP [ABP]) measurements taken within one week of each other.
Results
The mean systolic/diastolic BP differences between ausAOBP and other BPs according to different BP measurement methods were 3.5/2.3 mmHg for aAOBP; 6.1/2.9 mmHg for aUAOBP; 15.0/7.3 mmHg for daytime ABP; and 10.6/3.4 mmHg for average HBP. The increasing disparity between ausAOBP and other BPs in multivariable regression analysis was significantly associated with increasing BP. The prevalence of white-coat hypertension and masked hypertension in 107 individuals not taking antihypertensive medication was 25.4–26.8% and 30.6–33.3% based on ausAOBP, daytime ABP, and average HBP, respectively. The prevalence of white-coat uncontrolled hypertension and masked uncontrolled hypertension in 76 of those taking antihypertensive medication was 31.7–34.1% and 17.1– 37.1%, respectively.
Conclusion
This study showed a large disparity between office BP and out-of-office BP which became more pronounced when office BP by auscultation increased, suggesting that various BP measurement methods should be used to more accurately assess BP status.

Keyword

Ambulatory Blood Pressure Monitoring; Blood Pressure; Blood Pressure; Monitoring; Self; Home Blood Pressure

Figure

• 

  Fig. 1 Bland-Altman plots for the comparison between SBP and DBP according to different BP measurement methods.(A) Systolic ausAOBP and aAOBP, (B) systolic ausAOBP and aUAOBP, (C) systolic ausAOBP and daytime ABP, (D) systolic ausAOBP and mean HBP, (E) diastolic ausAOBP and aAOBP, (F) diastolic ausAOBP and aUAOBP, (G) diastolic ausAOBP and daytime ABP, and (H) diastolic ausAOBP and mean HBP. The middle solid line depicts the mean difference (95% CI) and the top and bottom dotted lines represent the limits of agreement (± 1.96 SD).SBP = systolic blood pressure, DBP = diastolic blood pressure, BP = blood pressure, ausAOBP = auscultatory attended office blood pressure, aAOBP = automated attended office blood pressure, aUAOBP = automated unattended office blood pressure, ABP = ambulatory blood pressure, HBP = home blood pressure, SD = standard deviations, CI = confidence interval.

• 

  Fig. 2 Prevalence of hypertension according to different blood pressure measurement methods in 107 individuals not taking antihypertensive medication.The hypertension cutoff level was defined as ≥ 140/90 mmHg for ausAOBP, aAOBP, and aUAOBP-1 and ≥135/85 mmHg for aUAOBP-2, daytime ABP, and mean HBP.ausAOBP = auscultatory attended office blood pressure, aAOBP = automated attended office blood pressure, aUAOBP = automated unattended office blood pressure, ABP = ambulatory blood pressure, HBP = home blood pressure.

• 

  Fig. 3 Prevalence of hypertension phenotypes based on ausAOBP, daytime ABP, and mean HBP in 107 individuals not taking antihypertensive medication.(A) Based on ausAOBP and daytime ABP. (B) Based on ausAOBP and mean HBP. Sustained hypertension was defined as ≥ 140/90 mmHg ausAOBP and ≥ 135/85 mmHg daytime ABP and mean HBP. White-coat hypertension was defined as ≥ 140/90 mmHg ausAOBP and < 135/85 mmHg daytime ABP and mean HBP. Masked hypertension was defined as < 140/90 mmHg ausAOBP and ≥ 135/85 mmHg daytime ABP and mean HBP. No hypertension was defined as < 140/90 mmHg ausAOBP and < 135/85 mmHg daytime ABP and mean HBP.ausAOBP = auscultatory attended office blood pressure, ABP = ambulatory blood pressure, HBP = home blood pressure.

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