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Clinically significant differences between different blood pressure measurement methods
1. In this systematic review and meta-analysis, estimated blood pressure was found to vary significantly between different methods, such as home, ambulatory, and office measurement.
2. Larger discrepancies between measurement methods were observed as average reference blood pressure increased, suggesting that a fixed conversion between methods may not be appropriate for all patients.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Although office blood pressure measurement (OBPM) is commonly used to diagnose hypertension, it may not accurately reflect an individual’s true blood pressure (BP). While out-of-office blood pressure measurement (BPM) methods, such as ambulatory BPM (ABPM) and home BPM (HBPM) have also been studied, OBPM continues to be a mainstay for research studies, and guidelines have established benchmarks for comparing out-of-office BPM methods to OBPM. This study aimed to compare BP estimates across multiple BPM methods and at different BP levels. It was found that nighttime ABPM yielded the lowest systolic BP measurements, followed by 24-hour ABPM, HBPM, automated OBPM, daytime ABPM, and convenient OBPM. With the exception of convenient OBPM, differences in BP between research OBPM and other BPM methods increased with higher mean BP levels as measured by research OBPM. Notably, the design of included studies significantly influenced the difference in BP between BPM methods, largely due to poor agreement between research OBPM and daytime ABPM. The generalizability of this study is limited by the heterogeneity of patient characteristics and detailed BPM protocols as well as lack of information on the sequential order of BPM methods used. Nevertheless, this study suggests that BP differences across BPM methods vary from current recommendations, and that these discrepancies appear to be magnified by higher average BP.
Click to read this study in AIM
In-Depth [systematic review and meta-analysis]: This systematic review and network meta-analysis aimed to compare BP measurements across multiple BPM methods and at different BP levels. The final review included 65 studies with a combined population of 40,022 participants, which had a median age of 57 years (range, 42.6 to 76.5 years). Hypertensive participants made up 34.4% (n = 13,800) of the population. Among the 39,124 (97.8%) participants whose sex was recorded, 22,789 (58.2%) were men. The review included 6 (9.2%) RCTs, 36 (55.4%) cross-sectional studies, 21 (32.3%) prospective cohort studies, and 2 (3.1%) retrospective cohort studies; 43 (66.2%), 49 (75.4%), 34 (52.3%), and 29 (44.6%) studies used research OBPM, ABPM, HBPM, and automated OBPM, respectively. Regarding study quality, 28 (43.1%) were of medium quality and 37 (56.9%) were of high quality. With research OBPM as the reference, nighttime ABPM yielded the lowest systolic BP measurements (mean difference, -18.14 mm Hg [95% CI, -20.06 to -16.21 mm Hg]), followed by 24-hour HBPM (mean difference, -8.63 mm Hg [95% CI, -10.28 to -6.97 mm Hg]), HBPM (mean difference, -4.59 mm Hg [95% CI, -6.34 to -2.83 mm Hg]), automated OBPM (mean difference, -4.57 mm Hg [95% CI, -6.60 to -2.54 mm Hg]), daytime ABPM (mean difference, -4.22 mm Hg [95% CI, -5.82 to -2.62 mm Hg]), and convenient OBPM (mean difference, 2.69 mm Hg [95% CI, -0.13 to 5.51 mm Hg]). Except for convenient OBPM, differences in BP between research OBPM and the other BPM methods grew as mean BP increased. Results did not seem to be affected by demographic factors or clinical comorbidities. A few comparisons had significant heterogeneity, but most comparisons had low incoherence. No risk of reporting bias or serious imprecision or indirectness concerns were noted, and confidence levels were generally rated medium or high across all comparisons. Overall, this study suggests that discrepancies in BP across various BPM methods may differ from existing guideline recommendations and may be positively correlated with increasing average reference BP.
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