Are Unattended Blood Pressure Measurements Necessary in All Patients Visiting an Outpatient Cardiology Clinic?

Introduction: Unattended automatic office blood pressure (BP) measurement has given new evidence regarding treatment goals.

Aim: We aimed to explore any differences between unattended and conventional office BP measurements in different groups of patients visiting a European Society of Hypertension (ESH)  Excellence Centre.

Methods: We performed two unattended (Microlife Watch BP Home) followed by a single attended (mercury sphygmomanometer) BP measurement in 310 patients (mean age 62 ± 15 years, 151 males, 64% hypertensives and 36% normotensive individuals) visiting our ESH Centre for a scheduled follow-up. Office BP < 140 mmHg (systolic) and < 90 mmHg (diastolic) were characterized as controlled or normal in hypertensives and normotensive individuals, respectively.

Results: Attended BP (systolic/diastolic) was higher than unattended BP in total population (p < 0.001 and p = 0.02) and hypertensives (p < 0.001). In hypertensives, attended BP was higher than unattended BP regardless of age, smoking habit, obesity or controlled BP status but it was similar to unattended in diabetic patients. In normotensive individuals, attended BP was higher than unattended BP in older (p = 0.04), non-smoker (p = 0.002) and non-diabetic (p = 0.02) subjects. Finally, unattended BP was important for treatment decisions only in a small group of non-diabetic hypertensive patients (7%) whose unattended BP was controlled while attended BP was uncontrolled.

Conclusions: Unattended BP was lower than attended BP in the majority of hypertensive patients. However, it was useful only in a small percentage of non diabetic hypertensive patients in order to take appropriate treatment plan decisions.