Comparison of a self-automated blood pressure measurement according to the American Heart Association recommendation versus a routine practice, a randomized-controlled trial

Background Home blood pressure monitoring is currently a gold standard for guiding an adjustment of antihypertensive medications. According to the American Heart Association (AHA), the self-automated blood pressure (BP) measurement may represent accurate home BP. However, there is a limited data in real-world practice Objective To explore the accuracy of a self-automated BP measurement in representing the actual home BP monitoring, in comparison with a single spot-arm automated BP measurement, which is routinely used in the clinical setting. Methods We conducted a single center, randomized cross-over trial. At the Cardiology clinic, hypertensive patients aged between 18 and 80 years, who were able to perform self-automated BP measurement, were included in the study. The patients were categorized into two groups using different BP measurement methods: a self-automated BP measurement according to the AHA Recommendation 2017 and a single spot-arm automated BP measurement, and then crossed over to alternative methods. All participants were instructed to rest at least 5 minutes prior to undergo BP measurement in both methods. The data of BP measurements were subsequently compared with the standard home BP monitoring. Results Overall, 190 patients underwent randomization. Mean differences of systolic blood pressure (SBP) in the self-automated AHA measurement and the single spot-arm measurement, compared with the standard home BP monitoring, were 3.57 mmHg (95% confidence interval (CI); 1.39 to 5.74 mmHg) and 9.44 mmHg (95% CI; 7.03 to11.86 mmHg), respectively (P<0.001) (table1). Mean differences of diastolic blood pressure (DBP) in the self-automated AHA and the single spot-arm measurements, compared with the standard home BP were −1.51 mmHg (95% CI; −2.76 to −0.25) and 2.69 mmHg (95% CI; 1.07–4.31), respectively (P<0.001) (table 1). White coat hypertension was detected in 7 (3.72%) of patients by AHA measurement and 17 (9.04%) by the single-spot arm measurement (P=0.008). Conclusion The self-automated BP measurement according to the AHA Recommendation 2017 was more accurate than the single spot-arm automated BP measurement in representing the actual home BP monitoring and reduced the possibility of the white coat effect. FUNDunding Acknowledgement Type of funding sources: None. Table 1