A comparative trial of blood pressure monitoring in a self-care kiosk, in office, and with ambulatory blood pressure monitoring.

Ambulatory blood pressure Clinical trial Self-blood pressure monitoring

Journal

BMC cardiovascular disorders

ISSN: 1471-2261

Titre abrégé: BMC Cardiovasc Disord

Pays: England

ID NLM: 100968539

Informations de publication

Date de publication:
03 Jan 2024

Historique:

received: 04 09 2023

accepted: 28 12 2023

medline: 4 1 2024

pubmed: 4 1 2024

entrez: 3 1 2024

Statut: epublish

Résumé

Automated measurement of blood pressure (BP) in designated BP kiosks have in recent years been introduced in primary care. If kiosk blood pressure (BP) monitoring provides results equivalent to in-office BP or daytime ambulatory BP monitoring (ABPM), follow-up of adult patients could be managed primarily by self-checks. We therefore designed a comparative trial and evaluated the diagnostic performance of kiosk- and office-based BP (nurse- versus physician-measured) compared with daytime ABPM. A trial of automated BP monitoring in three settings: a designated BP kiosk, by nurses and physicians in clinic, and by ABPM. The primary outcome was systolic and diastolic BP, with respective diagnostic thresholds of ≥135 mmHg and/or ≥ 85 mmHg for daytime ABPM and kiosk BP and ≥ 140 mmHg and/or ≥ 90 mmHg for office BP (nurse- and physician-measured). Compared with daytime ABPM, mean systolic kiosk BP was higher by 6.2 mmHg (95% confidence interval [CI] 3.8-8.6) and diastolic by 7.9 mmHg (95% CI 6.2-9.6; p < 0.001). Mean systolic BP taken by nurses was similar to daytime ABPM values (+ 2.0 mmHg; 95% CI - 0.2-4.2; p = 0.071), but nurse-measured diastolic values were higher, by 7.2 mmHg (95% CI 5.9-9.6; p < 0.001). Mean systolic and diastolic physician-measured BPs were higher compared with daytime ABPM (systolic, by 7.6 mmHg [95% CI 4.5-10.2] and diastolic by 5.8 mmHg [95% CI 4.1-7.6]; p < 0.001). Receiver operating characteristic curves of BP monitoring across pairs of systolic/diastolic cut-off levels among the three settings, with daytime ABPM as reference, demonstrated overall similar diagnostic performance between kiosk and nurse-measured values and over the curve performance for physician-measured BP. Accuracy with nurse-measured BP was 69.2% (95% CI 60.0-77.4%), compared with 65.8% (95% CI 56.5-74.3%) for kiosk BP. In this study kiosk BP monitoring was not comparable to daytime ABPM but could be an alternative to in-office BP monitoring by trained nurses. The diagnostic performance of kiosk and nurse-measured BP monitoring was similar and better than that of physician-measured BP. ClinicalTrials.gov (NCT04488289) 27/07/2020.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

A trial of automated BP monitoring in three settings: a designated BP kiosk, by nurses and physicians in clinic, and by ABPM. The primary outcome was systolic and diastolic BP, with respective diagnostic thresholds of ≥135 mmHg and/or ≥ 85 mmHg for daytime ABPM and kiosk BP and ≥ 140 mmHg and/or ≥ 90 mmHg for office BP (nurse- and physician-measured).

RESULTS RESULTS

Compared with daytime ABPM, mean systolic kiosk BP was higher by 6.2 mmHg (95% confidence interval [CI] 3.8-8.6) and diastolic by 7.9 mmHg (95% CI 6.2-9.6; p < 0.001). Mean systolic BP taken by nurses was similar to daytime ABPM values (+ 2.0 mmHg; 95% CI - 0.2-4.2; p = 0.071), but nurse-measured diastolic values were higher, by 7.2 mmHg (95% CI 5.9-9.6; p < 0.001). Mean systolic and diastolic physician-measured BPs were higher compared with daytime ABPM (systolic, by 7.6 mmHg [95% CI 4.5-10.2] and diastolic by 5.8 mmHg [95% CI 4.1-7.6]; p < 0.001). Receiver operating characteristic curves of BP monitoring across pairs of systolic/diastolic cut-off levels among the three settings, with daytime ABPM as reference, demonstrated overall similar diagnostic performance between kiosk and nurse-measured values and over the curve performance for physician-measured BP. Accuracy with nurse-measured BP was 69.2% (95% CI 60.0-77.4%), compared with 65.8% (95% CI 56.5-74.3%) for kiosk BP.

CONCLUSIONS CONCLUSIONS

In this study kiosk BP monitoring was not comparable to daytime ABPM but could be an alternative to in-office BP monitoring by trained nurses. The diagnostic performance of kiosk and nurse-measured BP monitoring was similar and better than that of physician-measured BP.

TRIAL REGISTRATION BACKGROUND

ClinicalTrials.gov (NCT04488289) 27/07/2020.

Identifiants

DOI: 10.1186/s12872-023-03701-1 PMID: 38172659

pubmed: 38172659

doi: 10.1186/s12872-023-03701-1

pii: 10.1186/s12872-023-03701-1

doi:

Banques de données

ClinicalTrials.gov

['NCT04488289']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

Informations de copyright

Références

Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16:223–37.

doi: 10.1038/s41581-019-0244-2 pubmed: 32024986 pmcid: 7998524

Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm hg, 1990-2015. JAMA. 2017;317:165–82.

doi: 10.1001/jama.2016.19043 pubmed: 28097354

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet. 2017;389:37–55. Erratum in: Lancet. 2020;396:886

doi: 10.1016/S0140-6736(16)31919-5

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. ESC scientific document group. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

doi: 10.1093/eurheartj/ehy339 pubmed: 30165516

Banegas JR, López-García E, Dallongeville J, Guallar E, Halcox JP, Borghi C, et al. Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study. Eur Heart J. 2011;32:2143–52.

doi: 10.1093/eurheartj/ehr080 pubmed: 21471134 pmcid: 3164103

Egan BM, Kjeldsen SE, Grassi G, Esler M, Mancia G. The global burden of hypertension exceeds 1.4 billion people: should a systolic blood pressure target below 130 become the universal standard? J Hypertens. 2019;37:1148–53.

doi: 10.1097/HJH.0000000000002021 pubmed: 30624370

SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373:2103–16. Erratum in: N Engl J Med. 2017;377:2506

doi: 10.1056/NEJMoa1511939

SPS3 Study Group, Benavente OR, Coffey CS, Conwit R, Hart RG, McClure LA, Pearce LA, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382:507–15. Erratum in: Lancet. 2013;382:506

doi: 10.1016/S0140-6736(13)60852-1

ACCORD Study Group, Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, Cutler JA, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575–85.

doi: 10.1056/NEJMoa1001286

Hansson L, Zanchetti A, Carruthers SG, Dahlöf B, Elmfeldt D, Julius S, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the hypertension optimal treatment (HOT) randomised trial. HOT Study Group Lancet. 1998;351:1755–62.

O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension Working Group on blood pressure monitoring. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31:1731–68. Erratum in: J Hypertens 2013:2467

doi: 10.1097/HJH.0b013e328363e964 pubmed: 24029863

Parati G, Stergiou G, O'Brien E, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32:1359–66.

doi: 10.1097/HJH.0000000000000221 pubmed: 24886823

Seidlerová J, Gelžinský J, Mateřánková M, Ceral J, König P, Filipovský J. In the aftermath of SPRINT: further comparison of unattended automated office blood pressure measurement and 24-hour blood pressure monitoring. Blood Press. 2018;27:256–61.

doi: 10.1080/08037051.2018.1454258 pubmed: 29566565

Seidlerová J, Ceral J, Mateřánková M, König P, Řiháček I, Vysočanová P, et al. Long-term relationship between unattended automated blood pressure and auscultatory BP measurements in hypertensive patients. Blood Press. 2019;28:34–9.

doi: 10.1080/08037051.2018.1540260 pubmed: 30474412

Filipovský J, Seidlerová J, Kratochvíl Z, Karnosová P, Hronová M, Mayer O Jr. Automated compared to manual office blood pressure and to home blood pressure in hypertensive patients. Blood Press. 2016;25:228–34.

doi: 10.3109/08037051.2015.1134086 pubmed: 26852625

Green BB, Anderson ML, Campbell J, Cook AJ, Ehrlich K, Evers S, et al. Blood pressure checks and diagnosing hypertension (BP-CHECK): design and methods of a randomized controlled diagnostic study comparing clinic, home, kiosk, and 24-hour ambulatory BP monitoring. Contemp Clin Trials. 2019;79:1–13.

doi: 10.1016/j.cct.2019.01.003 pubmed: 30634036 pmcid: 7067555

Green BB, Anderson ML, Cook AJ, Ehrlich K, Hall YN, Hsu C, et al. Clinic, home, and kiosk blood pressure measurements for diagnosing hypertension: a randomized diagnostic study. J Gen Intern Med. 2022;37:2948–56.

doi: 10.1007/s11606-022-07400-z pubmed: 35239109 pmcid: 9485334

Kjeldsen SE, Lund-Johansen P, Nilsson PM, Mancia G. Unattended blood pressure measurements in the systolic blood pressure intervention trial: implications for entry and achieved blood pressure values compared with other trials. Hypertension. 2016;67:808–12.

doi: 10.1161/HYPERTENSIONAHA.116.07257 pubmed: 27001295

Thompson MJ, Anderson ML, Cook AJ, Ehrlich K, Hall YN, Hsu C, et al. Acceptability and adherence to home, kiosk, and clinic blood pressure measurement compared to 24-H ambulatory monitoring. J Gen Intern Med. 2023:1–8. https://doi.org/10.1007/s11606-023-08036-3 .

https://www.medcalc.org/calc/diagnostic_test.php (Version 20.218); Accessed 22 Feb 2023.

Andreadis EA, Geladari CV, Angelopoulos ET, Savva FS, Georgantoni AI, Papademetriou V. Attended and unattended automated office blood pressure measurements have better agreement with ambulatory monitoring than conventional office readings. J Am Heart Assoc. 2018;7:e008994.

doi: 10.1161/JAHA.118.008994 pubmed: 29627767 pmcid: 6015428

Alpert BS. Are kiosk blood pressure readings trustworthy? Blood Press Monit. 2012;17:257–8.

doi: 10.1097/MBP.0b013e32835b9ea1 pubmed: 23147536

Al Hamarneh YN, Houle SK, Chatterley P, Tsuyuki RT. The validity of blood pressure kiosk validation studies: a systematic review. Blood Press Monit. 2013;18:167–72.

doi: 10.1097/MBP.0b013e328360fb85 pubmed: 23635486

Alpert BS, Dart RA, Sica DA. Public-use blood pressure measurement: the kiosk quandary. J Am Soc Hypertens. 2014;8:739–42.

doi: 10.1016/j.jash.2014.07.034 pubmed: 25418496

Padwal RS, Townsend RR, Trudeau L, Hamilton PG, Gelfer M. Comparison of an in-pharmacy automated blood pressure kiosk to daytime ambulatory blood pressure in hypertensive subjects. J Am Soc Hypertens. 2015;9:123–9.

doi: 10.1016/j.jash.2014.11.004 pubmed: 25600420

Bager JE, Mourtzinis G, Andersson T, Nåtman J, Rosengren A, Björck S, et al. Trends in blood pressure, blood lipids, and smoking from 259 753 patients with hypertension in a Swedish primary care register: results from QregPV. Eur J Prev Cardiol. 2022;29:158–66.

doi: 10.1093/eurjpc/zwab087 pubmed: 34056646

Cohen DL, Townsend RR. Blood pressure readings using public kiosks or smart phone apps: caveat emptor (for now). J Clin Hypertens (Greenwich). 2017;19:946–7.

doi: 10.1111/jch.13013 pubmed: 28942604

GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1923–94. Erratum in: Lancet. 2019;393:132. Erratum in: Lancet. 2019;393:e44

doi: 10.1016/S0140-6736(18)32225-6