In-Office Ambulatory Blood Pressure Monitoring: Could it replace traditional office BP assessment?

That’s just the question Dr. Mark C. van der Wel and colleagues sought the answer to in an article published in the Annals of Family Medicine. As we at SunTech have mentioned in previous posts, two of the most prevalent problems with traditional in-office blood pressure assessment is improper observer technique and the white-coat effect.  As a way to overcome this, the authors developed a method of taking a series of in-office automated oscillometric blood pressure readings for 30 minutes by utilizing an ambulatory blood pressure monitor (ABPM) and compared those results with mean daytime ABPM results.

What they found was no clinically relevant difference between BP averages taken in the office over a 30 minute period and daytime ABPM averages. One of the potential benefits of these findings is that the same device could be used for in-office and ambulatory BP measurement, thereby removing one potential source of bias. The authors point out that only 24-hour ambulatory blood pressure monitoring can provide important data on nocturnal dipping, blood pressure variability, morning rise and mean night time blood pressures. However, they present this new method of office blood pressure measurement as something that “can potentially enable family physicians to overcome the well-known problems of observer bias and the white coat effect”. We’d be very interested to hear what others think about this unique application of ABPM and the potential it has to be used as an in-office method of BP measurement.