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Measurement of Blood Pressure in the Office


Questions

1

What is office blood pressure measurement?

Blood pressure (BP) measurement in the office has been standard practice for over 100 years, and most physicians continue to use office BP for diagnosis and to follow patients with known or suspected hypertension.

2

What are the major types of office BP measurement?

Two major types of office BP measurement exist. The auscultatory technique is performed with a mercury or aneroid sphygmomanometer by listening for Korotkoff sounds with a stethoscope. Onset of the sounds (K1) coincides with systolic BP (SBP), and the pressure at which the sounds are no longer heard (K5) is the diastolic BP (DBP). The oscillometric technique utilizes an automated device that, if singly or repeatedly activated, can take one or more readings, or an automated office BP (AOBP) device that is preprogrammed to take multiple sequential readings. In the latter case, a provider can leave the room, which is known as “unattended” BP measurement. It is important that only automated devices that have been validated according to an internationally accepted clinical protocol be used. Oscillometric devices work by recording, filtering, and analyzing arterial pulsations. BP is determined by applying a proprietary algorithm to these recordings.

BP measurement techniques, advantages, and disadvantages are summarized in Table 1.1 .

Table 1.1
Types of Blood Pressure Measurement
Data from Padwal R, Campbell NRC, Schutte AE, et al. Optimizing observer performance of clinic blood pressure measurement: a position statement from the Lancet Commission on Hypertension Group . J Hypertens. 2019;37:1737-1745.
DEVICE BENEFITS CHALLENGES
Mercury auscultation

  • Does not require calibration as long as the mercury column is intact and the meniscus is zeroed.

  • Accuracy: Two-observer mercury-based auscultation is the gold standard measurement method but is too impractical to be used in clinical settings.

  • Human error in technique.

  • Risk of spills (extremely rare). Nevertheless, mercury has been banned in many jurisdictions because of this theoretical risk. LED devices may be an alternative.

  • White coat and masked effect.

  • Does not facilitate unattended measurement.

Aneroid auscultation

  • Can be accurate if a calibrated device and proper technique are used.

  • Human error in technique.

  • Requires regular calibration (every 3–6 months) to maintain accuracy.

  • White coat and masked effect.

  • Does not facilitate unattended measurement.

Single activation automated device (can include a home BP device)

  • Standardizes the measurement process and eliminates some human error.

  • Less expensive than AOBP device.

  • Must be reactivated to take multiple readings.

  • Unattended readings cannot be performed.

AOBP device

  • Enables multiple, sequential measurements.

  • Auto calculates mean blood pressure.

  • Measurements can be unattended, potentially reducing white coat effect.

  • Due to limited outcome data and high variability relative to out-of-office measurement modalities, AOBP is not a replacement for out-of-office measurement.

AOBP, Automated office blood pressure; LED, light-emitting diode.

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