A meta-analysis of blood pressure monitoring studies supports closely monitoring patients at risk for hypertension and cardiovascular disease. This included support for using ambulatory methods on patients in order to prevent overdiagnosis due to office-related elevated blood pressure.
The analysis, performed by the U.S. Preventive Services Task Force, provided more direct evidence for recommendations on regular blood pressure monitoring for patients with observed high office blood pressure measurements. The task force culled studies from five sources to develop the evidence base.
Margaret A. Piper, PhD, MPH, from the Kaiser Permanente Center for Health Research in Portland, Ore., and colleagues examined available studies for the benefits and harms of high blood pressure screening, screening frequency and accuracy of measurement methods both in and out of office.
Few studies directly explored the benefits and harms of blood pressure screening, they found. The one they did find looked at adults age 65 and older and the findings were not necessarily applicable to other age groups. Likewise, few studies explored comparing office and manual blood pressure testing.
They did, however, write that both at-home and office blood pressure screening appeared to reveal risks for cardiovascular disease. Ambulatory methods predicted stroke and cardiovascular risks independent of office measurements with no apparent differences between 24-hour, daytime, or night-time measurements in predictive value.
Piper et al noted that while population characteristics drove variation in incident hypertension, it only highlighted the need to ensure improved monitoring among patients at high risk. They wrote that office-based measurements should be confirmed by use of ambulatory blood pressure monitoring as “the available evidence suggests that repeated measurements may improve the diagnostic accuracy of OBPM [office blood pressure measurement] for screening.”
They suggested repeated blood pressure monitoring and frequent follow-ups among patients who are older, with above-normal body mass index, African Americans, and those who present with high blood pressure to in-office measurements.
The meta-analysis was published online Dec. 23 in the Annals of Internal Medicine.