Revisiting Unattended Versus Attended Automated Office Blood Pressure Measurements: A Systematic Review and Meta-Analysis.

BACKGROUND: Standardized automated office blood pressure (AOBP) measurement is widely accepted as the preferred method for monitoring blood pressure (BP) in health care settings. However, disagreements persist as to the need to perform AOBP unattended, where the patient is left alone in a quiet room. Thus, this study aimed to assess the BP differences between unattended and attended AOBP. METHODS: This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered on PROSPERO (International Prospective Register of Systematic Reviews). Studies were included if unattended and attended AOBP measurements were performed on the same participants in a randomized or alternating sequence order during a single visit, using the same device and measurement protocol. The primary outcome was the difference between unattended and attended systolic BP and the secondary outcome, the difference in diastolic BP. Pooled results were expressed as weighted mean differences (95% CI) obtained using random-effects meta-analysis. RESULTS: From 8088 screened studies, data were extracted from 15 studies (n=1747 participants). The unattended systolic BP and diastolic BP were -2.7 (-4.7 to -0.6) and -0.9 (-1.8 to -0.1) mm Hg lower than attended BPs. In a leave-one-out analysis, the overall difference was largely driven by a single outlier study. After excluding that study, the estimated difference was -2.0 mmHg (95% CI -4.1 to 0.0). CONCLUSIONS: Standardized unattended AOBP measurements result in slightly lower readings than attended AOBP. Whether these small measurement differences translate into clinically significant changes in management remains uncertain. Therefore, attended AOBP appears to be a reasonable option for BP measurement in a real-world clinical setting.