Optimal duration and number of readings for unattended automated office blood pressure measurements in patients with type 2 diabetes.

OBJECTIVE

Unobserved automated office blood pressure (uAOBP) measurement is better correlated to daytime ambulatory blood pressure monitoring (dABPM) than traditional office blood pressure (BP) measurements. However, prolonged uAOBP duration may underestimate BP levels. We aimed to determine the duration of uAOBP that has the lowest proportion of white-coat hypertension (WCH) or masked hypertension (MH) compared with the gold-standard using dABPM in patients with type 2 diabetes (T2DM). Additionally, we examined variables associated with discrepancy between uAOBP and dABPM.

METHODS

A total of 135 patients with T2DM underwent dABPM as well as uAOBP. uAOBP recordings were taken in the sitting position without prior rest for 24 min at 3-min intervals. Hypertension was defined as blood pressure ≥135/85 mmHg. Multiple uAOBP measurement intervals were compared with dABPM by the proportions of patients with WCH, MH, or consistent classification.

RESULTS

Participants had a mean age of 57.7 years, 38% were female, and 66% used antihypertensive drugs. Average dABPM was 126.9/79.5 mmHg. Extension of uAOBP measurements from 3 to 24 min reduced the proportion with WCH significantly (20.7 vs. 27.4%, P  = 0.012), with an identical proportion of MH (4.4 vs. 3.7%). Higher BMI, higher urine albumin-creatinine ratio, and higher education were associated with MH, while WCH was associated with older age and early retirement.

CONCLUSION

Extending the duration of uAOBP measurements from 3 to 24 min in patients with T2DM increased the proportion of patients with consistent classification by reducing WCH without increasing MH, but clinically relevant individual differences between uAOBP measurements and dABPM remained.