Should patients stand on BP desk readings?

Standing desk blood pressure (BP) readings, alone or with sitting blood pressure readings, outperform sitting blood pressure readings for the initial diagnosis of Hypertensionsuggests a new study.

Combining three blood pressure measurements while standing and three sitting at the same visit may result in “a faster diagnosis and provide a return trip for people to the office,” according to Wanben Vongpatanasen, professor of internal medicine and director of the division of hypertension, division of cardiology, Utah. Southwest Medical Center in Dallas, Texas | Medscape Heart.

The study was presented at the American Heart Association (AHA) Hypertension 2022 Scientific Sessions in San Diego, California.

change practice?

Clinical guidelines recommend taking BP in a seated position for most patients.

but, Suggest a search Vongpatanasen explained that the sensitivity of a sitting-office blood pressure monitor in diagnosing hypertension is only about 50%, with a high specificity of about 90% during a single visit.

However, at the follow-up visit, the second office BP yielded a sensitivity higher to 80% but specificity decreased to 55%. However, the accuracy of standing BP measurements for diagnosing hypertension has not been investigated.

In a cross-sectional study, Vongpatanasen and colleagues determined the accuracy of sitting and standing blood pressure for diagnosing hypertension at one visit in 125 healthy adults who had no previous diagnosis of hypertension and were not taking any blood pressure medications. The median age of the group was 49 years, 62% of women, and 24% of blacks.

During each office visit, sitting blood pressure was measured three times, then blood pressure while standing was measured three times using an automated device and validated.

Mean sitting blood pressure was 123/76 mm Hg and average steady blood pressure 126/80 mm Hg.

Among 125 participants, 42 (34%) had hypertension, which was defined as a 24-hour systolic/diastolic blood pressure (SBP/DBP) of ≥ 125/75 mm Hg.

The sensitivity and specificity of SBP for seated hypertension were 43% and 92%, respectively.

“Interestingly, with the SBP standing, sensitivity improved to 74% and specificity decreased to 65% – which is good; you’d have to confirm a positive test anyway, and when checking for a common disease you’d rather have a high sensitivity than a low sensitivity to pick it up in This is the case,” Vongpatanasen said.

The area under the AUROC curve for the standing SBP was significantly higher than the sitting SBP (Bayes factor). [BF] = 11.8) when hypertension was defined as SBP 125 mmHg over 24 hours.

Similarly, when hypertension was defined as a 24-hour DBP of 75 mmHg or a daytime DBP ≥ 80 mmHg, the AUROC for the standing DBP was higher than the sitting DBP (all BF > 3).

Adding standing to sitting blood pressure improved detection of hypertension compared with sitting blood pressure alone based on 24-hour SBP/DBP or 125/75 mmHg or daytime SBP/DBP ≥ 130/80 mmHg (All BF > 3).

John Giacuna, PA-C, a doctoral candidate at UT Southwestern Medical Center and co-author of the study, said, | Medscape Heart, “In our hypertension clinic, we always measure blood pressure while sitting and standing in all of our patients.”

Multiple readings, the most important of which is

Coming to the commentary, Joanna Contreras, MD, a cardiologist at Mount Sinai Hospital in New York City, notes that diagnosing high blood pressure is “difficult” and agrees with the importance of multiple readings.

“I usually do at least two readings at two different visits before I tell a patient they have high blood pressure,” Contreras said. | Medscape Heart.

Contreras said she measures blood pressure in a sitting and standing position.

“I’m not sure that standing versus sitting makes a huge difference. However, when a patient first comes into the office, it’s really important to let them rest and calm before taking their blood pressure,” she said.

The study had no commercial funding. The authors and Contreras did not disclose any relevant financial relationships.

American Heart Association (AHA) Hypertension Scientific Sessions 2022: Poster 011. Filed September 10, 2022.

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