title: Performance of the automated BpTRU measurement device in the assessment of white-coat hypertension and white-coat effect.
abstract: OBJECTIVE
  BpTRU (VSM MedTech Ltd, Vancouver, Canada) is an automated oscillometric device that provides serial blood pressure measurements in an office setting in the absence of a healthcare professional. We sought to determine whether the white-coat effect is reduced by a blood pressure measurement protocol using BpTRU compared with casual office measurements. Secondarily, we also sought to determine whether a blood pressure measurement protocol using BpTRU reduced white-coat hypertension compared with the casual office measurements, and reduced white-coat effect and white-coat hypertension compared with blood pressure obtained by a research nurse.
  
  
  METHODS
  Blood pressure was measured in 107 adult hypertensive patients referred for ambulatory blood pressure monitoring using an ambulatory blood pressure monitor, a standardized protocol by a trained research nurse, and a protocol using BpTRU (five readings over 25 min, using the 5-min blood pressure measurement interval setting). Casual office blood pressure was also recorded in the family physicians' offices. Using the mean daytime ambulatory blood pressure as the reference standard, the proportion of patients with white-coat effect and white-coat hypertension were determined for measurements obtained by BpTRU, the research nurse, and the family physicians' offices.
  
  
  RESULTS
  Casual office blood pressure measurements demonstrated a white-coat effect in 39 (36.4%) patients; seven (6.5%) patients demonstrated a white-coat effect using BpTRU (P<0.0001). White-coat hypertension was also less common using BpTRU than with the casual office readings (13 vs. 1 patient, P<0.0001). White-coat effect was also reduced with BpTRU compared with the research nurse measurements. Unfortunately, percentage agreement for the diagnosis of hypertension between the protocol using BpTRU and the reference standard was only 48%. This resulted in substantial misclassification of hypertension by the BpTRU measurement protocol.
  
  
  CONCLUSIONS
  Although BpTRU reduces white-coat effect and white-coat hypertension, blood pressure is underestimated by the device, leading to misclassification of hypertension. BpTRU, when set at 5-min blood pressure measurement intervals, should not be used in clinical practice.
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada. Bruce.Culleton@CalgaryHealthRegion.ca
authors.forename: Bruce F
authors.initials: BF
authors.lastname: Culleton
authors.forename: Donald W
authors.initials: DW
authors.lastname: McKay
authors.forename: Norman R
authors.initials: NR
authors.lastname: Campbell
mesh_terms: D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000295:instrumentation* / Q000592:standards; D018660:Blood Pressure Monitoring, Ambulatory / Q000295:instrumentation* / Q000592:standards; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D012015:Reference Standards