419 - Evaluating Patient Perceptions of the Accuracy of Different Blood Pressure Modalities

Publication Number: 1402.419

Victoria Cueto Vilorio, Yale School of Medicine, New Haven, CT, United States; Emily B. Finn, Yale School of Medicine, New Haven, CT, United States; Carlin F. Aloe, Yale School of Medicine, New Haven, CT, United States; Geisa Wilkins, Yale School of Medicine, New Haven, CT, United States; Hugh M. Medvecky, The Warren Alpert Medical School of Brown University, Guilford, CT, United States; Mona Sharifi, Yale School of Medicine, New Haven, CT, United States; James T. Nugent, Yale School of Medicine, New Haven, CT, United States

Background: Pediatric guidelines recommend ambulatory blood pressure monitoring (ABPM) as the gold standard for the diagnosis of hypertension. However, patient and family perceptions of the accuracy of different blood pressure (BP) modalities are unknown and may influence adherence and hypertension control.

Objective: To evaluate patients' perceived accuracy of ABPM compared to other common modalities: clinic-based automated monitors, manual measurements by healthcare professionals, home blood pressure self-monitoring (HBPM).

Design/Methods: We recruited patients aged 6-21 years with a guideline-recommended indication for ABPM at an academic medical center in the Northeast. Patients and parents were provided with devices and instructed to complete ABPM for 24 hours and HBPM twice daily for 7 days. Following completion of all out-of-office measurements, patients and parents completed a survey to rate the perceived accuracy of different BP modalities. In a sequential explanatory mixed methods design, patients were then invited to participate in semi-structured qualitative interviews to explore the factors that informed their ratings. Interviews were analyzed using thematic analysis.

Results: Of the 37 patients with clinic, HBPM, and ABPM measurements that completed the survey (15 years [IQR, 13-16 ], 38% female, 32% White, 30% Black, 49% Hispanic, 81% overweight/obesity) (Table 1), 81% of patients reported that manual BP by a healthcare professional was very accurate/accurate vs. 65% for automated BP in clinic, 65% for HBPM, and 59% for ABPM (P=0.20) (Fig 1). We achieved thematic saturation after interviewing 33 patients, revealing the following themes: (1) Frequency and consistency of out-of-office measurement ("I just figured since it was more frequent it would probably be more accurate"); (2) Trust in accuracy of manual BP due to professional expertise ("I feel more comfortable knowing the results coming out of a doctor"); (3) Technical issues with automated devices ("if something in the machine goes wrong, it might not get the reading right"); and (4) Anxiety affects accuracy of clinic readings ("it wasn't really accurate at the clinic 'cause people get more nervous") (Table 2).

Conclusion(s): Although ABPM is the gold standard, its accuracy is not clear to patients. While patients recognized the value of ABPM's frequent readings and less anxiety due to being home, patients perceived high accuracy of clinic readings due to healthcare professional expertise and lack of technical errors with manual BP. These insights can inform patient-centered integration of different BP modalities into practice.

Table 1. Characteristics of participants, n=37.
BMI, Body Mass Index; BP, Blood Pressure.

Table 2. Representative Quotes


Figure 1. Patients Perceive Manual Measurements by Healthcare Professionals as Most Accurate
BP, (Blood Pressure); Clinic Manual (Doctor/Nurse), Manual blood pressure measurements by a doctor or nurse; Automated BP in clinic, Clinic-based automated monitors; Home Automated, home blood pressure self-monitoring (HBPM); 24-Hour Automated, 24 hours ambulatory blood pressure monitoring (ABPM).