Close versus loose contact between physician and patient during attended office blood pressure measurement: does it play a role?

Objective: Compared to unattended office blood pressure measurement (uOBP), attended office blood pressure measurement (aOBP) gives higher blood pressure (BP) values. It is not known, however, to what extent the distance between physician and patient during aOBP influences BP. Design and method: Participants were stable hypertensive patients, followed in the university hospital-based out-patient centre. During a session, automated office BP was measured three times after a pre-set five-minute pause, using Omron 907 device; both aOBP and uOBP were done, in a random order. Simultaneously, beat-to-beat BP measurement (bbBP) was done using Finapress device. During aOBP, some participants were in close contact with the physician: he placed the stethoscope to the cubital fossa, thus imitating the auscultatory measurement; other patients were in “loose’’ contact where the doctor was sitting in the room, about two meters apart. One year later, the second session with the same protocol was organized, but the close and loose contact were interchanged. The data were analysed using a paired t-test. Results: Complete data were collected in 32 patients (53% males, age 66.2 ± 8.1 years, uOBP 122.8 ± 14.8 / 69.5 ± 11.7 mmHg, treatment with 2.7 ± 1.0 antihypertensive drugs). Systolic and diastolic aOBP with close contact was higher by 4.6 ± 6.9 and 1.9 ± 3.4 mmHg (p < 0.0007 and 0.0039, respectively), while aOBP with loose contact was not different from uOBP. bbBP increased during aOBP by up to 6.5 ± 8.5 / 3.3 ± 4.8 mmHg, as compared to baseline BP values measured before the physician entered the office. The increase persisted during all the three aOBP measurements (p < 0.001 for all systolic and diastolic BP values); the results were similar for close and loose contact. The peak increase during uOBP was of similar magnitude as during aOBP but it lasted shorter: it increased highly significantly (p < 0.001) only during the first uOBP measurement. Conclusions: Compared to uOBP, aOBP values were higher with close, but not with loose contact between physician and patient. These differences were, however, not detected by bbBP measurement.