Blood pressure response to close or loose contact between physician and patient during attended office blood pressure measurement

Compared to unattended office blood pressure (uOBP), attended office blood pressure (aOBP) is higher. It is not known, however, to what extent distance between physician and patient influences blood pressure (BP) values.
Participants were stable hypertensive patients, followed in the university hospital-based out-patient center. During a session, automated office BP was measured three times after a pre-set five-minute pause, using the Omron 907 device; both aOBP and uOBP were done, in a random order. Simultaneously, beat-to-beat BP measurement was performed using the Finapress device. During aOBP, some participants were in close contact with the physician while others were in loose contact where the doctor was sitting in the room about 2.5 m apart. One year later, the second session with the same protocol was organized, but the close and loose contact were interchanged. The data were analyzed using a paired t-test.
Complete data were collected in 32 patients, baseline uOBP was 122.8 ± 14.8/69.5 ± 11.7 mmHg. 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. Beat-to-beat BP increased during aOBP by 6.5 ± 8.5/3.3 ± 4.8 mmHg. The increase persisted during all the three aOBP measurements (p < 0.0001 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 reached the significance level of p < 0.0001 only during the first uOBP measurement.
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 beat-to-beat BP measurement.

与无医师在场的诊室血压（unattended office blood pressure, uOBP）相比，有医师在场的诊室血压（attended office blood pressure, aOBP）数值更高。然而目前尚不明确医师与患者之间的距离对血压（blood pressure, BP）值的影响程度。

本研究纳入病情稳定的高血压患者，均在大学医院门诊中心接受随访。某次随访流程中，受试者先经预设的5分钟静息后，使用欧姆龙907（Omron 907）设备自动测量三次诊室血压；有医师在场与无医师在场的血压测量随机顺序开展。同时，采用Finapress设备进行逐搏血压监测。在有医师在场的测量环节中，部分受试者与医师保持近距离接触，其余受试者则为远距离接触——医师坐在约2.5米外的房间内。一年后，按照相同方案开展第二次随访，并交换了近距离与远距离接触的分组。数据采用配对t检验进行分析。

最终32例患者获得完整有效数据。基线状态下无医师在场的诊室血压为122.8±14.8/69.5±11.7 mmHg。医师近距离接触时的有医师在场诊室收缩压与舒张压分别较无医师在场组高4.6±6.9 mmHg和1.9±3.4 mmHg（分别对应p<0.0007和p<0.0039）；而医师远距离接触时的有医师在场诊室血压与无医师在场组无显著差异。逐搏血压在有医师在场的测量环节中升高6.5±8.5/3.3±4.8 mmHg，且该升高趋势在三次有医师在场的血压测量中均持续存在（所有收缩压与舒张压指标均满足p<0.0001）；近距离与远距离接触的结果无显著差异。无医师在场测量环节中的峰值升高幅度与有医师在场组相近，但持续时间更短，仅在首次无医师在场测量时达到p<0.0001的显著性水平。

与无医师在场的诊室血压相比，医师与患者近距离接触时的有医师在场诊室血压更高，但远距离接触时则无此差异。然而，逐搏血压监测未能检测到上述差异。