End-digit preference in blood pressure recordings of patients with ischaemic heart disease in primary care

Lusignan, Simon de; Belsey, Jonathan; Hague, N; Dzregah, B

doi:10.1038/sj.jhh.1001663

Cited by 41 publications

(34 citation statements)

References 11 publications

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“…15 However, semi-automated blood pressure measuring devices have been introduced in general practice in the past 5 years 16 and are likely to have a significantly reduced terminal digit preference. 17,18 Unfortunately, we do not know how widely general practitioners have moved to using semi-automated devices.…”

Section: Principal Findingsmentioning

confidence: 99%

Blood pressure recording bias during a period when the Quality and Outcomes Framework was introduced

et al. 2009

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Section: Principal Findingsmentioning

confidence: 99%

Blood pressure recording bias during a period when the Quality and Outcomes Framework was introduced

et al. 2009

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“…A widely accepted indicator of low-quality BP measurement made with nonautomated sphygmomanometers is end-digit preference (EDP)-the occurrence of zeros as end digits more frequently than would be expected by chance alone. Earlier studies have found high prevalence of EDP in primary care (6,7) and specialty hypertension clinics (8). These studies have suggested that EDP might affect antihypertensive medication prescribing patterns (7) and that, in turn, the likelihood of EDP might be influenced by patient demographic characteristics (8).…”

mentioning

confidence: 99%

End-Digit Preference and the Quality of Blood Pressure Monitoring in Diabetic Adults

et al. 2007

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OBJECTIVE -Although tight blood pressure (BP) control is proven to reduce diabetesrelated cardiovascular risk, it has been difficult to achieve in practice, perhaps in part because of low-quality monitoring data. We hypothesized that low-quality BP data, reflected in end-digit preference (EDP), remains common in primary care of diabetic adults.RESEARCH DESIGN AND METHODS -Data were abstracted from the charts of 404 adults with type 2 diabetes seen at 16 academically affiliated clinics from 1999 to 2001. Enddigits of systolic and diastolic BPs taken with nonautomated sphygmomanometers were extracted, and prevalence of EDP for zero was calculated. Associations between EDP and selected patient characteristics were determined using multiple logistic regressions.RESULTS -EDP was highly prevalent in the BP measurements taken by nonphysicians (4,333 BPs; 50% of systolic, 50% of diastolic readings ended in zero; P Ͻ 0.001) and physicians (1,347 BPs; 69% of systolic, 64% of diastolic readings ended in zero; P Ͻ 0.001). In multivariate analysis, nonphysicians showed greater EDP for systolic BP in older patients (odds ratio [OR] 1.07 per 5 years) and women (OR 1.36 vs. men) and for diastolic BP in African-Americans (OR 1.25 vs. whites; all P Ͻ 0.05); physicians showed greater EDP for diastolic BP in less obese patients (OR 0.97 per 5 kg/m 2 increment in BMI; P ϭ 0.02).CONCLUSIONS -Low-quality BP measurement is common in primary care of diabetic adults. Procedural and technological improvements to BP measurement deserve attention as part of an overall strategy to tighten BP control and reduce cardiovascular risk. Diabetes Care 30:1959-1963, 2007A lthough tight blood pressure (BP) control is proven to reduce diabetes-related cardiovascular risk in controlled trials (1-3), it has been difficult to achieve in general practice (4,5). One reason might be low-quality monitoring data: compared with A1C and lipids, which are stable day to day and are measured in laboratories with strict quality control standards, BP is quite variable and is measured by busy clinicians with little attention to standardization. A widely accepted indicator of low-quality BP measurement made with nonautomated sphygmomanometers is end-digit preference (EDP)-the occurrence of zeros as end digits more frequently than would be expected by chance alone. Earlier studies have found high prevalence of EDP in primary care (6,7) and specialty hypertension clinics (8). These studies have suggested that EDP might affect antihypertensive medication prescribing patterns (7) and that, in turn, the likelihood of EDP might be influenced by patient demographic characteristics (8).We therefore conducted a study to identify EDP and its correlates in a cohort of adults with type 2 diabetes in primary care. We hypothesized that EDP remains common, even in contemporary practice, and that EDP would be influenced by patient characteristics, including age, sex, race, and BMI. Chart abstraction was performed by two trained registered nurses and reviewed by two physicians. Abst...

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“…In the present study, 57% of the 180 patients treatable under BHS4 but not under NICE had a systolic blood pressure of 140 mmHg or diastolic blood pressure of 90 mmHg. Accordingly, management decisions will be influenced by the well-known issue of end-digit preference in recording blood pressure 26 though it remains to be seen what difference this will make in the real world of general practice. As well as the impact on clinicians' time running and managing hypertension clinics, the stringent control targets and audit standards associated with each guideline will create further challenges.…”

Section: Discussionmentioning

confidence: 99%

The impact of implementing national hypertension guidelines on prevalence and workload in primary care: a population-based survey of older people

et al. 2005

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upon Tyne, UKRecently revised UK and US hypertension guidelines have reduced thresholds for both diagnosis and treatment and differ in their recommendations. We have used data from a random, stratified community-based sample of 4784 people aged 65 years and over to compare the prevalence of treatable hypertension and the potential impact on patients and primary care from using current guidelines. BHS, NICE and JNC7 guidelines were applied to blood pressures obtained from primary care medical records (94%) or measured at a screening clinic (6%). Risk factors were obtained by questionnaire and from medical records, supplemented by epidemiological data. Workload was estimated for a representative practice population of 10 000 patients. Blood pressures were obtained on 4514 patients (94%). Prevalence of treatable hypertension was over 67%. Compared to BHS4, prevalence estimates using NICE guidelines were comparable for men but significantly lower for women (Po0.05). They were significantly higher using JNC7 compared with BHS4 and NICE guidance (Po0.05). A general practice of 10 000 patients could expect 1287 older hypertensive patients using BHS4 guidelines and 1231 patients using NICE guidelines. Under BHS4, an extra 94 patients will require annual, rather than 5-yearly review compared with that using the previous guideline. In conclusion, implementation of BHS4 guidelines, with their revised thresholds for diagnosis, will not add materially to the prevalence of treatable hypertension compared to previous BHS3 guidelines but will have a major impact on practice workload. Use of NICE guidelines in preference to BHS4 will result in GPs treating fewer patients and reviewing untreated patients less often.

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End-digit preference in blood pressure recordings of patients with ischaemic heart disease in primary care

Cited by 41 publications

References 11 publications

Blood pressure recording bias during a period when the Quality and Outcomes Framework was introduced

Blood pressure recording bias during a period when the Quality and Outcomes Framework was introduced

End-Digit Preference and the Quality of Blood Pressure Monitoring in Diabetic Adults

The impact of implementing national hypertension guidelines on prevalence and workload in primary care: a population-based survey of older people

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