Modern approaches to blood pressure measurement

Staessen, Jan A.; O’Brien, Eoin; Thijs, Lutgarde; Fagard, Robert

doi:10.1136/oem.57.8.510

Cited by 69 publications

(65 citation statements)

References 141 publications

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“…The character of these results is consistent with those found in other populations of health professionals throughout the world, [4][5][6][7][8][9] although this is the first study to examine such behaviour in a population of patients likely to be at high risk of experiencing further cardiovascular events.…”

Section: Main Findingssupporting

confidence: 77%

“…4,5 It is not a problem unique to GPs; it is reported for nurses, 6 and in obstetric practice 7 for physicians. 8,9 All these studies indicate strongest end-digit preference for zero, followed by five and then by the other even numbers (2,4,6,8), with the remaining odd numbers (1,3,7,9) used least frequently. Two of the studies looked at recording around treatment/ intervention levels.…”

Section: End-digit Preferencementioning

confidence: 99%

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

et al. 2004

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End-digit preference describes the disproportionate selection of specific end digits. The rounding of figures might lead to either an under-or over-recording of blood pressure (BP) and a lack of accuracy and reliability in treatment decisions. A total of 85 000 BP values taken from computerised general practice records of ischaemic heart disease patients in England between 2001 and 2003 were examined. Zero preference accounts for 64% of systolic and 59% of diastolic readings, compared with an expected frequency of 10% (Po0.000001). Even numbers are more frequently seen than odd numbers. In all, 64% of nonzero systolic recordings and 65% of diastolic recordings ended in even numbers, compared with expected proportions of 44% (Po0.0001). Among the nonzero even numbers, eight is the most frequently observed: 28% of systolic and 31% of diastolic recordings compared with an expected proportion of 25% (Po0.0001). Among the five nonzero odd numbers, five is the most frequently observed end digit, representing 59% systolic and 62% of diastolic compared with an expected level of 20% (Po0.00001). English general practice displays marked end-digit preference. This is strongly for the end-digit zero. However, there is more use of other enddigits, notably 8 and 5. This bias potentially carries important treatment consequences for this high-risk population.

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Section: Main Findingssupporting

confidence: 77%

Section: End-digit Preferencementioning

confidence: 99%

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

et al. 2004

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“…31 Twenty-four hour ambulatory blood pressure recordings are characterised by high reproducibility, are not subject to digit preference or observer bias and minimise the transient rise of a person's blood pressure in response to the observer, the so-called white-coat effect. 90 Only one study 6 used this new technique of blood pressure measurement but did not support the hypothesis of a consistent positive relationship between blood pressure and blood lead concentration.…”

Section: Discussionmentioning

confidence: 99%

An epidemiological re-appraisal of the association between blood pressure and blood lead: a meta-analysis

et al. 2002

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Studies on the possible association between blood pressure and blood lead have reached divergent conclusions. In a previous meta-analysis, a doubling of the blood lead concentration was associated with a 1.0/0.6 mm Hg increase in systolic and diastolic blood pressure (BP). This meta-analysis updates the analysis originally performed in 1994. Articles on the association between BP and blood lead were identified from computer searches from January 1980 to February 2001 using the Medical Literature Analysis and Retrieval System. Of the studies reviewed, 31 provided sufficient details to be considered. The meta-analysis included 58 518 subjects recruited from the general population in 19 surveys and from occupationally exposed groups in 12 studies. In all but four studies, the results were adjusted for age, and

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“…The use of automatic monitors eliminates the observer biases and results in more reproducible, accurate readings. Many clinical trials have incorporated use of home BP monitoring and ambulatory BP monitoring, [15][16][17] which remove observer bias. The findings in this and previous studies raise the concern that traditional office BP measurements have significant limitations for diagnosis and management of hypertension.…”

Section: Discussionmentioning

confidence: 99%

Terminal digit bias in a specialty hypertension faculty practice

2003

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Traditional blood pressure (BP) methodology is subject to observer error such as terminal digit preference and single number preference leading to inaccuracies in measurement. A high percentage (60-90%) of terminal BP readings digit being zero has been reported from general medical-and hospital-based clinics. This study examined terminal digit preference in a hypertension specialty practice and assessed clinical factors that may be associated with zero preference in this setting. A retrospective chart review of patients presenting to the hypertension clinic at the University of Connecticut Health Center during the month of September 2001 was performed. Data were extracted on age, gender, height, weight, treatment status, and systolic and diastolic BP measurements taken by nursing staff and attending physicians. Terminal digit preference was apparent in BP readings taken by both nursing staff and physicians. Zero was the terminal systolic BP digit in 40% of readings taken by the nursing staff and 31% of readings taken by physicians. For diastolic BP readings, the percentages were 23 and 36%, respectively. Nurses also recorded 43% of diastolic BP readings with terminal digit 2. Age was significantly higher in those persons in whom the physician diastolic BP terminal digit was zero than in those with nonzero terminal digits (67 7 14 vs 59 7 18 years, P ¼ 0.008). Body mass index was lower in the patient group with diastolic terminal digit zero bias compared to those with nonzero terminal digits (28 7 5 vs 32 7 6 kg/m 2 , P ¼ 0.02). In conclusion, although the frequency of zero digit preference did not reach the 60-80% levels found in previous studies, there was evidence of terminal digit preference in the systolic and diastolic measurements taken by nursing staff and attending physicians in a specialist hypertension clinic. We believe that the lower levels of terminal digit preference observed are an effect of increased training in proper BP measurement and technique. However, the observed bias in measurement even in a hypertension unit argues for regular monitoring and feedback to minimize such errors.

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Modern approaches to blood pressure measurement

Cited by 69 publications

References 141 publications

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

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

An epidemiological re-appraisal of the association between blood pressure and blood lead: a meta-analysis

Terminal digit bias in a specialty hypertension faculty practice

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