Type and accuracy of sphygmomanometers in primary care: a cross-sectional observational study

A’Court, Christine; Stevens, R J; Sanders, Sarah; Ward, Alison; McManus, Richard J; Heneghan, Carl

doi:10.3399/bjgp11x593884

Cited by 49 publications

(41 citation statements)

References 11 publications

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“…The failure rate of 13% identified in this study is very similar to that found by A'Court et al 29 when testing monitors used in GP practices, namely 14% overall and 12% specifically for digital devices. Interestingly, for technical reasons those investigators were not able to test the monitors included in this study, which suggests that the underlying technologies in oscillometric monitors may be similarly robust.…”

Section: Comparison With Existing Literaturesupporting

confidence: 77%

Accuracy of monitors used for blood pressure checks in English retail pharmacies: a cross-sectional observational study

Hodgkinson¹,

Koshiaris

Martin

et al. 2016

Br J Gen Pract

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BackgroundFree blood pressure (BP) checks offered by community pharmacies provide a potentially useful opportunity to diagnose and/or manage hypertension, but the accuracy of the sphygmomanometers in use is currently unknown.AimTo assess the accuracy of validated automatic BP monitors used for BP checks in a UK retail pharmacy chain.Design and settingCross-sectional, observational study in 52 pharmacies from one chain in a range of locations (inner city, suburban, and rural) in central England.MethodMonitor accuracy was compared with a calibrated reference device (Omron PA-350), at 50 mmHg intervals across the range 0–300 mmHg (static pressure test), with a difference from the reference monitor of +/− 3 mmHg at any interval considered a failure. The results were analysed by usage rates and length of time in service.ResultsOf 61 BP monitors tested, eight (13%) monitors failed (that is, were >3 mmHg from reference), all of which underestimated BP. Monitor failure rate from the reference monitor of +/− 3 mmHg at any testing interval varied by length of time in use (2/38, 5% <18 months; 4/14, 29% >18 months,P= 0.038) and to some extent, but non-significantly, by usage rates (4/22, 18% in monitors used more than once daily; 2/33, 6% in those used less frequently,P= 0.204).ConclusionBP monitors within a pharmacy setting fail at similar rates to those in general practice. Annual calibration checks for blood pressure monitors are needed, even for new monitors, as these data indicate declining performance from 18 months onwards.

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Section: Comparison With Existing Literaturesupporting

confidence: 77%

Accuracy of monitors used for blood pressure checks in English retail pharmacies: a cross-sectional observational study

Hodgkinson¹,

Koshiaris

Martin

et al. 2016

Br J Gen Pract

Self Cite

View full text Add to dashboard Cite

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“…Second, the list of comorbidities used was not exhaustive. Third, measurements of biological variables are subject to error, particularly in the case of BP, which is measured using instruments of variable accuracy and is prone to digit bias in recording [23]. Also, since 2004, UK practices have had financial incentives for controlling BP and there is evidence to show that recordings of systolic BP have been biased downwards for patients with values just above the target levels (target levels for diabetic patients were 145 mmHg from 2004/2005 to 2010/2011 and 140 mmHg from 2011/2012) [24].…”

Section: Discussionmentioning

confidence: 99%

Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study

et al. 2014

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Aims/hypothesis We aimed to describe the shape of observed relationships between risk factor levels and clinically important outcomes in type 2 diabetes after adjusting for multiple confounders.Methods We used retrospective longitudinal data on 246,544 adults with type 2 diabetes from 600 practices in the Clinical Practice Research Datalink, 2006Datalink, -2012 Proportional hazards regression models quantified the risks of mortality and microvascular or macrovascular events associated with four modifiable biological variables (HbA 1c , systolic BP, diastolic BP and total cholesterol), while controlling for important patient and practice covariates. Results U-shaped relationships were observed between allcause mortality and levels of the four biometric risk factors. Lowest risks were associated with HbA 1c 7.25-7.75% (56-61 mmol/mol), total cholesterol 3.5-4.5 mmol/l, systolic BP 135-145 mmHg and diastolic BP 82.5-87.5 mmHg. Coronary and stroke mortality related to the four risk factors in a positive, curvilinear way, with the exception of systolic BP, which related to deaths in a U-shape. Macrovascular events showed a positive and curvilinear relationship with HbA 1c but a U-shaped relationship with total cholesterol and systolic BP. Microvascular events related to the four risk factors in a curvilinear way: positive for HbA 1c and systolic BP but negative for cholesterol and diastolic BP. Conclusions/interpretation We identified several relationships that support a call for major changes to clinical practice. Most importantly, our results support trial data indicating that normalisation of glucose and BP can lead to poorer outcomes. This makes a strong case for target ranges for these risk factors rather than target levels.Electronic supplementary material The online version of this article

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“…12 This has led to the common practice of allowing readers to assume that the OR is an RR in order to gain an intuitive feel for the size of the effect demonstrated in a study. 6,11 The problem is that, although the two measures will always move in the same direction, their values diverge when baseline risk (or odds) is high in either of the two groups being compared.…”

Section: Should Relative Risk or The Odds Ratio Be Used?mentioning

confidence: 99%

Against all odds? Improving the understanding of risk reporting

A’Court¹,

Stevens²,

Heneghan³

2012

Br J Gen Pract

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Type and accuracy of sphygmomanometers in primary care: a cross-sectional observational study

Cited by 49 publications

References 11 publications

Accuracy of monitors used for blood pressure checks in English retail pharmacies: a cross-sectional observational study

Accuracy of monitors used for blood pressure checks in English retail pharmacies: a cross-sectional observational study

Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study

Against all odds? Improving the understanding of risk reporting

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