Family Practice Advance Access originally published online on December 6, 2005
Family Practice 2006 23(1):20-27; doi:10.1093/fampra/cmi096
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Pitfalls in blood pressure measurement in daily practice
a Department of Internal Medicine, Isala Clinics, Weezenlanden Location Zwolle, b Department of Family Practice, University of Groningen and c Department of Internal Medicine, University of Groningen, Groningen, The Netherlands.
Correspondence to Sebastiaan T Houweling, Diabetes Outpatient Clinic, Isala clinics, Weezenlanden location, PO Box 10500, 8000 GM Zwolle, The Netherlands; Email: houweling{at}langerhans.com
Background. Accurate blood pressure (BP) readings and correctly interpreting the obtained values are of great importance. However, there is considerable variation in the different BP measuring methods suggested in guidelines and used in hypertension trials.
Objective. To compare the different methods used to measure BP; measuring once, the method used for a large study such as the UKPDS, and the methods recommended by various BP guidelines.
Methods. In 223 patients with type 2 diabetes from five family practices BP was measured according to a protocol to obtain the following data: A = first reading, B = mean of two initial readings, C = at least four readings and the mean of the last three readings with less than 15% coefficient of variation difference, D = mean of the first two consecutive readings with a maximum of 5 mm Hg difference. Mean outcomes measure is the mean difference between different BP measuring methods in mm Hg.
Results. Significant differences in systolic/diastolic BP were found between A and B [mean difference (MD) systolic BP 1.6 mm Hg, P < 0.001], B and C (MD 5.7/2.8 mm Hg, P < 0.001), B and D (MD 6.2/2.8 mm Hg, P < 0.001), A and C (MD 7.3/3.3 mm Hg), and A and D (MD 7.9/3.0 mm Hg, P < 0.001).
Conclusion. Different methods to assess BP during one visit in the same patient lead to significantly different BP readings and can lead to overestimation of the mean BP. These differences are clinically relevant and show a gap between different methods in trials, guidelines and daily practice.
Keywords. Blood pressure determination, clinical trials, human, hypertension, practice guidelines.
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