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Selective recording in blood pressure readings may increase subsequent mortality
D Wingfield1, G K Freeman, C J Bulpitt
1Department of Primary Health Care and General Practice and. Section of Care of the Elderly, Imperial College, Faculty of Medicine, London, UK. david@hammerpcg.org.uk
QJM : Monthly Journal of the Association of Physicians
|September 3, 2002
Summary
Blood pressure measurement biases, like number preference, can affect hypertension screening accuracy. This study found that a diastolic blood pressure reading of 88-89 mmHg in women was associated with increased cardiovascular and all-cause mortality compared to 90-99 mmHg.
Area of Science:
- Cardiology
- Clinical Epidemiology
- Biostatistics
Background:
- Blood pressure (BP) measurement inaccuracies, such as terminal digit preference and number preference, are known issues.
- These biases can compromise diagnostic accuracy and potentially impact patient treatment and survival outcomes.
Purpose of the Study:
- To investigate number preference in hypertension screening.
- To determine if this preference influences subsequent mortality rates.
Main Methods:
- A prospective case-control screening study was conducted within the General Practice Hypertensive Study Group (GPHSG).
- 23,574 patients were screened for high phase-IV diastolic BP (DBP4) (≥90 mmHg), with cases matched to normotensive controls.
- Mortality follow-up was established for 6,310 patients.
Main Results:
- A significant over-representation of the terminal digit '0' (28.2% vs. 20%) and the number '88' for DBP4 was observed in both sexes.
- Females with DBP4 of 88-89 mmHg showed significantly higher cardiovascular (RR 2.56) and all-cause mortality (RR 1.56) compared to those with 90-99 mmHg.
- Males exhibited non-significant reductions in mortality rates.
Conclusions:
- The study highlights the impact of BP measurement biases on clinical outcomes.
- Monitoring BP measurement quality in research and clinical practice is crucial for accurate diagnosis and effective patient management.