Related Experiment Video

Updated: Jun 4, 2026

Doppler Ultrasound-Based Leg Blood Flow Assessment During Single-Leg Knee-Extensor Exercise in an Uncontrolled Setting
09:18

Doppler Ultrasound-Based Leg Blood Flow Assessment During Single-Leg Knee-Extensor Exercise in an Uncontrolled Setting

Published on: December 15, 2023

ESCAPE-ancillary blood pressure measurement study: end-digit preference in blood pressure measurement within a

Jean-Pierre Lebeau1, Denis Pouchain, Dominique Huas

  • 1Department of General Practice, Tours Medical University, France. jean-pierre.lebeau@univ-tours.fr

Blood Pressure Monitoring
|March 2, 2011
PubMed

Insights

End-digit preference in blood pressure (BP) measurements significantly impacts readings. Oscillometric devices reduce this bias compared to manual methods, leading to more accurate hypertension management.

Area of Science:

  • Cardiology
  • Clinical Research
  • Hypertension Management

Background:

  • A cluster-randomized trial involving 1832 hypertensive patients compared oscillometric BP measurement devices used by general practitioners (GPs) in the intervention group (IG) versus control groups (CG).
  • Baseline BP was higher in the IG (146/84 mmHg) than the CG (139/81 mmHg), necessitating an investigation into potential biases.
  • The control group comprised GPs using either oscillometric (OCG) or manual (MCG) devices, with 75.4% using manual methods.

Purpose of the Study:

  • To determine if differences in BP values between intervention and control groups were attributable to end-digit preference (EDP) or selection bias.
  • To evaluate the influence of measurement method (oscillometric vs. manual) on BP readings and potential biases.

Main Methods:

  • Analysis of 3629 BP measurements from 257 GPs.
  • Utilized hierarchical mixed-effect models with random physician effects and fixed-effect covariables to analyze BP data.

Main Results:

  • Frequencies of end-digit preference (e.g., ending in 0) were significantly lower with oscillometric devices (IG: 16.7% SBP, 17.7% DBP) compared to manual devices (MCG: 68.8% SBP, 74.1% DBP).
  • End-digit preference in the control group led to an underestimation of systolic BP (SBP) and diastolic BP (DBP) by an average of 2.4 mmHg.
  • Systolic BP was higher in the IG compared to the OCG (+3.65 mmHg, P=0.017), suggesting a residual effect beyond EDP.

Conclusions:

  • Observed BP differences between groups are partly explained by the impact of end-digit preference.
  • Oscillometric BP measurement devices appear to reduce end-digit preference compared to manual methods.
  • Accurate BP measurement is crucial for effective hypertension management, and device selection can mitigate bias.
Abstract

Related Concept Videos

Pre-Procedural Guidelines for Assessing Blood Pressure01:10

Pre-Procedural Guidelines for Assessing Blood Pressure

Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the patient.
Sites for measuring blood pressure01:21

Sites for measuring blood pressure

Blood pressure measurement is a fundamental clinical procedure, providing crucial data for assessing cardiovascular health. Among the various sites for this measurement, the brachial and popliteal arteries are predominantly utilized due to their accessibility and the reliability of their readings. This lesson delves into the anatomical significance, methodology, and considerations of measuring blood pressure at these locations.
The Brachial Artery: Primary Site for Blood Pressure Measurement
Special considerations while measuring blood pressure01:28

Special considerations while measuring blood pressure

When assessing blood pressure (BP), healthcare professionals must consider various factors and potential unexpected outcomes to ensure accurate readings and provide proper patient care. Adhering to these guidelines is essential to achieving the most reliable results.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
Measurement of Blood Pressure01:17

Measurement of Blood Pressure

Assessing blood pressure is a standard procedure executed in virtually all medical environments. The method utilized today was established over a hundred years ago by an innovative Russian doctor, Dr. Nikolai Korotkoff. The soft ticking noise, known as Korotkoff sounds, heard while taking blood pressure readings results from turbulent blood flow within the vessels. The apparatus required for this procedure includes a sphygmomanometer, a blood pressure cuff attached to a gauge, and a stethoscope.
Assessment of blood pressure in brachial artery(two-step method)01:23

Assessment of blood pressure in brachial artery(two-step method)

Measuring blood pressure is a fundamental skill in healthcare that aids in diagnosing and monitoring hypertension and other cardiovascular conditions. An aneroid sphygmomanometer, commonly used in clinical settings, offers a manual and precise method for blood pressure measurement. The technique for using this instrument involves specific steps that must be carefully executed to ensure accuracy. The following detailed description outlines a two-step technique for assessing blood pressure using...
Assessment of blood pressure in brachial artery(one-step method)01:15

Assessment of blood pressure in brachial artery(one-step method)

This procedural guide systematically measures blood pressure using an oscillometric digital sphygmomanometer, emphasizing accuracy, patient safety, and comfort.
Prepare for the Procedure: