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Should the first blood pressure reading be discarded?
M R Salazar1, W G Espeche1, M Aizpurúa2
11] Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina [2] Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina.
Insights
Excluding the first blood pressure (BP) reading does not significantly alter BP estimates or their correlation with ambulatory BP monitoring. Repeated BP measurements are recommended, including the initial reading.
Area of Science:
- Cardiovascular Medicine
- Clinical Hypertension Research
Background:
- Standard clinical practice often involves taking multiple blood pressure (BP) readings.
- The practice of discarding the first BP measurement is common but lacks robust evidence.
Purpose of the Study:
- To evaluate the impact of excluding the first BP reading on BP estimates.
- To compare the correlation of BP measurements (with and without the first reading) with ambulatory BP monitoring (ABPM).
Main Methods:
- Analysis of BP readings from a population sample, general practice, and hypertension center.
- Comparison of BP estimates including versus excluding the first reading.
- Correlation analysis with daytime ambulatory BP monitoring (ABPM).
Main Results:
- Systolic BP (SBP) and diastolic BP (DBP) decreased across sequential readings.
- Excluding the first BP reading resulted in slightly higher mean SBP estimates, but the difference was small (1.5-1.6 mm Hg).
- Correlation with daytime ABPM was comparable whether the first BP reading was included or excluded (r ≈ 0.69).
Conclusions:
- The study does not support discarding the first BP measurement.
- Repeated BP measurements, including the first, are advisable for accurate assessment.
- Current evidence suggests including all readings provides reliable BP estimation.
Abstract:
We evaluated the consequences of excluding the first of three blood pressure (BP) readings in different settings: a random population sample (POS, n=1525), a general practice office (GPO, n=942) and a specialized hypertension center (SHC, n=462). Differences between systolic and diastolic BP (SBP and DBP) estimates obtained including and excluding the first reading were compared and their correlation with ambulatory BP monitoring (ABPM) was estimated. The samples were divided into quartiles according to the difference between the third and the first SBP (3-1ΔSBP). SBP decreased through sequential readings, 3-1ΔSBP was -5.5 ± 9.7 mm Hg (P<0.001), -5.1 ± 10.4 mm Hg (P<0.001) and -6.1 ± 9.3 mm Hg (P<0.001) for POS, GPO and SHC, respectively. However, individuals included in the top quartile of 3-1ΔSBP showed their highest values on the third reading. The mean SBP estimate was significantly higher excluding the first reading (P<0.001), but the differences among both approaches were small (1.5-1.6 mm g). Moreover, the correlation between SBP values including and excluding the first reading and daytime ABPM were comparable (r = 0.69 and 0.68, respectively). Similar results were observed for DBP. In conclusion, our study does not support the notion of discarding the first BP measurement and suggests that it should be measured repeatedly, regardless the first value.
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