Related Experiment Video
Updated: Jun 16, 2025
Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness
Published on: May 3, 2018
Absolute cardiovascular risk assessment using 'real world' clinic blood pressures compared to standardized unobserved
Niamh Chapman1,2, Senali Jayasinghe3, Myles N Moore3
1Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia. Niamh.Chapman@Sydney.edu.au.
Insights
Real-world clinic blood pressure (BP) measurements overestimate cardiovascular disease (CVD) risk compared to standardized methods. More accurate BP monitoring is essential for reliable CVD risk assessment.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Measurement
Background:
- Clinic blood pressure (BP) is standard for cardiovascular disease (CVD) risk assessment.
- Real-world clinic BP measurements are often unstandardized and less reliable than rigorous methods.
- The impact of unstandardized clinic BP on CVD risk assessment is not well understood.
Purpose of the Study:
- To compare absolute CVD risk assessment using real-world clinic BP versus standardized BP measurement techniques.
- To quantify the differences in CVD risk classification based on BP measurement methods.
Main Methods:
- Patients with hypertension underwent BP assessment using real-world clinic BP, unobserved automated office BP (AOBP), and 24-h ambulatory BP monitoring (ABPM).
- Absolute CVD risk was calculated using the Framingham risk score based on systolic BP from each method.
- Agreement between risk classifications was assessed using the Kappa statistic.
Main Results:
- Clinic BP was significantly higher than AOBP and ABPM (18-22 mmHg higher).
- Absolute CVD risk scores were higher using clinic BP, classifying 40% of participants as high risk versus 17-20% with AOBP/ABPM.
- Agreement in risk classification between clinic BP and standardized methods was weak (Kappa values 0.52-0.57).
Conclusions:
- Unstandardized 'real-world' clinic BP measurements lead to higher CVD risk scores and misclassification of risk compared to AOBP and ABPM.
- The findings highlight significant discrepancies in CVD risk assessment due to BP measurement variability.
- More rigorous BP measurement methods are necessary for accurate absolute CVD risk assessment in clinical practice.
Abstract:
Clinic blood pressure (BP) is recommended for absolute cardiovascular disease (CVD) risk assessment. However, in 'real-world' settings, clinic BP measurement is unstandardised and less reliable compared to more rigorous methods but the impact for absolute CVD risk assessment is unknown. This study aimed to determine the difference in absolute CVD risk assessment using real-world clinic BP compared to standardised BP methods. Participants were patients (n = 226, 59 ± 15 years; 58% female) with hypertension referred to a BP clinic for assessment. 'Real-world' clinic BP was provided by the referring doctor. All participants had unobserved automated office BP (AOBP) and 24-h ambulatory BP monitoring (ABPM) measured at the clinic. Absolute CVD risk was calculated (Framingham) using systolic BP from the referring doctor (clinic BP), AOBP and ABPM, with agreement assessed by Kappa statistic. Clinic systolic BP was 18 mmHg than AOBP and daytime ABPM and 22 mmHg higher than 24-h ABPM (p < 0.001). Subsequently, absolute CVD risk scores using clinic BP were higher compared to AOBP, daytime ABPM and 24-h ABPM (10.4 ± 8.1%, 7.8 ± 6.4%, 7.8 ± 6.3%, and 7.3 ± 6.1%, respectively, P < 0.001). As a result, more participants were classified as high CVD risk using clinic BP (n = 89, 40%) compared with AOBP (n = 44, 20%) daytime ABPM (n = 38, 17%) and 24-h ABPM (n = 38, 17%) (p < 0.001) with weak agreement in risk classification (κ = 0.57[0.45-0.69], κ = 0.52[0.41-0.64] and κ = 0.55[0.43-0.66], respectively). Real-world clinic BP was higher and classified twice as many participants at high CVD risk compared to AOBP or ABPM. Given the challenges to high-quality BP measurement in clinic, more rigorous BP measurement methods are needed for absolute CVD risk assessment.
Related Concept Videos
01:23Assessment of blood pressure in brachial artery(two-step method)
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:25Errors occurring during blood pressure monitoring
Several factors...
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:28Special considerations while measuring blood pressure
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.
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement