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Published on: May 3, 2018
Implications of Inaccurate Blood Pressure Measurement on Hypertension Prevalence
Alexander A Leung1, Swapnil Hiremath2, Jeanne V A Williams3
1Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Inaccurate home blood pressure (BP) devices can lead to misdiagnosis and overtreatment of hypertension. Overestimation by 10 mm Hg could falsely increase hypertension prevalence by 50%, impacting millions.
Area of Science:
- Cardiology
- Public Health
- Medical Device Regulation
Background:
- Accurate blood pressure (BP) measurement is crucial for hypertension management.
- Over 50% of home BP devices in Canada lack validated accuracy.
- Inaccurate BP readings pose risks for diagnosis and treatment.
Purpose of the Study:
- To model the impact of inaccurate BP measurements on hypertension diagnosis and control.
- To quantify the potential consequences of using unvalidated BP devices.
Main Methods:
- Utilized data from the Canadian Health Measures Survey.
- Modeled effects of BP over/underestimation by 5 or 10 mm Hg.
- Defined hypertension as BP ≥ 140/90 mm Hg (or ≥130/80 mm Hg with diabetes).
Main Results:
- A 10 mm Hg BP overestimation could falsely increase hypertension prevalence from 50% to 63%.
- This overestimation could lead to overtreatment for approximately 3.5 million Canadians.
- BP underestimation impact was minimal, potentially due to study design limitations.
Conclusions:
- Overestimating BP by 10 mm Hg may result in overtreatment for up to 3.5 million Canadians.
- Mandatory validation of BP devices before sale is recommended.
- Clinicians and patients should exercise caution and use validated device lists for selection.
Background:
The cornerstone of the management of hypertension is accurate measurement of blood pressure (BP). A recent study showed that more than one-half of home BP devices sold in Canada have no evidence of validation for accuracy. The purpose of this study was to model the implications of inaccurate BP measurements on diagnosis and control of hypertension.
Methods:
We used data from the Canadian Health Measures Survey to model the effects of inaccurate BP devices by 5 or 10 mm Hg over or under the true BP value. Hypertension was defined as BP ≥ 140/90 mm Hg (or ≥130/80 mm Hg in those patients with diabetes).
Results:
If both systolic and diastolic BP were overestimated by 10 mm Hg, the prevalence of hypertension would falsely increase by 50% to 63%, potentially leading to overtreatment of approximately 3.5 million Canadians. Conversely, the impact of underestimation of BP appeared minimal, but mostly because of design limitations of our study.
Conclusions:
We found that overestimation of BP by only 10 mm Hg could lead to overtreatment of up to 3.5 million Canadians. Government should mandate the validation of BP devices before they can be sold; until then, clinicians and patients should be cautious in their selection of BP devices, using the Hypertension Canada Recommended Device Program to guide selection.
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