Potential impact of systematic and random errors in blood pressure measurement on the prevalence of high office blood pressure in the United States

Swati Sakhuja, Byron C. Jaeger, Oluwasegun P. Akinyelure, Adam P. Bress, Daichi Shimbo, Joseph E. Schwartz, Shakia T. Hardy, George Howard, Paul Drawz, Paul Muntner

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

The authors examined the proportion of US adults that would have their high blood pressure (BP) status changed if systolic BP (SBP) and diastolic BP (DBP) were measured with systematic bias and/or random error versus following a standardized protocol. Data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES; n = 5176) were analyzed. BP was measured up to three times using a mercury sphygmomanometer by a trained physician following a standardized protocol and averaged. High BP was defined as SBP ≥130 mm Hg or DBP ≥80 mm Hg. Among US adults not taking antihypertensive medication, 32.0% (95%CI: 29.6%,34.4%) had high BP. If SBP and DBP were measured with systematic bias, 5 mm Hg for SBP and 3.5 mm Hg for DBP higher and lower than in NHANES, the proportion with high BP was estimated to be 44.4% (95%CI: 42.6%,46.2%) and 21.9% (95%CI 19.5%,24.4%). Among US adults taking antihypertensive medication, 60.6% (95%CI: 57.2%,63.9%) had high BP. If SBP and DBP were measured 5 and 3.5 mm Hg higher and lower than in NHANES, the proportion with high BP was estimated to be 71.8% (95%CI: 68.3%,75.0%) and 48.4% (95%CI: 44.6%,52.2%), respectively. If BP was measured with random error, with standard deviations of 15 mm Hg for SBP and 7 mm Hg for DBP, 21.4% (95%CI: 19.8%,23.0%) of US adults not taking antihypertensive medication and 20.5% (95%CI: 17.7%,23.3%) taking antihypertensive medication had their high BP status re-categorized. In conclusions, measuring BP with systematic or random errors may result in the misclassification of high BP for a substantial proportion of US adults.

Original languageEnglish (US)
Pages (from-to)263-270
Number of pages8
JournalJournal of Clinical Hypertension
Volume24
Issue number3
DOIs
StatePublished - Mar 2022

Bibliographical note

Funding Information:
Dr. Hardy receives support through R01HL139716 from the National Heart Lung and Blood Institute (NHLBI). Dr. Jaeger receives support through R01HL144773 from the NHLBI and 15SFRN2390002 from the American Heart Association. Dr. Shimbo receives support through R01HL139716 and K24HL125704 from the NHLBI. Dr. Bress is supported by R01AG065805, K01HL133468, and R01HL139837 from the NHLBI. The funders had no role in the design and conduct of the study; collection, management, analysis, interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funding Information:
Dr. Hardy receives support through R01HL139716 from the National Heart Lung and Blood Institute (NHLBI). Dr. Jaeger receives support through R01HL144773 from the NHLBI and 15SFRN2390002 from the American Heart Association. Dr. Shimbo receives support through R01HL139716 and K24HL125704 from the NHLBI. Dr. Bress is supported by R01AG065805, K01HL133468, and R01HL139837 from the NHLBI. The funders had no role in the design and conduct of the study; collection, management, analysis, interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
© 2021 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC

Keywords

  • blood pressure
  • measurement error
  • misclassification
  • random error

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