Variation in Blood Pressure Classification Using 7 Blood Pressure Estimation Protocols Among Adults in Taiwan
Journal
JAMA network open
Journal Volume
3
Journal Issue
11
Pages
e2024311
Date Issued
2020
Author(s)
Abstract
Importance: Discrepancies in blood pressure (BP) estimates lead to incomparable BP assessment. Objective: To determine intraindividual discrepancies in BP estimates and classifications based on different BP estimation protocols. Design, Setting, and Participants: This cross-sectional study was a secondary analysis of data from the May Measurement Month Taiwan in 2017 and 2018, which were cross-sectional survey campaigns at pharmacies nationwide to raise awareness of high BP. Participants were volunteers aged 20 years or older. Analysis was conducted from February 2 to August 7, 2020. Exposure: Pharmacist-measured sitting BP using oscillometric sphygmomanometers. Main Outcomes and Measures: A total of 7 BP estimation protocols were assessed according to the latest American College of Cardiology (ACC), Chinese Hypertension League (CHL), European Society of Cardiology (ESC), International Society of Hypertension, Japanese Society of Hypertension, and National Institute of Health and Care Excellence (NICE) hypertension guidelines, and the proposed Averaging the Lowest Two systolic readings protocol. According to BP classification schemes of ESC and ACC guidelines, intraindividual discrepancies were identified if classification inconsistencies among 7 BP estimates were present. Results: Of 81041 participants, 62647 adults with 3 BP readings were included. The median (interquartile range) age was 59.0 (46.0-69.0) years, and 31922 (51.5%) were women. The intraindividual maximum mean (SD) differences in systolic/diastolic BP estimates among the seven protocols were 4.8 (4.3)/3.3 (3.1) mm Hg. The highest prevalence of BP of 140/90 mm Hg or higher was by CHL (16405 participants [26.2%]) and the lowest was by Averaging the Lowest Two (13996 participants [22.3%]; P <.001); while the highest prevalence of 130/80 mm Hg or higher was by NICE (37232 participants [59.4%]) and the lowest prevalence was by Averaging the Lowest Two (32788 participants [52.4%]; P <.001). Compared with the other 6 estimates, Averaging the Lowest Two reclassified 7.3% to 15.8% of participants designated as 140/90 mm Hg or higher to less than 140/90 mm Hg, and 4.9% to 14.1% of those as 130/80 mm Hg or higher to less than 130/80 mm Hg. Intraindividual discrepancies in classifications occurred in 19815 participants (31.6%) with the ESC classification and 16401 participants (26.2%) with the ACC BP classification. Classification agreements were the lowest between NICE (κ coefficient, 0.667 [95% CI, 0.662-0.671]) and ESC protocols (κ coefficient, 0.705 [95% CI, 0.701-0.709]). Conclusions and Relevance: This cross-sectional study of adults in Taiwan found that different BP estimation protocols led to considerable intraindividual discrepancies in BP estimates and classifications. These findings suggest that the Averaging the Lowest Two protocol is less likely to overestimate BP and could serve as a prudent recommendation for BP estimation. ? 2020 American Medical Association. All rights reserved.
Other Subjects
adult; aged; Article; blood pressure measurement; blood pressure variability; classification; cross-sectional study; diastolic blood pressure; female; human; major clinical study; male; middle aged; observational study; priority journal; secondary analysis; systolic blood pressure; Taiwan; health promotion; hypertension; organization and management; practice guideline; procedures; Aged; Blood Pressure Determination; Cross-Sectional Studies; Female; Health Promotion; Humans; Hypertension; Male; Middle Aged; Practice Guidelines as Topic; Taiwan
Publisher
NLM (Medline)
Type
journal article