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Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study
OBJECTIVES: To study systematic errors in recording blood pressure (BP) as measured by end digit preference (EDP); to determine associations between EDP, uptake of Automated Office BP (AOBP) machines and cardiovascular outcomes. DESIGN: Retrospective observational study using routinely collected ele...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347875/ https://www.ncbi.nlm.nih.gov/pubmed/30679298 http://dx.doi.org/10.1136/bmjopen-2018-024970 |
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author | Greiver, Michelle Kalia, Sumeet Voruganti, Teja Aliarzadeh, Babak Moineddin, Rahim Hinton, William Dawes, Martin Sullivan, Frank Syed, Saddaf Williams, John de Lusignan, Simon |
author_facet | Greiver, Michelle Kalia, Sumeet Voruganti, Teja Aliarzadeh, Babak Moineddin, Rahim Hinton, William Dawes, Martin Sullivan, Frank Syed, Saddaf Williams, John de Lusignan, Simon |
author_sort | Greiver, Michelle |
collection | PubMed |
description | OBJECTIVES: To study systematic errors in recording blood pressure (BP) as measured by end digit preference (EDP); to determine associations between EDP, uptake of Automated Office BP (AOBP) machines and cardiovascular outcomes. DESIGN: Retrospective observational study using routinely collected electronic medical record data from 2006 to 2015 and a survey on year of AOBP acquisition in Toronto, Canada in 2017. SETTING: Primary care practices in Canada and the UK. PARTICIPANTS: Adults aged 18 years or more. MAIN OUTCOME MEASURES: Mean rates of EDP and change in rates. Rates of EDP following acquisition of an AOBP machine. Associations between site EDP levels and mean BP. Associations between site EDP levels and frequency of cardiovascular outcomes. RESULTS: 707 227 patients in Canada and 1 558 471 patients in the UK were included. From 2006 to 2015, the mean rate of BP readings with both systolic and diastolic pressure ending in zero decreased from 26.6% to 15.4% in Canada and from 24.2% to 17.3% in the UK. Systolic BP readings ending in zero decreased from 41.8% to 32.5% in the 3 years following the purchase of an AOBP machine. Sites with high EDP had a mean systolic BP of 2.0 mm Hg in Canada, and 1.7 mm Hg in the UK, lower than sites with no or low EDP. Patients in sites with high levels of EDP had a higher frequency of stroke (standardised morbidity ratio (SMR) 1.15, 95% CI 1.12 to 1.17), myocardial infarction (SMR 1.16, 95% CI 1.14 to 1.19) and angina (SMR 1.25, 95% CI 1.22 to 1.28) than patients in sites with no or low EDP. CONCLUSIONS: Acquisition of an AOBP machine was associated with a decrease in EDP levels. Sites with higher rates of EDP had lower mean BPs and a higher frequency of adverse cardiovascular outcomes. The routine use of manual office-based BP measurement should be reconsidered. |
format | Online Article Text |
id | pubmed-6347875 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-63478752019-02-08 Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study Greiver, Michelle Kalia, Sumeet Voruganti, Teja Aliarzadeh, Babak Moineddin, Rahim Hinton, William Dawes, Martin Sullivan, Frank Syed, Saddaf Williams, John de Lusignan, Simon BMJ Open Cardiovascular Medicine OBJECTIVES: To study systematic errors in recording blood pressure (BP) as measured by end digit preference (EDP); to determine associations between EDP, uptake of Automated Office BP (AOBP) machines and cardiovascular outcomes. DESIGN: Retrospective observational study using routinely collected electronic medical record data from 2006 to 2015 and a survey on year of AOBP acquisition in Toronto, Canada in 2017. SETTING: Primary care practices in Canada and the UK. PARTICIPANTS: Adults aged 18 years or more. MAIN OUTCOME MEASURES: Mean rates of EDP and change in rates. Rates of EDP following acquisition of an AOBP machine. Associations between site EDP levels and mean BP. Associations between site EDP levels and frequency of cardiovascular outcomes. RESULTS: 707 227 patients in Canada and 1 558 471 patients in the UK were included. From 2006 to 2015, the mean rate of BP readings with both systolic and diastolic pressure ending in zero decreased from 26.6% to 15.4% in Canada and from 24.2% to 17.3% in the UK. Systolic BP readings ending in zero decreased from 41.8% to 32.5% in the 3 years following the purchase of an AOBP machine. Sites with high EDP had a mean systolic BP of 2.0 mm Hg in Canada, and 1.7 mm Hg in the UK, lower than sites with no or low EDP. Patients in sites with high levels of EDP had a higher frequency of stroke (standardised morbidity ratio (SMR) 1.15, 95% CI 1.12 to 1.17), myocardial infarction (SMR 1.16, 95% CI 1.14 to 1.19) and angina (SMR 1.25, 95% CI 1.22 to 1.28) than patients in sites with no or low EDP. CONCLUSIONS: Acquisition of an AOBP machine was associated with a decrease in EDP levels. Sites with higher rates of EDP had lower mean BPs and a higher frequency of adverse cardiovascular outcomes. The routine use of manual office-based BP measurement should be reconsidered. BMJ Publishing Group 2019-01-24 /pmc/articles/PMC6347875/ /pubmed/30679298 http://dx.doi.org/10.1136/bmjopen-2018-024970 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Cardiovascular Medicine Greiver, Michelle Kalia, Sumeet Voruganti, Teja Aliarzadeh, Babak Moineddin, Rahim Hinton, William Dawes, Martin Sullivan, Frank Syed, Saddaf Williams, John de Lusignan, Simon Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study |
title | Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study |
title_full | Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study |
title_fullStr | Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study |
title_full_unstemmed | Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study |
title_short | Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study |
title_sort | trends in end digit preference for blood pressure and associations with cardiovascular outcomes in canadian and uk primary care: a retrospective observational study |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347875/ https://www.ncbi.nlm.nih.gov/pubmed/30679298 http://dx.doi.org/10.1136/bmjopen-2018-024970 |
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