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Ma J, Tang X, Zhao J, Zhang J, Wang Q, Wang Y, Yang Q, Shi Y, Cheng M, Wang Y, Zhu D. Intelligent Assist Office Blood Pressures (IOBP) versus awake ambulatory monitoring and conventional auscultatory office readings in Chinese primary medical institutions. Hypertens Res 2024; 47:1822-1830. [PMID: 38671216 DOI: 10.1038/s41440-024-01687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/22/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024]
Abstract
To practice standardized office blood pressure (OBP) measurement guidelines pragmatically, we developed an intelligent assisted OBP (IOBP) measurement system in the Chinese community, which can automatically obtain two or three BP values after a 5-min rest before the patients visit the doctor and transfer values to the community medical network in real time. We conducted a comparative study to investigate the agreement among IOBP, awake ambulatory BP (ABP), and conventional auscultatory OBP at different BP levels. Participants were divided into three groups according to BP, with 120/80 mmHg and 160/100 mmHg as the cut-off points. Attended IOBP, unattended IOBP, and auscultatory OBP were randomly measured before ABP monitoring. In total, 245 participants were included in the analysis. The mean systolic attended/unattended IOBP, auscultatory OBP, and awake ABP were 135.0, 136.7, 135.6, and 136.2 mmHg, respectively. Bland-Altman analysis revealed a bias of -1.1 and 0.5 mmHg for systolic attended/unattended IOBP compared with awake ABP in the overall sample. For auscultatory OBP, the bias was -0.4 (attended) and 1.2 mmHg (unattended). The discrepancy between the systolic attended/unattended IOBP and awake ABP was inconsistent at different BP levels. In Group 1 the values were -8.4 and -6.9 mmHg, whereas in Group 3, the values were 9.4 and 10.0 mmHg. BP measured using the IOBP measurement system was in accordance with awake ABP and conventional OBP, and can be a good choice in the Chinese community.
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Affiliation(s)
- Jing Ma
- Department of Cardiovascular Medicine, Research Center for Hypertension Management and Prevention in Community, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaofeng Tang
- Department of Cardiovascular Medicine, Research Center for Hypertension Management and Prevention in Community, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junfeng Zhao
- Shanghai Huangpu Center for Disease Control and Prevention, Shanghai, China
| | - Jin Zhang
- Department of Cardiovascular Medicine, Research Center for Hypertension Management and Prevention in Community, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qin Wang
- Department of Cardiovascular Medicine, Research Center for Hypertension Management and Prevention in Community, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuheng Wang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Qinping Yang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yan Shi
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Minna Cheng
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
| | - Yan Wang
- Department of Cardiovascular Medicine, Research Center for Hypertension Management and Prevention in Community, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Dingliang Zhu
- Department of Cardiovascular Medicine, Research Center for Hypertension Management and Prevention in Community, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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O'Connor SG, O'Connor LE, Higgins KA, Bell BM, Krueger ES, Rawal R, Hartmuller R, Reedy J, Shams-White MM. Conceptualization and Assessment of 24-H Timing of Eating and Energy Intake: A Methodological Systematic Review of the Chronic Disease Literature. Adv Nutr 2024; 15:100178. [PMID: 38242444 PMCID: PMC10877687 DOI: 10.1016/j.advnut.2024.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/29/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
Timing of eating (TOE) and energy intake (TOEI) has important implications for chronic disease risk beyond diet quality. The 2020 Dietary Guidelines Advisory Committee recommended developing consistent terminology to address the lack of TOE/TOEI standardization. The primary objective of this methodological systematic review was to characterize the conceptualization and assessment of TOE/TOEI within the chronic disease literature (International Prospective Register of Systematic Reviews registration number: CRD42021236621). Literature searches in Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, Embase, PubMed, and Scopus were limited to English language publications from 2000 to August 2022. Eligible studies reported the association between TOE/TOEI and obesity, cardiovascular disease, type 2 diabetes mellitus, cancer, or a related clinical risk factor among adults (≥19 y) in observational and intervention studies. A qualitative synthesis described and compared TOE/TOEI conceptualization, definitions, and assessment methods across studies. Of the 7579 unique publications identified, 259 studies (observational [51.4 %], intervention [47.5 %], or both [1.2 %]) were eligible for inclusion. Key findings indicated that most studies (49.6 %) were conducted in the context of obesity and body weight. TOE/TOEI variables or assigned conditions conceptualized interrelated aspects of time and eating or energy intake in varying ways. Common TOE/TOEI conceptualizations included the following: 1) timepoint (specific time to represent when intake occurs, such as time of breakfast [74.8 %]); 2) duration (length of time or interval when intake does/does not occur, such as "eating window" [56.5 %]); 3) distribution (proportion of daily intake at a given time interval, such as "percentage of energy before noon" [29.8 %]); and 4) cluster (grouping individuals based on temporal ingestive characteristics [5.0 %]). Assessment, definition, and operationalization of 24-h TOE/TOEI variables varied widely across studies. Observational studies most often used surveys or questionnaires (28.9 %), whereas interventions used virtual or in-person meetings (23.8 %) to assess TOE/TOEI adherence. Overall, the diversity of terminology and methods solidifies the need for standardization to guide future research in chrononutrition and to facilitate inter-study comparisons.
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Affiliation(s)
- Sydney G O'Connor
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, United States; Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.
| | - Lauren E O'Connor
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States; Food Components and Health Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD, United States
| | - Kelly A Higgins
- Food Components and Health Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD, United States; Exponent Inc., Washington, DC, United States
| | - Brooke M Bell
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States; Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Emily S Krueger
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Rita Rawal
- Food Components and Health Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD, United States
| | - Reiley Hartmuller
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Jill Reedy
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Marissa M Shams-White
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
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Lapostolle F, Schneider E, Agostinucci JM, Nadiras P, Martineau L, Metzger J, Bertrand P, Petrovic T, Vianu I, Adnet F. Digit preference and biased conclusions in cardiac arrest studies. Am J Emerg Med 2023; 69:114-120. [PMID: 37086656 DOI: 10.1016/j.ajem.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/07/2023] [Accepted: 03/05/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND In cardiac arrest (CA), time is directly predictive of patients' prognosis. The increase in mortality resulting from delayed cardiopulmonary resuscitation has been quantified minute by minute. Times reported in CA management studies could reflect a timestamping bias referred to as "digit preference". This phenomenon leads to a preference for certain numerical values (such as 2, 5, or 10) over others (such as 13). Our objective was to investigate whether or not digit preference phenomenon could be observed in reported times of the day related to CA management, as noted in a national registry. METHODS We analyzed data from the French National Electronic Registry of Cardiac Arrests. We analyzed twelve times-of-the-day corresponding to each of the main steps of CA management reported by the emergency physicians who managed the patients in prehospital settings. We postulated that if CA occurred at random times throughout the day, then we could expect to see events related to CA management occurring at a similar rate each minute of each hour of the day, at a fraction of 1/60. We compared the fraction of times reported as multiples of 15 (0, 15, 30, and 45 - on the hour, quarters, half hour) with the expected fraction of 4/60 (i.e. 4 × 1/60). MAIN RESULTS A total of 47,211 times-of-the-day in relation to 6131 CA were analyzed. The most overrepresented numbers were: 0, with 3737 occurrences (8% vs 2% expected, p < 0.0001) and 30, with 2807 occurrences (6% vs 2% expected, p < 0.0001). Times-of-the-day as multiples of 15 were overrepresented (22% vs 7% expected, p < 0.0001). CONCLUSION Prospectively collected times were considerably influenced by digit preference phenomenon. Studies that are not based on automatic time recordings and that have not evaluated and considered this bias should be interpretated with caution.
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Affiliation(s)
- Frédéric Lapostolle
- SAMU 93, UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, APHP, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Elodie Schneider
- SAMU 93, UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, APHP, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Jean-Marc Agostinucci
- SAMU 93, UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, APHP, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Pierre Nadiras
- SMUR, Groupe hospitalier intercommunal Le Raincy-Montfermeil, 10, rue du Général Leclerc, 93370 Montfermeil, France.
| | - Laurence Martineau
- SMUR, Urgences, Centre hospitalier intercommunal Robert Ballanger, Boulevard Robert Ballanger, 93600 Aulnay-sous-Bois, France.
| | - Jacques Metzger
- SAMU 93, UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, APHP, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Philippe Bertrand
- SAMU 93, UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, APHP, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Tomislav Petrovic
- SAMU 93, UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, APHP, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Isabelle Vianu
- SAMU 93, UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, APHP, 125, rue de Stalingrad, 93009 Bobigny, France
| | - Frédéric Adnet
- SAMU 93, UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, APHP, 125, rue de Stalingrad, 93009 Bobigny, France.
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Kottke TE, Anderson JP, Zillhardt JD, Sperl-Hillen JM, O’Connor PJ, Green BB, Williams RA, Averbeck BM, Stiffman MN, Beran M, Rakotz M, Margolis KL. Association of an Automated Blood Pressure Measurement Quality Improvement Program With Terminal Digit Preference and Recorded Mean Blood Pressure in 11 Clinics. JAMA Netw Open 2022; 5:e2229098. [PMID: 36044216 PMCID: PMC9434355 DOI: 10.1001/jamanetworkopen.2022.29098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Terminal digit preference has been shown to be associated with inaccurate blood pressure (BP) recording. OBJECTIVE To evaluate whether converting from manual BP measurement with aneroid sphygmomanometers to automated BP measurement was associated with terminal digit preference, mean levels of recorded BP, and the rate at which hypertension was diagnosed. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted from May 9, 2021, to March 24, 2022, using interrupted time series analysis of medical record data from 11 primary care clinics in a single health care system from April 2008 to April 2015. The study population was patients aged 18 to 75 years who had their BP measured and recorded at least once during the study period. EXPOSURES Manual BP measurement before April 2012 vs automated BP measurement with the Omron HEM-907XL monitor from May 2012 to April 2015. MAIN OUTCOMES AND MEASURES The main outcome was the distribution of terminal digits and mean systolic BP (SBP) values obtained during 4 years of manual measurement vs 3 years of automated measurement, assessed using a generalized linear mixed regression model with a random intercept for clinic and adjusted for seasonal fluctuations and patient demographic and clinical characteristics. RESULTS The study included 1 541 227 BP measurements from 225 504 unique patients during the entire study period, with 849 978 BP measurements from 165 137 patients (mean [SD] age, 47.1 [15.2] years; 58.2% female) during the manual measurement period and 691 249 measurements from 149 080 patients (mean [SD] age, 48.4 [15.3] years; 56.3% female) during the automated measurement period. With manual measurement, 32.8% of SBP terminal digits were 0 (20% was the expected value because nursing staff was instructed to record BP to the nearest even digit). This proportion decreased to 12.4% during the automated measurement period (expected value, 10%) when both even and odd digits were to be recorded. After automated measurement was implemented, the mean SBP estimated with statistical modeling increased by 5.09 mm Hg (95% CI, 4.98-5.19 mm Hg). Fewer BP values recorded during the automated than the manual measurement period were below 140/90 mm Hg (69.9% vs 84.3%; difference, -14.5%; 95% CI, -14.6% to -14.3%) and below 130/80 mm Hg (42.1% vs 60.0%; difference, -17.9%; 95% CI, -18.0% to -17.7%). The proportion of patients with a diagnosis of hypertension was 4.3 percentage points higher (23.4% vs 19.1%) during the automated measurement period. CONCLUSIONS AND RELEVANCE In this quality improvement study, automated BP measurement was associated with decreased terminal digit preference and significantly higher mean BP levels. The method of BP measurement was also associated with the rate at which hypertension was diagnosed. These findings may have implications for pay-for-performance programs, which may create an incentive to record BP levels that meet a particular goal and a disincentive to adopt automated measurement of BP.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - MarySue Beran
- Park Nicollet Health Services, Saint Louis Park, Minnesota
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Pérez-Gimeno G, Ruperez AI, Gil-Campos M, Aguilera CM, Anguita A, Vázquez-Cobela R, Skapino E, Moreno LA, Leis R, Bueno-Lozano G. Height-based equations as screening tools for high blood pressure in pediatric practice, the GENOBOX study. J Clin Hypertens (Greenwich) 2022; 24:713-722. [PMID: 35596598 PMCID: PMC9180328 DOI: 10.1111/jch.14489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
Due to the absence of easily applicable cut‐off points to determine high blood pressure or hypertension in children, as in the adult population, blood pressure is rarely measured in the pediatrician's clinical routine. This has led to an underdiagnosis of high blood pressure or hypertension in children. For this reason, the present study evaluate the utility of five equations for the screening of high blood pressure in children: blood pressure to height ratio, modified blood pressure to height ratio, new modified blood pressure to height ratio, new simple formula and height‐based equations. The authors evaluated 1599 children between 5 and 18 years. The performance of the five equations was analyzed using the receiver‐operating characteristics curves for identifying blood pressure above P90th according to the American Academy of Pediatrics Clinical Practice Guideline 2017. All equations showed an area under the curve above 0.882. The new modified blood pressure to height ratio revealed a high sensitivity whereas the height‐based equations showed the best performance, with a positive predictive value above 88.2%. Finally, all equations showed higher positive predictive values in children with overweight or obesity. The height‐based equation obtained the highest PPV values above 71.1% in children with normal weight and above 90.2% in children with overweight or obesity. In conclusions, the authors recommend the use of the height‐based equations equation because it showed the best positive predictive values to identify children with elevated blood pressure, independently of their sex, pubertal and weight status.
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Affiliation(s)
- Gloria Pérez-Gimeno
- Growth Exercise, Nutrition and Development (GENUD) Research group, Universidad de Zaragoza, Instituto de Investigación Sanitartia de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain
| | - Azahara I Ruperez
- Growth Exercise, Nutrition and Development (GENUD) Research group, Universidad de Zaragoza, Instituto de Investigación Sanitartia de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain
| | - Mercedes Gil-Campos
- Metabolic Pediatric and Investigation Unit, Reina Sofía University Hospital, Maimónides Insitute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain.,CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Concepción M Aguilera
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain.,Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology "José Mataix", Center of Biomedical Research, University of Granada, Armilla, Granada, Spain.,Biosanitary Research Institute (IBS), University of Granada, Granada, Spain
| | - Augusto Anguita
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain.,Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology "José Mataix", Center of Biomedical Research, University of Granada, Armilla, Granada, Spain.,Biosanitary Research Institute (IBS), University of Granada, Granada, Spain
| | - Rocío Vázquez-Cobela
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain.,Pediatric Nutrition Research Group. Institute of Sanitary Research of Santiago de Compostela (IDIS). CHUS-USC., Santiago de Compostela, Spain.,Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), Santiago de Compostela, Spain.,Unit of Pediatric Gastroenterology, Hepatology and Nutrition. Pediatric Service. University Clinical Hospital of Santiago (CHUS)., Santiago de Compostela, Spain
| | - Estela Skapino
- Growth Exercise, Nutrition and Development (GENUD) Research group, Universidad de Zaragoza, Instituto de Investigación Sanitartia de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain.,Department of Clinical Nutrition, School of Nutrition, University of the Republic, Montevideo, Uruguay
| | - Luis A Moreno
- Growth Exercise, Nutrition and Development (GENUD) Research group, Universidad de Zaragoza, Instituto de Investigación Sanitartia de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain.,CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Rosaura Leis
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain.,Pediatric Nutrition Research Group. Institute of Sanitary Research of Santiago de Compostela (IDIS). CHUS-USC., Santiago de Compostela, Spain.,Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), Santiago de Compostela, Spain.,Unit of Pediatric Gastroenterology, Hepatology and Nutrition. Pediatric Service. University Clinical Hospital of Santiago (CHUS)., Santiago de Compostela, Spain
| | - Gloria Bueno-Lozano
- Growth Exercise, Nutrition and Development (GENUD) Research group, Universidad de Zaragoza, Instituto de Investigación Sanitartia de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain.,CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain.,Unit of Pediatric Endocrinology, University Clinical Hospital Lozano Blesa, Zaragoza, Spain
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Minhas J, Baird G, Appleby D, McClelland R, Min J, Mazurek J, Ventetuolo CE, Al-Naamani N, Kawut SM. Terminal Digit Preference in Pulmonary Hypertension Endpoints. Am J Respir Crit Care Med 2022; 205:1482-1485. [PMID: 35380935 DOI: 10.1164/rccm.202108-2015le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jasleen Minhas
- University of Pennsylvania, 6572, Pulmonary, Allergy and Critical Care, Philadelphia, Pennsylvania, United States;
| | - Grayson Baird
- Lifespan Hospital System, Biostatistics Core, Providence, Rhode Island, United States
| | - Dina Appleby
- University of Pennsylvania, 6572, Department of Biostatistics, Epidemiology, & Informatics, Philadelphia, Pennsylvania, United States
| | - Robyn McClelland
- University of Washington School of Public Health, Biostatistics, Seattle, Washington, United States
| | - Jeff Min
- University of Pennsylvania, 6572, Pulmonary, Allergy and Critical Care, Philadelphia, Pennsylvania, United States
| | - Jeremy Mazurek
- University of Pennsylvania, 6572, Division of Cardiology, Philadelphia, Pennsylvania, United States
| | | | - Nadine Al-Naamani
- University of Pennsylvania, 6572, Pulmonary, Allergy and Critical Care, Philadelphia, Pennsylvania, United States
| | - Steven M Kawut
- University of Pennsylvania, 6572, Pulmonary, Allergy and Critical Care, Philadelphia, Pennsylvania, United States
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Blood Pressure Checks for Diagnosing Hypertension: Health Professionals' Knowledge, Beliefs, and Practices. J Am Board Fam Med 2022; 35:310-319. [PMID: 35379718 PMCID: PMC9621313 DOI: 10.3122/jabfm.2022.02.210318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The US Preventive Services Task Force recommends out-of-office blood pressure (BP) measurement before making a new hypertension diagnosis and initiating treatment, using 24-hour ambulatory (ABPM) or home BP monitoring. However, this approach is not common. METHODS e-mail-linked surveys were sent to primary care team members (n = 421) from 10 clinics. The sample included medical assistants, licensed practical nurses, registered nurses, and advanced practice registered nurses (LPN/RN/APRNs), physician assistants (PAs), and physicians. Those licensed to diagnosis hypertension (physician/PA/APRNs) received additional questions. Data were collected from November 2017 to July 2019. RESULTS 2-thirds of invitees responded (163 MA/LPN/RNs, 86 physicians, and 33 PA/APRNs). When making a new hypertension diagnosis, most respondents believed that BP measured manually with a stethoscope (78.6%) or ABPM (84.2%) were very or highly accurate. In contrast, most did not believe that automated clinic BPs, home BP, or kiosk BP measurements were very or highly accurate. Almost all reported always or almost always relying on clinic BP measurements in making a diagnosis (95.7%), but most physician/PA/APRNs (60.5%) would prefer ABPM if it was readily available. Very few physician/PA/APRNs used the guideline-concordant diagnostic threshold (135/85 mmHg) with home monitoring (14.0%) or ABPM (8.4%), with 140/90 mmHg the most commonly reported threshold for home (59.4%) and ABPM (49.6%). DISCUSSION Our study found health care professional knowledge, beliefs, and practices gaps in diagnosing hypertension. These gaps could lead to clinical care that is not aligned with guidelines. CONCLUSION System changes and interventions to increase use of evidence-based practices could improve hypertension diagnosis and outcomes.
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