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Research ArticleOriginal Research

Sources of Error in Office Blood Pressure Measurement

Roy N. Morcos, Kimbroe J. Carter, Frank Castro, Sumira Koirala, Deepti Sharma and Haroon Syed
The Journal of the American Board of Family Medicine September 2019, 32 (5) 732-738; DOI: https://doi.org/10.3122/jabfm.2019.05.190085
Roy N. Morcos
the Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (RNM, SK); Department of Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (RNM); Medical Decision Making Society of Youngstown Ohio, c/o Jeghers Medical Index, St. Elizabeth Youngstown Hospital, Youngstown, OH (FC, KJC); Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (SK, DS); Department of Pathology, Northeast Ohio Medical University, Rootstown, OH (KJC).
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Kimbroe J. Carter
the Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (RNM, SK); Department of Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (RNM); Medical Decision Making Society of Youngstown Ohio, c/o Jeghers Medical Index, St. Elizabeth Youngstown Hospital, Youngstown, OH (FC, KJC); Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (SK, DS); Department of Pathology, Northeast Ohio Medical University, Rootstown, OH (KJC).
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Frank Castro
the Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (RNM, SK); Department of Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (RNM); Medical Decision Making Society of Youngstown Ohio, c/o Jeghers Medical Index, St. Elizabeth Youngstown Hospital, Youngstown, OH (FC, KJC); Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (SK, DS); Department of Pathology, Northeast Ohio Medical University, Rootstown, OH (KJC).
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Sumira Koirala
the Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (RNM, SK); Department of Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (RNM); Medical Decision Making Society of Youngstown Ohio, c/o Jeghers Medical Index, St. Elizabeth Youngstown Hospital, Youngstown, OH (FC, KJC); Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (SK, DS); Department of Pathology, Northeast Ohio Medical University, Rootstown, OH (KJC).
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Deepti Sharma
the Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (RNM, SK); Department of Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (RNM); Medical Decision Making Society of Youngstown Ohio, c/o Jeghers Medical Index, St. Elizabeth Youngstown Hospital, Youngstown, OH (FC, KJC); Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (SK, DS); Department of Pathology, Northeast Ohio Medical University, Rootstown, OH (KJC).
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Haroon Syed
the Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (RNM, SK); Department of Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (RNM); Medical Decision Making Society of Youngstown Ohio, c/o Jeghers Medical Index, St. Elizabeth Youngstown Hospital, Youngstown, OH (FC, KJC); Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (SK, DS); Department of Pathology, Northeast Ohio Medical University, Rootstown, OH (KJC).
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Article Figures & Data

Tables

    • View popup
    Table 1.

    Example Distribution of Terminal Digits for One Nurse Using a Manual Device

    Terminal DigitActualExpected*
    0350150
    2130150
    473150
    692150
    8105150
    Total750750
    • P < .01.

    • ↵* Expected number in the absence of terminal digit bias.

    • View popup
    Table 2.

    P-Values for the χ2 Test of Equality of the Proportion of Blood Pressure Ending Digits

    Manual SystolicManual DiastolicAuto SystolicAuto Diastolic
    Nurse 1SignificantSignificantNot SignificantNot Significant
    Nurse 2SignificantSignificantNot SignificantNot Significant
    Nurse 3SignificantSignificantNot SignificantNot Significant
    • Significant, P < .01.

    • Not Significant, P ≥ .1.

    • View popup
    Table 3.

    Significant Blood Pressure Differences and Misclassification of Hypertensive Disease Using JNC-7 Guideline and ACC/AHA 2017 Guidelines

    Using JNC-7 Guideline Definition of Hypertension
    N = 294Significant loweringMisclassification, pre-hypertensionMisclassification, hypertension
    Patients, n (%)128 (43.5%)46 (15.6%)48 (16.3%)
        Systolic reading101 (34.3%)24 (8.2%)28 (9.5%)
        Diastolic reading75 (25.2%)27 (9.2%)24 (8.2%)
    ACC/AHA 2017 Guideline Definition of Hypertension
    N = 294Significant loweringMisclassification, elevatedMisclassification, hypertension
    Patients, n (%)128 (43.5%)14 (4.8%)59 (20.1%)
        Systolic reading101 (34.3%)14 (4.8%)27 (9.2%)
        Diastolic reading75 (25.2%)0 (0.0%)41 (16.9%)
    • ACC, American College of Cardiology; AHA, American Heart Association; JNC-7, Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

    • View popup
    Table 4.

    Logistic Regression of the Clinical Factors Influencing the Significant Blood Pressure Difference

    Clinical FactorSystolic P-ValueDiastolic P-Value
    Age.78.29
    Sex.93.90
    Hypertension.17.67
    Diabetes.11.15
    Hyperlipidemia.0046*.33
    Smoker.93.59
    Cardiovascular disease.0054†.63
    • ↵* Patients with hyperlipidemia had significantly decreased risk of misclassification.

    • ↵† Patients with cardiovascular disease had significantly increased risk of misclassification.

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The Journal of the American Board of Family     Medicine: 32 (5)
The Journal of the American Board of Family Medicine
Vol. 32, Issue 5
September-October 2019
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Sources of Error in Office Blood Pressure Measurement
Roy N. Morcos, Kimbroe J. Carter, Frank Castro, Sumira Koirala, Deepti Sharma, Haroon Syed
The Journal of the American Board of Family Medicine Sep 2019, 32 (5) 732-738; DOI: 10.3122/jabfm.2019.05.190085

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Sources of Error in Office Blood Pressure Measurement
Roy N. Morcos, Kimbroe J. Carter, Frank Castro, Sumira Koirala, Deepti Sharma, Haroon Syed
The Journal of the American Board of Family Medicine Sep 2019, 32 (5) 732-738; DOI: 10.3122/jabfm.2019.05.190085
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