Artery Research

Volume 12, Issue C, December 2015, Pages 19 - 19

P4.18 THE ASSUMPTION THAT BLOOD PRESSURE DECREASES OVER CONSECUTIVE MEASUREMENTS IS FALSE: MAJOR IMPLICATIONS FOR HYPERTENSION DIAGNOSIS AND GUIDELINES

Authors
Panagiota Veloudi*1, Leigh Blizzard1, Velandai Srikanth1, 2, Martin Schultz1, James E. Sharman1
1Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
2Dept. of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
Available Online 23 November 2015.
DOI
10.1016/j.artres.2015.10.262How to use a DOI?
Abstract

Background: There is anecdotal belief that clinic blood pressure (BP) drops over consecutive measurements. This has led to guideline recommendations to discard the first BP reading, or take only one reading if systolic BP (SBP) <140 mmHg. However, the magnitude and direction of change in SBP over consecutive measurements is not clear, and the effect of age and BP level on this change in SBP is unknown. We investigated these issues, and their effect on hypertension diagnosis.

Methods: Duplicate BP (or triplicate if large BP differences) was recorded by oscillometry among 20,752 participants (aged 45[95CI; 45,46] years; males 50%) from the 2011-13 Australian Health Survey. SBP change was defined as the difference between measurements.

Results: SBP decreased between the first two measures in only 56%, whereas it increased in 37% and did not change in 7% of the population. There was a strong, age-dependent, J-curved relationship between SBP change and SBP level (p<0.001), with the smallest SBP change corresponding to controlled SBP (100 – 140 mmHg). The age-dependent SBP changes resulted in significant diagnostic reclassification compared with the approach of discarding the first reading; 63% and 35% reclassified from hypertension to normal BP, and 4% and 13% reclassified from normal to hypertension among those aged <50 years and ≥50 years respectively.

Conclusions: The assumption that SBP drops over consecutive measurements is false, and significant age-and BP-dependent reclassification of hypertension diagnosis will result if the first SBP is discarded. These findings highlight the need for change to some international hypertension guidelines.

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Journal
Artery Research
Volume-Issue
12 - C
Pages
19 - 19
Publication Date
2015/11/23
ISSN (Online)
1876-4401
ISSN (Print)
1872-9312
DOI
10.1016/j.artres.2015.10.262How to use a DOI?
Open Access
This is an open access article distributed under the CC BY-NC license.

Cite this article

TY  - JOUR
AU  - Panagiota Veloudi*
AU  - Leigh Blizzard
AU  - Velandai Srikanth
AU  - Martin Schultz
AU  - James E. Sharman
PY  - 2015
DA  - 2015/11/23
TI  - P4.18 THE ASSUMPTION THAT BLOOD PRESSURE DECREASES OVER CONSECUTIVE MEASUREMENTS IS FALSE: MAJOR IMPLICATIONS FOR HYPERTENSION DIAGNOSIS AND GUIDELINES
JO  - Artery Research
SP  - 19
EP  - 19
VL  - 12
IS  - C
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2015.10.262
DO  - 10.1016/j.artres.2015.10.262
ID  - Veloudi*2015
ER  -