Key result
Checking a second BP only if initially ≥130/80 yields low misclassification vs standard triplicate readings.
Why the study?
Standard triplicate blood pressure measurements pose time barriers to hypertension screening, particularly in resource-limited settings.
Do simplified blood pressure measurement approaches maintain low misclassification rates compared to standard triplicate measurements in adults not on anti-hypertensive medications?
Cross-Sectional (n=52,180)
Yes
Do simplified blood pressure measurement approaches maintain low misclassification rates compared to standard triplicate measurements in adults not on anti-hypertensive medications?
A simplified hypertension screening approach using a first BP measurement, supplemented by a second only if the first is ≥130/80, offers low misclassification rates while halving the number of required measurements.
May support efficient hypertension screening with low misclassification; hypothesis-generating and requires prospective validation before practice change.
Standard triplicate blood pressure (BP) measurements pose time barriers to hypertension screening, especially in resource-limited settings. We assessed the implications of simplified approaches using fewer measurements with adults (≥18 years old) not using anti-hypertensive medications from the US National Health and Nutrition Examination Survey 1999-2016 (n = 30 614), and two datasets from May Measurement Month 2017-2018 (n = 14 795 for Nepal and n = 6 771 for India). We evaluated the proportion of misclassification of hypertension when employing the following simplified approaches: using only 1st BP, only 2nd BP, 2nd if 1st BP in a given range (otherwise using 1st), and average of 1st and 2nd BP. Hypertension was defined as average of 2nd and 3rd systolic BP ≥140 and/or diastolic BP ≥90 mm Hg. Using only the 1st BP, the proportion of missed hypertension ranged from 8.2%-12.1% and overidentified hypertension from 4.3%-9.1%. Using only 2nd BP reduced the misclassification considerably (corresponding estimates, 4.9%-6.4% for missed hypertension and 2.0%-4.4% for overidentified hypertension) but needed 2nd BP in all participants. Using 2nd BP if 1st BP ≥130/80 demonstrated similar estimates of missed hypertension (3.8%-8.1%) and overidentified hypertension (2.0%-3.9%), but only required a 2nd BP in 33.8%-59.8% of participants. In conclusion, a simplified approach utilizing 1st BP supplemented by 2nd BP in some individuals has low misclassification rates and requires approximately half of the total number of measurements compared to the standard approach, and thus can facilitate screening in resource-constrained settings.
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Tang et al. (2021) conducted a cross-sectional in Hypertension (n=52,180). Simplified BP measurement approaches (e.g., 2nd BP if 1st BP ≥130/80) vs. Standard triplicate BP measurements (average of 2nd and 3rd BP) was evaluated on Proportion of misclassification of hypertension (missed and overidentified). A simplified screening approach using a 2nd BP only if the 1st BP is ≥130/80 mm Hg yielded low missed (3.8%-8.1%) and overidentified (2.0%-3.9%) hypertension rates compared to standard triplicate BP.
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