Key result
A single systolic BP reading shows good agreement with the average of three consecutive readings.
Why the study?
Guidelines recommend averaging multiple blood pressure readings, but this can be inconvenient during opportunistic screening and public health actions, with prior studies showing mixed results on the reliability of single versus averaged measurements.
Does a single blood pressure reading provide comparable accuracy to the average of three consecutive readings in opportunistic screening?
Cross-Sectional (n=269)
Randomized sequence
No
Does a single blood pressure reading provide comparable accuracy to the average of three consecutive readings in opportunistic screening?
A single systolic blood pressure measurement shows good agreement with the average of three readings, suggesting it may be sufficient for opportunistic screening and public health awareness campaigns.
Answers are grounded in this paper and cite their sources.
May streamline opportunistic screening; leaves open prospective validation before changing diagnostic protocols.
Objective: All relevant guidelines recommend averaging the last two of three blood pressure (BP) readings for better accuracy. However, in opportunistic screening studies and educational public health actions this may be inconvenient. Previous studies have shown mixed results regarding the reliability of a single versus averaged measurement. Our aim was to compare one BP reading with the average of three BP readings taken by a two different oscilometric devices. Design and method: This cross-sectional study was conducted in August 2025 on the island of Dugi Otok, Croatia, as a part of the public health action “Hunting the silent killer” organizes by the Croatian Hypertension League. A total of 269 adult participants were recruited through voluntary, opportunistic sampling (mean age 65; 56.9% female). BP was measured following the guideline recommendations using two devices: device A (ApWell Alpha, Rossmax), which recorded a single measurement, and device B (Microlife BP B3 AFIB), which provided the average of three consecutive readings. The sequence of BP measurement was determined using a randomized list. Results: There were no differences in average BP values obtained with device A vs. device B (systolic: 143.9 ± 21.2 vs. 144.0 ± 21.5 mmHg; diastolic: 82.7 ± 11.3 vs. 85.3 ± 12.3 mmHg). Bland-Altman analysis showed a systolic BP bias of negative 0.16 mmHg (LoA: negative 25.88 to 25.56 mmHg), with CCC and ICC of 0.81, TDI of 24 mmHg, and CP of 0.37. For diastolic BP, the bias was negative 2.58 mmHg (LoA negative 17.58 to 12.43 mmHg), with CCC of 0.77, ICC of 0.99, TDI of 15 mmHg, and CP of 0.62. Conclusions: Bland-Altman analysis, along with CCC and ICC, demonstrated high reproducibility and good agreement between devices, while also highlighting the range of potential deviations. For clinical practice and research studies, multiple BP measurements remain optimal, while a single systolic BP measurement may be sufficient for screening purposes and in public health actions for increasing awareness about hypertension.
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Dumancic et al. (2026) conducted a cross-sectional in Hypertension screening (n=269). Single blood pressure reading vs. Average of three consecutive blood pressure readings was evaluated on Systolic blood pressure (Bias -0.16 mmHg, 95% CI -25.88 to 25.56). A single systolic blood pressure reading demonstrated good agreement with the average of three readings.
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