Device-related differences in blood pressure measurement and their impact on hypertension prevalence in children and adolescents

Objectives: Accurate blood pressure (BP) measurement is essential for reliably estimating hypertension prevalence in population-based surveys. However, evidence supporting the use of oscillometric BP devices in pediatric populations remains limited. This study compared BP measurements obtained using an oscillometric device (OD) and an auscultatory device (AD) and evaluated inter-device agreement and the impact of device choice on hypertension prevalence estimates. Methods: BP was measured sequentially with the AD and OD in 251 children and adolescents participating in the Korea National Health and Nutrition Examination Survey. Inter-device agreement was assessed using mean differences, limits of agreement, concordance correlation coefficients (CCCs), and regression analyses. Differences in prevalence estimates for elevated BP (EBP) and hypertension were also examined. Results: Mean inter-device differences were minimal for systolic BP (SBP) (0.2 ± 5.9 mmHg) but negative for diastolic BP (DBP) (-1.5 ± 6.1 mmHg), with larger discrepancies in older girls. Agreement was moderate to good for SBP (CCC = 0.79) and weaker for DBP (CCC = 0.60). Nevertheless, more than 85% of paired measurements were within ±10 mmHg. Prevalence estimates for EBP (11.6% vs. 10.0%) and hypertension (4.8% vs. 4.4%) were comparable between devices, with relatively high negative agreement and overall agreement. Conclusion: Despite modest underestimation of DBP in specific subgroups, oscillometric BP measurement showed acceptable agreement with the auscultatory method and yielded similar hypertension prevalence estimates. These findings suggest that oscillometric devices may be useful for pediatric BP measurement in public health surveillance systems.