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Foti KE, Appel LJ, Matsushita K, et al. Digit Preference in Office Blood Pressure Measurements, United States 2015-2019. Am J Hypertens. 2021;34(5):521-530doi: 10.1093/ajh/hpaa196.
Foti, K. E., Appel, L. J., Matsushita, K., Coresh, J., Alexander, G. C., & Selvin, E. (2021). Digit Preference in Office Blood Pressure Measurements, United States 2015-2019. American journal of hypertension, 34(5), 521-530. https://doi.org/10.1093/ajh/hpaa196
Foti, Kathryn E, et al. "Digit Preference in Office Blood Pressure Measurements, United States 2015-2019." American journal of hypertension vol. 34,5 (2021): 521-530. doi: https://doi.org/10.1093/ajh/hpaa196
Foti KE, Appel LJ, Matsushita K, Coresh J, Alexander GC, Selvin E. Digit Preference in Office Blood Pressure Measurements, United States 2015-2019. Am J Hypertens. 2021 May 22;34(5):521-530. doi: 10.1093/ajh/hpaa196. PMID: 33246327; PMCID: PMC8628654.
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Am J Hypertens. 2021 May 22;34(5):521-530. doi: 10.1093/ajh/hpaa196.

Digit Preference in Office Blood Pressure Measurements, United States 2015-2019.

American journal of hypertension

Kathryn E Foti, Lawrence J Appel, Kunihiro Matsushita, Josef Coresh, G Caleb Alexander, Elizabeth Selvin

Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  2. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
  3. Center for Drug Safety and Effectiveness, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

PMID: 33246327 PMCID: PMC8628654 DOI: 10.1093/ajh/hpaa196

Abstract

BACKGROUND: Blood pressure (BP) measurement error may lead to under- or overtreatment of hypertension. One common source of error is terminal digit preference, most often a terminal digit of "0." The objective was to evaluate national trends in terminal digit preference in office BP measurements among adults with treated hypertension.

METHODS: Data were from IQVIA's National Disease and Therapeutic Index, a nationally representative, serial cross-sectional survey of office-based physicians. The analysis included office visits from 2015 to 2019 among adults aged ≥18 years receiving antihypertensive treatment. Annual trends were examined in the percent of systolic and diastolic BP measurements ending in zero by patient sex, age, and race/ethnicity, physician specialty, and first or subsequent hypertension treatment visit.

RESULTS: From 2015 to 2019, there were ~60 million hypertension treatment visits annually (unweighted N: 5,585-9,085). There was a decrease in the percent of visits with systolic (41.7%-37.7%) or diastolic (42.7%-37.8%) BP recordings ending in zero. Trends were similar by patient characteristics. However, a greater proportion of measurements ended in zero among patients aged ≥80 (vs. 15-59 or 60-79) years, first (vs. subsequent) treatment visits, visits to cardiologists (vs. primary care physicians), and visits with systolic BP ≥140 or diastolic BP ≥90 (vs. <140/90) mm Hg.

CONCLUSIONS: Despite modest improvement, terminal digit preference remains a common problem in office BP measurement in the United States. Without bias, 10%-20% of measurements are expected to end in zero. Reducing digit preference is a priority for improving BP measurement accuracy and hypertension management.

© American Journal of Hypertension, Ltd 2020. All rights reserved. For Permissions, please email: [email protected].

Keywords: blood pressure; blood pressure measurement; hypertension; measurement error; terminal digit preference

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