Mean Blood Pressure of the General Population with the Mean of Three Measurements Versus the Mean of the Second and Third Measurements. Ricarto Study
Our aim was to determine the difference between measuring blood pressure (BP) with the mean of three determinations versus the mean of the second and the third determinations in a random general population sample.
Epidemiological study of the general population aged ≥ 18 from the Health Area of Toledo (Spain), based on the health card database. Three readings of systolic and diastolic BP were taken with validated oscillometric devices OMRON HEM-907. The mean of the three readings was compared with the mean of the second and third readings after discarding the first measurement. We analyzed age, sex, BMI, abdominal obesity, dyslipidemia, diabetes mellitus, smoking and sedentary lifestyle. A descriptive study was conducted, as well as the agreement in the diagnosis of hypertension.
1532 subjects were analyzed (mean age 49.01 ± 15.79 years old, 55.5% women). Response rate 36.3%. The mean systolic BP with three readings was 125.39 ± 17.43 mmHg, versus 124.33 ± 17.07 mmHg with the mean of the second and third readings (mean difference 1.01 ± 4.31; Cohen’s D = 0.059). The mean diastolic BP was 73.93 ± 10.89 versus 73.71 ± 10.93 mmHg with both methods (mean difference 0.19 ± 2.11; Cohen’s D = 0.017). Differences by age, sex, BMI, abdominal obesity, dyslipidemia, diabetes, smoking and sedentary lifestyle were all small (Cohen’s D < 0.08). The agreement between both models for classifying subjects as hypertensive/non-hypertensive showed a Kappa value = 0.936 (McNemar’s test p < 0.001).
Determining the mean of three readings of BP does not make a significant difference in relation to the reading of the second and third measurements in a sample of general population.
KeywordsBlood pressure Cardiovascular risk General population Primary Health Care
Compliance with Ethical Standards
This study was funded from 2011 to 2013 by the Government of Castilla-La Mancha, through a Grant for Biomedical and Health Sciences Research (file number PI-2010/043) from Castilla-La Mancha Social and Health Care Foundation (FISCAM). The Foundation of the Spanish Society of Primary Care Physicians (SEMERGEN) has been collaborating since 2013 in the funding of the RICARTO study with an unconditional grant.
Conflict of interest
The authors declare that there is no conflict of interest.
- 2.Carey RM, Whelton PK, for the 2017 ACC/AHA Hypertension Guideline Writing Committee. Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline. Ann Intern Med. 2018;168(5):351–8.CrossRefGoogle Scholar
- 4.Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81.CrossRefGoogle Scholar
- 5.Royo-Bordonada MA, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Álvarez F, Elosua R, en nombre del Comité Español Interdisciplinario para la Prevencióni Cardiovascular (CEIPC), et al. Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica. Hipertens Riesgo Vasc. 2017;34(1):24–40.CrossRefGoogle Scholar
- 7.Piper MA, Evans CV, Burda BU, Margolis KL, O’Connor E, Whitlock EP. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the US Preventive Services Task Force. Ann Intern Med. 2015;162(3):192–204.CrossRefGoogle Scholar
- 12.Rodríguez-Roca GC, Rodríguez-Padial L, Alonso-Moreno FJ, Segura-Fragoso A, Villarín-Castro A, Rodríguez-García ML, en representación del grupo de trabajo RICARTO, et al. Justificación, objetivos y diseño metodológico del estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo). Semergen. 2018;44(2):107–13.CrossRefGoogle Scholar
- 13.Rodríguez-Roca GC, Segura-Fragoso A, Villarín-Castro A, Alonso-Moreno FJ, Rodríguez-Padial L, Rodríguez-García ML, en representación del grupo de trabajo RICARTO, et al. Características de la población general incluida en el estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo): resultados con los primeros 1.500 individuos incluidos en el estudio. Semergen. 2018;44(3):180–91.CrossRefGoogle Scholar
- 15.Omboni S, Riva I, Giglio A, Caldara G, Groppelli A, Parati G. Validation of the Omron M5-I, R5-I and HEM-907 automated blood pressure monitors in elderly individuals according to the International Protocol of the European Society of Hypertension. Blood Press Monit. 2007;12:233–42.CrossRefGoogle Scholar
- 17.Parati G, Stergiou G, O’Brien E, Asmar R, Beilin L, Bilo G, on behalf of the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability, et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32:1359–66.CrossRefGoogle Scholar
- 19.Campbell NRC, Berbari AE, Cloutier L, Gelfer M, Kenerson JG, Khalsa TK, et al. Policy statement of the World Hypertension League on noninvasive blood pressure measurement devices and blood pressure measurement in the clinical o community setting. J Clin Hypertens. 2014;16(5):320–2.CrossRefGoogle Scholar
- 20.Weber MA, Schiffin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community. A statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens. 2014;32:3–15.CrossRefGoogle Scholar