Dataset Information

Variation in Blood Pressure Classification Using 7 Blood Pressure Estimation Protocols Among Adults in Taiwan.

ABSTRACT:

Importance

Discrepancies in blood pressure (BP) estimates lead to incomparable BP assessment.

Objective

To determine intraindividual discrepancies in BP estimates and classifications based on different BP estimation protocols.

Design, setting, and participants

This cross-sectional study was a secondary analysis of data from the May Measurement Month Taiwan in 2017 and 2018, which were cross-sectional survey campaigns at pharmacies nationwide to raise awareness of high BP. Participants were volunteers aged 20 years or older. Analysis was conducted from February 2 to August 7, 2020.

Exposure

Pharmacist-measured sitting BP using oscillometric sphygmomanometers.

Main outcomes and measures

A total of 7 BP estimation protocols were assessed according to the latest American College of Cardiology (ACC), Chinese Hypertension League (CHL), European Society of Cardiology (ESC), International Society of Hypertension, Japanese Society of Hypertension, and National Institute of Health and Care Excellence (NICE) hypertension guidelines, and the proposed Averaging the Lowest Two systolic readings protocol. According to BP classification schemes of ESC and ACC guidelines, intraindividual discrepancies were identified if classification inconsistencies among 7 BP estimates were present.

Results

Of 81 041 participants, 62 647 adults with 3 BP readings were included. The median (interquartile range) age was 59.0 (46.0-69.0) years, and 31 922 (51.5%) were women. The intraindividual maximum mean (SD) differences in systolic/diastolic BP estimates among the seven protocols were 4.8 (4.3)/3.3 (3.1) mm Hg. The highest prevalence of BP of 140/90 mm Hg or higher was by CHL (16 405 participants [26.2%]) and the lowest was by Averaging the Lowest Two (13 996 participants [22.3%]; P < .001); while the highest prevalence of 130/80 mm Hg or higher was by NICE (37 232 participants [59.4%]) and the lowest prevalence was by Averaging the Lowest Two (32 788 participants [52.4%]; P < .001). Compared with the other 6 estimates, Averaging the Lowest Two reclassified 7.3% to 15.8% of participants designated as 140/90 mm Hg or higher to less than 140/90 mm Hg, and 4.9% to 14.1% of those as 130/80 mm Hg or higher to less than 130/80 mm Hg. Intraindividual discrepancies in classifications occurred in 19 815 participants (31.6%) with the ESC classification and 16 401 participants (26.2%) with the ACC BP classification. Classification agreements were the lowest between NICE (κ coefficient, 0.667 [95% CI, 0.662-0.671]) and ESC protocols (κ coefficient, 0.705 [95% CI, 0.701-0.709]).

Conclusions and relevance

This cross-sectional study of adults in Taiwan found that different BP estimation protocols led to considerable intraindividual discrepancies in BP estimates and classifications. These findings suggest that the Averaging the Lowest Two protocol is less likely to overestimate BP and could serve as a prudent recommendation for BP estimation.

SUBMITTER: Lin HJ

PROVIDER: S-EPMC7675105 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Variation in Blood Pressure Classification Using 7 Blood Pressure Estimation Protocols Among Adults in Taiwan.

Lin Hung-Ju HJ Pan Heng-Yu HY Chen Wen-Jone WJ Wang Tzung-Dau TD

JAMA network open 20201102 11

<h4>Importance</h4>Discrepancies in blood pressure (BP) estimates lead to incomparable BP assessment.<h4>Objective</h4>To determine intraindividual discrepancies in BP estimates and classifications based on different BP estimation protocols.<h4>Design, setting, and participants</h4>This cross-sectional study was a secondary analysis of data from the May Measurement Month Taiwan in 2017 and 2018, which were cross-sectional survey campaigns at pharmacies nationwide to raise awareness of high BP. P ...[more]

PMID: 33206190

Similar Datasets

Project description:ImportanceLittle is known regarding the association between level of blood pressure (BP) in young adulthood and cardiovascular disease (CVD) events by middle age.ObjectiveTo assess whether young adults who developed hypertension, defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline, before age 40 years have higher risk for CVD events compared with those who maintained normal BP.Design, setting, and participantsAnalyses were conducted in the prospective cohort Coronary Artery Risk Development in Young Adults (CARDIA) study, started in March 1985. CARDIA enrolled 5115 African American and white participants aged 18 to 30 years from 4 US field centers (Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California). Outcomes were available through August 2015.ExposuresUsing the highest BP measured from the first examination to the examination closest to, but not after, age 40 years, each participant was categorized as having normal BP (untreated systolic BP [SBP] <120 mm Hg and diastolic BP [DBP] <80 mm Hg; n = 2574); elevated BP (untreated SBP 120-129 mm Hg and DBP <80 mm Hg; n = 445); stage 1 hypertension (untreated SBP 130-139 mm Hg or DBP 80-89 mm Hg; n = 1194); or stage 2 hypertension (SBP ≥140 mm Hg, DBP ≥90 mm Hg, or taking antihypertensive medication; n = 638).Main outcomes and measuresCVD events: fatal and nonfatal coronary heart disease (CHD), heart failure, stroke, transient ischemic attack, or intervention for peripheral artery disease (PAD).ResultsThe final cohort included 4851 adults (mean age when follow-up for outcomes began, 35.7 years [SD, 3.6]; 2657 women [55%]; 2441 African American [50%]; 206 taking antihypertensive medication [4%]). Over a median follow-up of 18.8 years, 228 incident CVD events occurred (CHD, 109; stroke, 63; heart failure, 48; PAD, 8). CVD incidence rates for normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension were 1.37 (95% CI, 1.07-1.75), 2.74 (95% CI, 1.78-4.20), 3.15 (95% CI, 2.47-4.02), and 8.04 (95% CI, 6.45-10.03) per 1000 person-years, respectively. After multivariable adjustment, hazard ratios for CVD events for elevated BP, stage 1 hypertension, and stage 2 hypertension vs normal BP were 1.67 (95% CI, 1.01-2.77), 1.75 (95% CI, 1.22-2.53), and 3.49 (95% CI, 2.42-5.05), respectively.Conclusions and relevanceAmong young adults, those with elevated blood pressure, stage 1 hypertension, and stage 2 hypertension before age 40 years, as defined by the blood pressure classification in the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, had significantly higher risk for subsequent cardiovascular disease events compared with those with normal blood pressure before age 40 years. The ACC/AHA blood pressure classification system may help identify young adults at higher risk for cardiovascular disease events.

Project description:ImportanceAlthough cumulative evidence suggests that higher blood pressure (BP) and a greater burden of social determinants of health (SDOH) are associated with an increased risk of stroke, few studies have examined whether SDOH burden modifies the association between BP and stroke risk.ObjectiveTo evaluate whether the association between BP classification and stroke risk differs by SDOH burden among Chinese adults.Design, setting, and participantsIn this cohort study, analyses were conducted among 90 850 participants in the prospective subcohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, with recruitment from January 1, 2016, to December 31, 2020. Participants without cardiovascular diseases and with complete data were included and followed up for stroke events until June 30, 2023.ExposuresSocial determinants of health burden was defined using 5 components: educational attainment, economic stability, health care access, social support, and urban vs rural residence. Blood pressure was categorized according to the 2017 American College of Cardiology/American Heart Association BP guideline.Main outcomes and measuresMultivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of BP classification with incident stroke stratified by SDOH burden groups.ResultsThe study included 90 850 participants (median age, 54.0 years [IQR, 46.0-62.0 years]; 55 390 women [61.0%]). During a median follow-up of 5.0 years (IQR, 4.1-5.8 years), 4408 incident stroke events were recorded. Compared with normal BP, elevated BP (HR, 1.33 [95% CI, 1.17-1.52]), stage 1 hypertension (HR, 1.60 [95% CI, 1.43-1.78]), and stage 2 hypertension (HR, 1.79 [95% CI, 1.61-2.00]) were associated with stroke among participants with high SDOH burden, while only stage 2 hypertension (HR, 1.52 [95% CI, 1.20-1.93]) was associated with stroke among those with low SDOH burden, with a significant multiplicative interaction of SDOH burden and BP classification (P = .03). Participants with high SDOH burden and stage 2 hypertension had the highest risk of stroke compared with participants with low SDOH burden and normal BP (HR, 2.13 [95% CI, 1.75-2.60]).Conclusions and relevanceThis study suggests that higher BP levels, even at lower stages of hypertension, pose a greater stroke risk for individuals with high SDOH burden. Early surveillance and intervention for high BP should be emphasized in socioeconomically disadvantaged populations.

Dataset Information

Variation in Blood Pressure Classification Using 7 Blood Pressure Estimation Protocols Among Adults in Taiwan.

Importance

Objective

Design, setting, and participants

Exposure

Main outcomes and measures

Results

Conclusions and relevance

Publications

Variation in Blood Pressure Classification Using 7 Blood Pressure Estimation Protocols Among Adults in Taiwan.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets