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. 2023 Jul;25(7):601-609.
doi: 10.1111/jch.14684. Epub 2023 Jun 21.

Blood pressure measurement and blood pressure control in Veterans Affairs medical centers

Meghan O' Halloran  1 , Ashley M Hughes  2   3 , Zhiping Huo  2 , Frances Weaver  2 , Kevin Stroupe  2 , Elizabeth Tarlov  4 , Holly Kramer  1   2   5
Affiliations

Blood pressure measurement and blood pressure control in Veterans Affairs medical centers

Meghan O' Halloran et al. J Clin Hypertens (Greenwich). 2023 Jul.

Abstract

The Veterans Affairs (VA) medical centers provide care for millions of Veterans at high risk of cardiovascular disease and accurate BP measurement in this population is vital for optimal BP control. Few studies have examined terminal digit preference (TDP), a marker of BP measurement bias, clinician perceptions of BP measurement, and BP control in VA medical centers. This mixed methods study examined BP measurements from Veterans aged 18 to 85 years with hypertension and a primary care visit within 8 VA medical centers. TDP for all clinic BP measurements was examined using a goodness of fit test assuming 10% frequency for each digit. Interviews were also conducted with clinicians from 3 VA medical centers to assess perceptions of BP measurement. The mean age of the 98,433 Veterans (93% male) was 68.5 years (SD 12.7). BP was controlled (<140/90 mmHg) in 76.5% and control rates ranged from 72.2% to 81.0% across the 8 VA medical centers. Frequency of terminal digits 0 through 9 differed significantly from 10% for both SBP and DBP within each center (P < .001) but level of TDP differed by center. The highest BP control rates were noted in centers with highest TDP for digits 0 and 8 for both SBP and DBP. Clinicians reported use of semi-automated oscillometric devices for clinic BP measurement, but elevated BP readings were often confirmed by auscultatory methods. Significant TDP exists for BP measurement in VA medical centers, which reflects continued use of auscultatory methods.

Keywords: antihypertensive therapy; clinical management of high blood pressure (HBP); epidemiology; hypertension in the elderly; hypertension-general.

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Conflict of interest statement

Dr. Kramer reports receiving consulting fees from Bayer Pharmaceuticals. No other author reports any competing interests.

Figures

FIGURE 1
FIGURE 1
Flowchart of study population for quantitative analysis of blood pressure terminal digit preference and blood pressure control.
FIGURE 2
FIGURE 2
Terminal digit frequency for systolic (top figure) and diastolic (bottom) pressure in blood pressure measurements from 98,433 Veterans with a hypertension diagnosis overall and by blood pressure level.
FIGURE 3
FIGURE 3
Terminal digit frequency for systolic (top) and diastolic (bottom) blood pressure measurements in 98,433 Veterans with a hypertension diagnosis by VA medical center.
FIGURE 4
FIGURE 4
Percent blood pressure control (<140/90 mmHg) within a Veterans Affairs (VA) medical center, based on last clinic visit recorded vitals, versus frequency of terminal digit zero or eight for systolic blood pressure (top) and diastolic blood pressure (bottom) in 98, 433 Veterans with a hypertension diagnosis. Each circle represents a VA medical center.
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