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 81041 participants, 62647 adults with 3 BP readings were included. The median (interquartile range) age was 59.0 (46.0-69.0) years, and 31922 (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 (16405 participants [26.2%]) and the lowest was by Averaging the Lowest Two (13996 participants [22.3%]; P