Impact of Single-Occasion American vs. Canadian Office Blood Pressure Measurement Recommendations on Blood Pressure Classification

Abstract

BACKGROUND The 2017 American hypertension guidelines [American College of Cardiology/American Heart Association (ACC/AHA)] define a blood pressure measurement (BPM) procedure that differs from the Canadian Hypertension Education Program (CHEP) guidelines. We studied the impact of the BPM procedure on arterial hypertension (AHT) prevalence rate. METHODS In 805 subjects, the mean of the first and second BPM (adapted ACC/AHA procedure) was compared with the mean of the second and third BPM (CHEP procedure). All BPMs were taken at a single occasion. According to ACC/AHA definition, office blood pressure (OBP) of <120/80 mm Hg was classified as normal, 120-129/<80 mm Hg as elevated, and ≥130/80 mm Hg as hypertensive. RESULTS Using the adapted ACC/AHA BPM procedure compared to the CHEP BPM procedure led to an increase in the AHT prevalence rate (≥130/80 mm Hg) of 4% (58% vs. 54%). Overall, 8.9% (72/805) of subjects were reclassified to a higher and 2.6% (21/805) to a lower blood pressure category when using the adapted ACC/AHA BPM procedure instead of the CHEP BPM procedure. In the group with elevated OBP (120-129/<80 mm Hg), 41.9% (36/86) of subjects were reclassified. CONCLUSIONS Minimal changes of BPM procedures lead to relevant changes of hypertension prevalence. CLINICAL TRIALS REGISTRATION Trial Number NCT02552030.