Comparing blood pressure values obtained by two different protocols : National Health and Nutrition Examination Survey, 2017–2018
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Comparing blood pressure values obtained by two different protocols : National Health and Nutrition Examination Survey, 2017–2018

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    https://www.cdc.gov/nchs/data/series/sr_02/sr2-187-508.pdf Background: Blood pressure (BP) is traditionally measured using a mercury sphygmomanometer. Given environmental concerns about mercury, clinical and survey settings are moving to automated devices with an oscillometric protocol to obtain BP. This report compares BP measurement using the mercury and oscillometric protocols. Methods: In the 2017–2018 National Health and Nutrition Examination Survey, among participants aged 18 and over (n = 4,477), BP was measured using two protocols in a randomly assigned order. The auscultation protocol (AP) was administered by a physician using a mercury sphygmomanometer. The oscillometric protocol (OP) was administered by a health technician using an Omron HEM–907 XL device. Between-protocol mean systolic BP (SBP) and diastolic BP (DBP) measurements were compared. The prevalence of stage 1 high blood pressure (equal to or greater than 130/80 mmHg) was determined, and agreement between protocols was evaluated using sensitivity, specificity, and kappa statistics. Results: Overall, mean BP difference between AP and OP was 1.5 mmHg for SBP and –1.3 mmHg for DBP (p < 0.01 for both). Mean differences in SBP between protocols were significantly higher using AP compared with OP for most groups except men, non-Hispanic Asian adults, and participants using large adult cuff sizes. Mean differences in DBP between protocols were significantly lower using AP compared with OP for most groups except those aged 40–59, non-Hispanic Asian and Hispanic adults, and participants using regular adult cuff sizes. Overall, stage 1 high blood pressure prevalence was 38.6% using AP and 37.3% using OP. Both protocols for stage 1 high blood pressure demonstrated a good agreement (κ ≥ 0.6), and sensitivity values and positive predictive values were 70% or more for all subcategories except the 18–39 age group. Conclusions: Although mean SBP and DBP obtained by AP and OP differed, the prevalence of stage 1 high blood pressure did not differ, suggesting that a change in protocol may not affect blood pressure prevalence estimates. Suggested citation: Ostchega Y, Nwankwo T, Chiappa M, Wolz M, Graber J, Nguyen DT. Comparing blood pressure values obtained by two different protocols: National Health and Nutrition Examination Survey, 2017–2018. National Center for Health Statistics. Vital Health Stat 2(187). 2021. DOI: https://doi.org/10.15620/cdc:104185. CS323069 sr2-187-508.pdf
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