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dc.contributor.authorGreiver, Michelle
dc.contributor.authorKalia, Sumeet
dc.contributor.authorVoruganti, Teja
dc.contributor.authorAliarzadeh, Babak
dc.contributor.authorMoineddin, Rahim
dc.contributor.authorHinton, William
dc.contributor.authorDawes, Martin
dc.contributor.authorSullivan, Frank
dc.contributor.authorSyed, Saddaf
dc.contributor.authorWilliams, John
dc.contributor.authorDe Lusignan, Simon
dc.identifier.citationGreiver , M , Kalia , S , Voruganti , T , Aliarzadeh , B , Moineddin , R , Hinton , W , Dawes , M , Sullivan , F , Syed , S , Williams , J & De Lusignan , S 2019 , ' Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care : a retrospective observational study ' , BMJ Open , vol. 9 , no. 1 , e024970 .
dc.identifier.otherPURE: 257967190
dc.identifier.otherPURE UUID: 28fb55fd-7d8c-4d4e-b13b-5be181cd09b7
dc.identifier.otherScopus: 85060546357
dc.identifier.otherPubMed: 30679298
dc.identifier.otherWOS: 000471116800218
dc.descriptionThis study received funding through a grant by the North York Genera Hospital Foundation’s Exploration Fund. MG held an investigator award from the Department of Family and Community Medicine, University of Toronto and was supported by a research stipend from North York General Hospital. The Canadian Primary Care Sentinel Surveillance Network was a committee of the College of Family Physicians of Canada and was funded through a contribution agreement with the Public Health Agency of Canada.en
dc.description.abstractObjectives: To study systematic errors in recording blood pressure (BP) as measured by end digit preference (EDP); to determine associations between EDP, uptake of Automated Office BP (AOBP) machines and cardiovascular outcomes. Design: Retrospective observational study using routinely collected electronic medical record data from 2006 to 2015 and a survey on year of AOBP acquisition in Toronto, Canada in 2017. Setting: Primary care practices in Canada and the UK. Participants: Adults aged 18 years or more. Main outcome measures: Mean rates of EDP and change in rates. Rates of EDP following acquisition of an AOBP machine. Associations between site EDP levels and mean BP. Associations between site EDP levels and frequency of cardiovascular outcomes. Results:  707 227 patients in Canada and 1 558 471 patients in the UK were included. From 2006 to 2015, the mean rate of BP readings with both systolic and diastolic pressure ending in zero decreased from 26.6% to 15.4% in Canada and from 24.2% to 17.3% in the UK. Systolic BP readings ending in zero decreased from 41.8% to 32.5% in the 3 years following the purchase of an AOBP machine. Sites with high EDP had a mean systolic BP of 2.0 mm Hg in Canada, and 1.7 mm Hg in the UK, lower than sites with no or low EDP. Patients in sites with high levels of EDP had a higher frequency of stroke (standardised morbidity ratio (SMR) 1.15, 95% CI 1.12 to 1.17), myocardial infarction (SMR 1.16, 95% CI 1.14 to 1.19) and angina (SMR 1.25, 95% CI 1.22 to 1.28) than patients in sites with no or low EDP. Conclusions:  Acquisition of an AOBP machine was associated with a decrease in EDP levels. Sites with higher rates of EDP had lower mean BPs and a higher frequency of adverse cardiovascular outcomes. The routine use of manual office-based BP measurement should be reconsidered.
dc.relation.ispartofBMJ Openen
dc.rightsCopyright © Author(s) (or their employer(s)) 2019. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:
dc.subjectInformation technologyen
dc.subjectIschaemic heart diseaseen
dc.subjectQuality in health careen
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.titleTrends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care : a retrospective observational studyen
dc.typeJournal articleen
dc.description.versionPublisher PDFen
dc.contributor.institutionUniversity of St Andrews.School of Medicineen
dc.contributor.institutionUniversity of St Andrews.Population and Behavioural Science Divisionen
dc.contributor.institutionUniversity of St Andrews.Sir James Mackenzie Institute for Early Diagnosisen
dc.description.statusPeer revieweden

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