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Diabetes Care Publish Ahead of Print published online ahead of print May 7, 2007
DOI: 10.2337/dc07-0020
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Original Research

End-Digit Preference and the Quality of Blood Pressure Monitoring in Diabetic Adults

Esther S.H. Kim, MD, MPH1, T. Alafia Samuels, MD, MPH, PhD2, Hsin-Chieh Yeh, PhD1,,2, Marcela Abuid, MD1, Spyridon S. Marinopoulos, MD, MBA1, Jeanne M. McCauley, MD, MPH1 and Frederick L. Brancati, MD, MHS1,,2

Departments of Medicine1
Epidemiology2 of the Johns Hopkins University, Baltimore, Maryland. Dr. Kim is currently in the Department of Cardiology, Cleveland Clinic, Cleveland, Ohio

kims{at}ccf.org

ABSTRACT

Objective:Although tight blood pressure (BP) control is proven to reduce diabetes-related cardiovascular risk, it has been difficult to achieve in practice, perhaps in part due to low-quality monitoring data. We hypothesized that low-quality BP data, reflected in end-digit preference (EDP), remains common in primary care of diabetic adults.

Research Design and Methods:Data were abstracted from the charts of 404 adults with type 2 diabetes seen at 16 academically-affiliated clinics from 1999-2001. End-digits of systolic and diastolic BPs taken with non-automated sphygmomanometers were extracted and prevalence of EDP for zero was calculated. Associations between EDP and selected patient characteristics were determined using multiple logistic regressions.

Results:EDP was highly prevalent in the BP measurements taken by non-physicians (4333 BPs; 50% of systolic, 50% of diastolic readings ended in zero; P<0.001) and physicians (1347 BPs; 69% of systolic, 64% of diastolic readings ended in zero; P<0.001). In multivariate analysis, non-physicians showed greater EDP for systolic BP in older patients (OR 1.07 per 5 years) and women (OR 1.36 vs men) and for diastolic BP in African Americans (OR 1.25 vs whites; all P< 0.05); physicians showed greater EDP for diastolic BP in less obese patients (OR 0.97 per 5 kg/m2 increment in BMI; P=0.02).

Conclusions:Low quality BP measurement is common in primary care of diabetic adults. Procedural and technologic improvements to BP measurement deserve attention as part of an over all strategy to tighten BP control and reduce cardiovascular risk.


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Find additional patient-related information at:

http://www.diabetes.org/diabetes-research/summaries/Kim-blood-pressure-readings-blur-patients-med-histories.jsp




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