title: Blood pressure measurement reliability among different racial-ethnic groups in a stroke prevention study.
abstract: OBJECTIVE
  High blood pressure (BP) is commonly not diagnosed, and patients do not achieve target values when treated. Among 20,000 patients encompassing most races-ethnicities, we evaluated BP measurements and treatment response in a stroke prevention trial. Our goal was to identify BP measurement differences between clinical trial and patient determinations and among the racial-ethnic groups.
  
  
  METHODS
  A total of 20,332 patients with ischemic stroke were randomized to receive antiplatelet treatment and 80 mg of telmisartan versus placebo. BP measurements were obtained at the first clinic visit and then 1 and 3 months later and every 6 months thereafter. One week after the first clinic visit, patients were requested to report a BP measurement obtained elsewhere. Measurements at the trial clinics were obtained with the same electronic device. Statistical analysis was used to detect significant differences.
  
  
  RESULTS
  The mean patient age was 66 years; 36% were women, and race-ethnicity comprised 58% Whites, 33% Asian, 4.9% Hispanic, and 4% Black. Overall, 74% of patients were hypertensive. BP varied between the race-ethnicity groups, being highest in Hispanics (145/85) and lowest in Blacks (144/82). BP at visits clinic 1, nonclinic 1A, and clinic 2 were, respectively, 144/84, 137/80, and 139/81 mmHg, with the difference between visits 1-2 and visit 1A being significant. BPs were normal in 42% of the cases at visit 1A, and of these, only 44% were normal at visit 1 and 57.6% were normal on visit 2. Similar findings were noted for all race-ethnicity groups.
  
  
  CONCLUSIONS
  BP values varied among race-ethnicities and showed differences between clinic and patient measurements. This finding questions the reliability of self-reported BP and has implications for BP management in daily clinical practice.
authors.affiliation: aNottingham City Hospital, Nottingham, UK bSaint Mary's Health Care, Grand Rapids, Michigan cBoehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut dDepartment of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina e910 Fifth Avenue, 6A, New York, NY, USA fDepartment of Molecular and Clinical Medicine, Su Sahlgrenska, Göteborg, Sweden gNeurological & Vascular Prevention Unit, Buenos Aires, Argentina.
authors.forename: Conrado J
authors.initials: CJ
authors.lastname: Estol
authors.forename: Philip M W
authors.initials: PM
authors.lastname: Bath
authors.forename: Philip B
authors.initials: PB
authors.lastname: Gorelick
authors.forename: Daniel
authors.initials: D
authors.lastname: Cotton
authors.forename: Renee H
authors.initials: RH
authors.lastname: Martin
authors.forename: Michael A
authors.initials: MA
authors.lastname: Weber
authors.forename: Bjorn
authors.initials: B
authors.lastname: Dahlof
mesh_terms: D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001565:Benzoates / Q000627:therapeutic use*; D001794:Blood Pressure / Q000235:genetics; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D002545:Brain Ischemia / Q000503:physiopathology; D003937:Diagnosis, Differential; D004311:Double-Blind Method; D005006:Ethnicity / Q000706:statistics & numerical data; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000208:ethnology* / Q000503:physiopathology; D008297:Male; D009819:Office Visits; D010044:Outpatient Clinics, Hospital; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D044469:Racial Groups / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D019722:Sphygmomanometers; D020521:Stroke / Q000208:ethnology / Q000517:prevention & control*; D000077333:Telmisartan; D019851:Thrombophilia / Q000150:complications / Q000188:drug therapy / Q000208:ethnology; D016896:Treatment Outcome; D059466:White Coat Hypertension / Q000175:diagnosis
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001565:Benzoates; D010975:Platelet Aggregation Inhibitors; D000077333:Telmisartan