ArticleJournal of human hypertension2008
Variation in recorded blood pressure terminal digit bias in general practice.
Article in Journal of human hypertension, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Sources of inaccuracy in the measurement of adult patients' resting blood pressure in clinical settings: a systematic review.Journal of hypertension · 2017Pooled it
- Long term monitoring in patients receiving treatment to lower blood pressure: analysis of data from placebo controlled randomised controlled trial.BMJ (Clinical research ed.) · 2009Trial
- Unraveling the Implications of Digit Bias in Digital Health - A Literature Review.Internal medicine (Tokyo, Japan) · 2025Review
- Association of an Automated Blood Pressure Measurement Quality Improvement Program With Terminal Digit Preference and Recorded Mean Blood Pressure in 11 Clinics.JAMA network open · 2022Article
- Hypertension Control and Retention in Care Among HIV-Infected Patients: The Effects of Co-located HIV and Chronic Noncommunicable Disease Care.Journal of acquired immune deficiency syndromes (1999) · 2019Article
- Observational
- Are self-reported telemonitored blood pressure readings affected by end-digit preference: a prospective cohort study in Scotland.BMJ open · 2018Article
- Article
- Trends in the diagnosis and management of hypertension: repeated primary care survey in South West England.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Article
- Creating a transdisciplinary research center to reduce cardiovascular health disparities in Baltimore, Maryland: lessons learned.American journal of public health · 2013Article
- Comparison of intra-arterial and manual auscultation of blood pressure during submaximal exercise in humans.Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme · 2013Article
- Blood pressure recording bias during a period when the Quality and Outcomes Framework was introduced.Journal of human hypertension · 2009Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This study aims to identify the extent of terminal digit bias in routinely recorded blood pressures (BP) across a number of different general practices and report on changes in terminal digit bias over a 10-year period. It also explores the effect this may have had on the mean recorded BP in this population. BP records were taken from The Health Improvement Network database containing anonymized patient records from information entered by UK general practices in the financial years 1996-1997 to 2005-2006. The proportion of measurements ending in zero and the mean BP readings were calculated for each practice and for each year of data.Over this 10-year period the percentage of systolic BPs with zero terminal digits fell from 71.2 to 36.7% and mean recorded BP fell from 152.3 to 145.3 mm Hg. Correcting the BPs to remove terminal digit bias indicates a 2-3 mm Hg underestimation of the mean population systolic BP over this period. The between-practice variation in the percentage of zero terminal digit readings increased from 3.5 to 6.5 s.d. Although it is welcome to see a reduction in terminal digit bias, it is worrying to see the increase in variation between practices. There is evidence that terminal digit bias may lead to potential misclassification and inappropriate treatment of hypertensive patients. The increase in variation observed may therefore lead to an increased variation in the quality of care given to patients.
Indexed as
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.