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Abstract P170: Validation Of A Practical Approach To Blood Pressure Measurement: Secondary Analysis Of Data From A Nationally Representative Household Survey In India


 Background:
 Various clinical guidelines differ on the required number of blood pressure (BP) measurements during clinic visits. The research standard approach is measuring BP three times and using the mean of the last two readings. India’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) recommends measuring twice and averaging the two readings. We hypothesized that a selective, practical approach to BP measurement in public health settings would be simpler, avoid calculating the mean, but not substantially erode measurement accuracy.
 
 
 Method:
 We used the data of adults (aged 30-54 years) from the National Family Health Survey (2015-16), with three seated BP measurements for each participant (N= 372,110). In the practical BP measurement approach, if the first reading is <140/90 mm Hg, the first BP was used. If first BP is ≥140/90 mm Hg, the second BP was used. If the difference between the two systolic or diastolic BP readings was ≥5 mm Hg, then third BP was used. We compared the accuracy of practical and NPCDCS approaches in stratifying high BP (≥140/90 mm Hg), each referencing against research standard.
 
 
 Results:
 The prevalence of high BP was 15.5% (95% CI: 15.5%, 15.7%), 14.9% (14.9%, 15.1%), and 19.3% (19.3%,19.5%), when used the standard, practical, and NPCDCS approaches, respectively. Referencing the research standard, the sensitivity, specificity, false positive and false negative rates of the practical approach were 85.4%, 98.0%, 11.3% and 2.7%; rates of the NPCDCS approach were 94.3%, 93.4%, 25.1% and 1.3%, respectively. For categorizing the stages of high BP, the agreement and kappa statistics for practical vs. standard were 94.7% and 0.80 at p <0.0001 and NPCDCS vs. standard were 92% and 0.742 at p <0.0001. The mean number of BP measurements required per person was 1.4 for the practical approach compared with 2.0 for the NPCDCS approach.
 
 
 Conclusions:
 Both the practical and NPCDCS approaches to BP measurement had high validity and agreement with the research standard. The practical approach is simpler and involves a lower measurement burden on health care professionals; this approach could improve the utility of BP measurement and hypertension diagnosis in public health settings.
