Wingfield D, Freeman G K, Bulpitt C J
Department of Primary Health Care and General Practice and. Section of Care of the Elderly, Imperial College, Faculty of Medicine, London, UK.
QJM. 2002 Sep;95(9):571-7. doi: 10.1093/qjmed/95.9.571.
Rounding blood pressure (BP) to the nearest 10 mmHg (terminal digit preference) and selecting for particular values near treatment cut-offs (number preference) have both been previously described. Both reduce measurement accuracy, and may have consequences for treatment and survival.
To check for number preference in screening for hypertension, and whether this influenced subsequent mortality.
Prospective case-control screening study.
In the General Practice Hypertensive Study Group (GPHSG), prospective case control study patients (n=23 574) were screened on one occasion for high phase-IV diastolic BP (DBP4) (> or =90 mmHg). Identified cases were matched with normotensive controls for age, sex, date of screen and ethnic group, and were registered for mortality follow-up (n=6310). Patients with a high DBP4 had two further readings, and were treated if it remained elevated.
For DBP4 terminal digit, '0' was over-represented (28.2% vs. 20%), and the number '88' was over-represented in both men and women. There was an excess adjusted death rate for females with DBP4 88-89 mmHg vs. 90-99 mmHg for both cardiovascular (RR 2.56, 95%CI 1.43-4.56, p=0.0015) and all-cause (1.56, 95%CI 1.06-2.29, p=0.023) mortality. For males, the corresponding rates were non-significantly reduced: cardiovascular RR 0.69, 95%CI 0.42-1.14, p=0.15; all-cause RR 0.93, 95%CI 0.68-1.27, p=0.64.
The quality of BP measurements should be monitored both in research studies and in clinical practice as part of clinical governance procedures.
既往已描述了将血压（BP）取整至最接近的10 mmHg（尾数偏好）以及在治疗临界值附近选择特定数值（数字偏好）的情况。这两者均会降低测量准确性，并可能对治疗和生存产生影响。
检查高血压筛查中的数字偏好，以及这是否会影响随后的死亡率。
前瞻性病例对照筛查研究。
在全科医疗高血压研究组（GPHSG）中，对前瞻性病例对照研究患者（n = 23574）进行一次筛查，以检测高IV期舒张压（DBP4）（≥90 mmHg）。将确诊病例与血压正常的对照者按年龄、性别、筛查日期和种族进行匹配，并登记进行死亡率随访（n = 6310）。DBP4高的患者再进行两次读数，如果血压仍升高则进行治疗。
对于DBP4的尾数，“0”出现的比例过高（28.2%对20%），并且数字“88”在男性和女性中出现的比例均过高。DBP4为88 - 89 mmHg的女性与90 - 99 mmHg的女性相比，心血管疾病（RR 2.56，95%CI 1.43 - 4.56，p = 0.0015）和全因死亡率（1.56，95%CI 1.06 - 2.29，p = 0.023）的调整死亡率均过高。对于男性，相应的比率无显著降低：心血管疾病RR 0.69，95%CI 0.42 - 1.14，p = 0.15；全因RR 0.93，95%CI 0.68 - 1.27，p = 0.64。
作为临床管理程序的一部分，在研究和临床实践中均应监测血压测量的质量。
