Final Research Report
View this project's final research report
Article Highlight: Proper diagnosis of hypertension can save a patient’s life. But blood pressure varies a lot over the day and one or two measurements in a clinic may not reflect a person’s average blood pressure. The BP-CHECK Study found that blood pressure measurements routinely taken at home are more likely to provide the basis for accurate diagnoses of hypertension than those taken in a clinic setting. The results were recently published in the Journal of General Internal Medicine. The study also found that blood pressure readings taken at home were consistent with the gold standard test for making a new diagnosis of high blood pressure. Blood pressure readings in clinics and kiosks resulted in a higher likelihood of missed diagnosis and overdiagnosis.
Results of This Project
Related Journal Citations
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers asked the researchers to discuss further their observations regarding misclassification of hypertension in doctors’ offices and in pharmacy kiosks measuring blood pressure. The researchers explained that misclassification occurred differently in the two settings: at clinic sites, there was more underdiagnosis of hypertension, or false negatives, whereas at pharmacy kiosk sites, there was more overdiagnosis, or false positives. The researchers added discussion of false positive and false negative rates to the report’s abstract but noted that because these rates may be influenced by the prevalence of hypertension, they retained their reporting of sensitivity and specificity results as well.
- The reviewers asked how incomplete data, such as failure to complete the required number of measures, would affect the ability to make a correct hypertension diagnosis. The researchers interpreted this question as a concern regarding their use of a per-protocol analysis rather than an intent-to-treat analysis as originally planned. The researchers reanalyzed their data using an intent-to-treat model and conducted sensitivity analysis to test whether the missing data had an impact on study results. They found that missing data or incomplete measures had little impact on the results or on provider decision making.
- The reviewers challenged the researchers’ concerns about blood pressure measurements in pharmacy kiosks. The study found that blood pressure measures systematically ran high at these locations, but the reviewers conjectured that this was a positive aspect of these kiosks because the higher numbers would prompt the patient to start a conversation with their pharmacist or contact their doctor. The researchers acknowledged that this was true but noted that anxiety about consistently higher numbers might lead to overuse of medical appointments. The researchers also noted that in qualitative interviews, patients stated that they did not trust blood pressure readings from the kiosks and were significantly less likely to complete diagnostic testing if they received a high reading in this setting.
Conflict of Interest Disclosures
Patient / Caregiver Partners
- Jerry Campbell, Patient
- Dwayne Joseph, Patient
- Health e-Heart Alliance, 2 Patient Representatives
Other Stakeholder Partners
- Andrea Cook, PhD, Associate Investigator, Biostatistics, Group Health Research Institute
- Yoshio Hall, MD, MPH, Nephrologist, Group Health
- Clarissa Hsu, PhD, Assistant Investigator, Anthropologist, Group Health Research Institute
- Predrag Klasnja, PhD, Assistant Investigator, Informatics, Group Health Research Institute
- Karen Margolis, MD, MPH, Director of Clinical Research, Health Partners Institute
- Sean Munsen, PhD, Assistant Professor, Human Centered Design & Engineering, University of Washington
- Dori Rosenberg, PhD, Assistant Investigator, Psychologist, Group Health Research Institute
- Matthew Thompson, MBChB, MPH, DPhil, MRCGP, Professor and Vice Chair for Research , Department of Family Medicine, University of Washington
- Bruce Alpert, MD, CoChair Association for the Advancement of Medical Instrumentation
- Jim Li PhD, MBA, Executive Director Medical Affairs, Omron Global
- Dan Morris, PhD, Senior Researcher, Microsoft Medical Research
- Michael Rakotz, MD, FAAFP, Director Chronic Disease Prevention, American Medical Association
- Eduardo Sanchez, MD, MPH, FAAFP, Chief Medical Officer for Prevention, American Heart Association
- Yachiam Ostega, PhD, RN, Nurse Consultant to the NHANES project
- Raj Padwal MD, MSc, FRCP, Professor of Medicine and Director, Hypertension Clinic, University of Alberta Canada
- Josh Sarkis, Vice President, PharmaSmart International
- Sharon Burks, Pharm D Director, Clinical Pharmacy Programs Group Health
- David Grossman, MD, MPH, Medical Director, Population & Purchaser Strategy Group Health, co-chair USPSTF
- Michael Parchman MD, MPH, Medical Director, MacColl Institute for Healthcare Innovation
- Chris Thayer, MD, Medical Director for Clinical Information Systems
^The original organization for the project was Group Health Cooperative.
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