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BMC Medical Research Methodology
Published in: BMC Medical Research Methodology 1/2015

Open Access 01-12-2015 | Research article

Challenges in standardization of blood pressure measurement at the population level

Authors: Hanna Tolonen, Päivikki Koponen, Androniki Naska, Satu Männistö, Grazyna Broda, Tarja Palosaari, Kari Kuulasmaa, for the EHES Pilot Project

Published in: BMC Medical Research Methodology | Issue 1/2015

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Abstract

Background

Accurate blood pressure measurements are needed in clinical practice, intervention studies and health examination surveys. Blood pressure measurements are sensitive: their accuracy can be affected by measurement environment, behaviour of the subject, measurement procedures, devices used for the measurement and the observer. To minimize errors in blood pressure measurement, a standardized measurement protocol is needed.

Methods

The European Health Examination Survey (EHES) Pilot project was conducted in 2009–2012. A pilot health examination survey was conducted in 12 countries using a standardized protocol. The measurement protocols used in each survey, training provided for the measurers, measurement data, and observations during site visits were collected and evaluated to assess the level of standardization.

Results

The EHES measurement protocol for blood pressure was followed accurately in all 12 pilot surveys. Most of the surveys succeeded in organizing a quiet and comfortable measurement environment, and staff instructed survey participants appropriately before examination visits. In all surveys, blood pressure was measured three times, from the right arm in a sitting posture. The biggest variation was in the device used for the blood pressure measurement.

Conclusions

It is possible to reach a high level of standardization for blood pressure measurements across countries and over time. A detailed, standardized measurement protocol, and adequate training and monitoring during the fieldwork and centrally organized quality assessment of the data are needed. The recent EU regulation banning the sale of mercury sphygmomanometer in European Union Member States has set new challenges for the standardization of measurement devices since the validity of oscillometric measurements is device-specific and performance of aneroid devices depends very much on calibration.
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Metadata
Title
Challenges in standardization of blood pressure measurement at the population level
Authors
Hanna Tolonen
Päivikki Koponen
Androniki Naska
Satu Männistö
Grazyna Broda
Tarja Palosaari
Kari Kuulasmaa
for the EHES Pilot Project
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2015
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/s12874-015-0020-3

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