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December 1986

Observer Error in Systolic Blood Pressure Measurement in the Elderly: A Case for Automatic Recorders?

Author Affiliations

From the Division of General Internal Medicine, Department of Medicine, Duke University Medical Center (Drs Hla and Feussner); the Ambulatory Care Service (Drs Hla and Feussner and Ms Vokaty), and the Health Services Research Field Program (Drs Hla and Feussner), Durham Veterans Administration Medical Center, Durham, NC.

Arch Intern Med. 1986;146(12):2373-2376. doi:10.1001/archinte.1986.00360240099017

• Measurement of systolic blood pressure (BP) in the elderly can be inaccurate due to observer errors such as terminal digit preference and expectation bias. Efforts to reduce these errors include use of trained observers, random-zero sphygmomanometers, and automatic BP recorders. To evaluate the value of an infrasonic recorder, the Infrasonde, we compared simultaneous systolic BP determinations obtained directly by intraarterial measurements, and indirectly by a standard cuffmercury sphygmomanometer using clinic nurses (casual and serial measurements), a trained physician assistant (PA), and the Infrasonde in 36 elderly hypertensive men. All the indirect measurements correlated positively with the direct measurement. A terminal digit preference for zero occurred more frequently in the casual and serial readings compared with the Infrasonde and PA cuff readings: 45% and 51% vs 21% and 22%, respectively. Our data suggest that the Infrasonde is a reliable, alternative device for systolic BP measurement that eliminates observer biases associated

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