Clinical Research in Cardiology

, Volume 108, Issue 9, pp 990–999 | Cite as

Impact of single-visit American versus European office blood pressure measurement procedure on individual blood pressure classification: a cross-sectional study

  • Annina S. VischerEmail author
  • Thenral Socrates
  • Clemens Winterhalder
  • Jens Eckstein
  • Michael Mayr
  • Thilo Burkard
Original Paper



Recently, ACC/AHA and ESC/ESH guidelines defined different office blood pressure measurement (OBPM) procedures and ranges. We aimed to describe the effect of the different methods to calculate OBPM on BP classification.

Methods and results

Four standardised OBPM were performed in 802 patients within a single visit. BP values were calculated (EUR-/US-BPM) and categorised (EUR-/US-Ranges) according to ACC/AHA and ESC/ESH guidelines. Comparing the BPM procedures, the mean absolute difference of systolic and diastolic BP was 4 (SD ± 5) and 3 (SD ± 3) and a difference ≥ 5 mmHg was found in 35% and 16%, respectively. There was an increase of grade 1/2 arterial hypertension of 87% and 120% comparing BP values categorised according to US-Ranges with EUR-Ranges after applying EUR- or US-BPM to all (p < 0.0001), of 25% and 6% comparing BP values calculated according to US-BPM with EUR-BPM applying EUR- or US-Ranges to all (p = 0.006 and p = 0.17), and of 134% comparing US-Ranges/US-BPM with EUR-Ranges/EUR-BPM (p < 0.0001), respectively. Overall, 16% were reclassified to higher categories when applying US-BPM, and 42–45% of patients classified as “high normal” applying EUR-BPM procedures were reclassified when applying US-BPM procedure, 76–77% of them to “hypertensive” categories.


Besides the effect of the redefinition of BP categories by ACC/AHA, the calculation method of US-BPM compared to EUR-BPM leads to a further relevant increase of patients classified as “hypertensive”. In addition to the definition of uniform outcome-oriented target BP values, there is an urgent need for a universal definition of an OBPM procedure as prerequisite for proper BP classification and patient management.


Hypertension Blood pressure Blood pressure determination Epidemiology Prevalence Methodology 



Many thanks to A. Winterhalder for the study coordination, as well as to all participants.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This trial was approved by the local ethics committee (EKNZ 2015-287), was compliant with the Declaration of Helsinki, and all patients provided written informed consent. The trial was registered on (NCT02552030).


  1. 1.
    Whelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr., Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD Sr., Wright JT Jr. (2017) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL,Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I, De Backer G, Heagerty AM, Agewall S, Bochud M, Borghi C, Boutouyrie P, Brguljan J, Bueno H, Caiani EG, Carlberg B, Chapman N, Cífková R, Cleland JGF, Collet J-P, Coman IM, de Leeuw PW, Delgado V,Dendale P, Diener H-C, Dorobantu M, Fagard R, Farsang C, Ferrini M, Graham IM, Grassi G, Haller H, Hobbs FDR, Jelakovic B, Jennings C, Katus HA, Kroon AA, Leclercq C, Lovic D, Lurbe E, Manolis AJ, McDonagh TA, Messerli F, Muiesan ML, Nixdorff U, Olsen MH,Parati G, Perk J, Piepoli MF, Polonia J, Ponikowski P, Richter DJ, Rimoldi SF, Roffi M, Sattar N, Seferovic PM, Simpson IA, Sousa-Uva M, Stanton AV, van de Borne P, Vardas P, Volpe M, Wassmann S, Windecker S, Zamorano JL, Windecker S, Aboyans V, Agewall S, Barbato E, Bueno H, Coca A, Collet J-P, Coman IM, Dean V, Delgado V, Fitzsimons D, Gaemperli O, Hindricks G, Iung B, Jüni P, Katus HA, Knuuti J, Lancellotti P, Leclercq C, McDonagh TA, Piepoli MF, Ponikowski P, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Zamorano JL, Tsioufis C, Lurbe E, Kreutz R, Bochud M, Rosei EA, Jelakovic B, Azizi M, Januszewics A, Kahan T, Polonia J, van de Borne P, Williams B, Borghi C, Mancia G, Parati G, Clement DL, Coca A, Manolis A, Lovic D, Benkhedda S, Zelveian P, Siostrzonek P, Najafov R, Pavlova O, De Pauw M, Dizdarevic-Hudic L, Raev D, Karpettas N, Linhart A, Olsen MH, Shaker AF, Viigimaa M, Metsärinne K, Vavlukis M, Halimi J-M,Pagava Z, Schunkert H, Thomopoulos C, Páll D, Andersen K, Shechter M, Mercuro G, Bajraktari G, Romanova T, Trušinskis K, Saade GA, Sakalyte G, Noppe S, DeMarco DC, Caraus A,Wittekoek J, Aksnes TA, Jankowski P, Polonia J, Vinereanu D, Baranova EI, Foscoli M, Dikic AD, Filipova S, Fras Z, Bertomeu-Martínez V, Carlberg B, Burkard T, Sdiri W, Aydogdu S, Sirenko Y, Brady A, Weber T, Lazareva I, Backer TD, Sokolovic S, Jelakovic B, Widimsky J, Viigimaa M, Pörsti I, Denolle T, Krämer BK, Stergiou GS, Parati G,Trušinskis K, Miglinas M, Gerdts E, Tykarski A, de Carvalho Rodrigues M, Dorobantu M, Chazova I, Lovic D, Filipova S, Brguljan J, Segura J, Gottsäter A, Pechère-Bertschi A, Erdine S, Sirenko Y, Brady A (2018) 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J.
  3. 3.
    Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT Jr., Whelton PK (2018) Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation 137(2):109–118. CrossRefPubMedGoogle Scholar
  4. 4.
    Burkard T, Mayr M, Winterhalder C, Leonardi L, Eckstein J, Vischer AS (2018) Reliability of single office blood pressure measurements. Heart 104(14):1173–1179. CrossRefPubMedGoogle Scholar
  5. 5.
    Takahashi H, Yokoi T, Yoshika M (2010) Validation of the OMRON HBP-1300 upper arm blood pressure monitor, in oscillometry mode, for clinic use in a general population, according to the European Society of Hypertension International Protocol revision 2010. http://www.dableducationalorg/dableducationalorg/Publications/2014/ESH-IP%202010%20Validation%20of%20Omron%20HBP-1300pdf. Accessed 29 Aug 2018
  6. 6.
    Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J (2016) Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation 134(6):441–450. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Lewington S, Clarke R, Qizilbash N, Peto R, Collins R (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360(9349):1903–1913CrossRefPubMedGoogle Scholar
  8. 8.
    Collins R, MacMahon S (1994) Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull 50(2):272–298CrossRefPubMedGoogle Scholar
  9. 9.
    Phillips RA, Xu J, Peterson LE, Arnold RM, Diamond JA, Schussheim AE (2018) Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension. J Am Coll Cardiol 71(15):1601–1610. CrossRefPubMedGoogle Scholar
  10. 10.
    Wang R, Zhao Y, He X, Ma X, Yan X, Sun Y, Liu W, Gu Z, Zhao J, He J (2009) Impact of hypertension on health-related quality of life in a population-based study in Shanghai, China. Public Health 123(8):534–539. CrossRefPubMedGoogle Scholar
  11. 11.
    Hamer M, Batty GD, Stamatakis E, Kivimaki M (2010) Hypertension awareness and psychological distress. Hypertension 56(3):547–550. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Pickering TG (2006) Now we are sick: labeling and hypertension. J Clin Hypertens (Greenwich) 8(1):57–60CrossRefGoogle Scholar
  13. 13.
    Vaucher J, Marques-Vidal P, Waeber G, Vollenweider P (2018) Population impact of the 2017 ACC/AHA guidelines compared with the 2013 ESH/ESC guidelines for hypertension management. Eur J Prev Cardiol 25(10):1111–1113. CrossRefPubMedGoogle Scholar
  14. 14.
    Whitworth JA (2003) 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 21(11):1983–1992. CrossRefGoogle Scholar
  15. 15.
    Guo X, Zhang X, Guo L, Li Z, Zheng L, Yu S, Yang H, Zhou X, Zhang X, Sun Z, Li J, Sun Y (2013) Association between pre-hypertension and cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Curr Hypertens Rep 15(6):703–716. CrossRefPubMedGoogle Scholar
  16. 16.
    SHEP Cooperative Research Group (1991) Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 265(24):3255–3264CrossRefGoogle Scholar
  17. 17.
    Williams B, MacDonald TM, Caulfield M, Cruickshank JK, McInnes G, Sever P, Webb DJ, Salsbury J, Morant S, Ford I, Brown MJ (2015) Prevention and treatment of hypertension with Algorithm-based therapy (PATHWAY) number 2: protocol for a randomised crossover trial to determine optimal treatment for drug-resistant hypertension. BMJ Open 5(8):e008951. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Williams B, MacDonald TM, Morant S, Webb DJ, Sever P, McInnes G, Ford I, Cruickshank JK, Caulfield MJ, Salsbury J, Mackenzie I, Padmanabhan S, Brown MJ (2015) Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. The Lancet 386(10008):2059–2068. CrossRefGoogle Scholar
  19. 19.
    Agodoa LY, Appel L, Bakris GL, Beck G, Bourgoignie J, Briggs JP, Charleston J, Cheek D, Cleveland W, Douglas JG, Douglas M, Dowie D, Faulkner M, Gabriel A, Gassman J, Greene T, Hall Y, Hebert L, Hiremath L, Jamerson K, Johnson CJ, Kopple J, Kusek J, Lash J, Lea J, Lewis JB, Lipkowitz M, Massry S, Middleton J, Miller ER, Norris K, O’Connor D, Ojo A, Phillips RA, Pogue V, Rahman M, Randall OS, Rostand S, Schulman G, Smith W, Thornley-Brown D, Tisher CC, Toto RD, Wright JT Jr., Xu S (2001) Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial. JAMA 285(21):2719–2728CrossRefPubMedGoogle Scholar
  20. 20.
    Appel LJ, Wright JT Jr., Greene T, Agodoa LY, Astor BC, Bakris GL, Cleveland WH, Charleston J, Contreras G, Faulkner ML, Gabbai FB, Gassman JJ, Hebert LA, Jamerson KA, Kopple JD, Kusek JW, Lash JP, Lea JP, Lewis JB, Lipkowitz MS, Massry SG, Miller ER, Norris K, Phillips RA, Pogue VA, Randall OS, Rostand SG, Smogorzewski MJ, Toto RD, Wang X (2010) Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med 363(10):918–929. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Beck GJ, Berg RL, Coggins CH, Gassman JJ, Hunsicker LG, Schluchter MD, Williams GW (1991) Design and statistical issues of the Modification of diet in renal disease trial. The Modification of Diet in Renal Disease Study Group. Control Clin Trials 12(5):566–586CrossRefPubMedGoogle Scholar
  22. 22.
    Baier D, Teren A, Wirkner K, Loeffler M, Scholz M (2018) Parameters of pulse wave velocity: determinants and reference values assessed in the population-based study LIFE-adult. Clin Res Cardiol. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Figueiredo D, Azevedo A, Pereira M, de Barros H (2009) Definition of hypertension: the impact of number of visits for blood pressure measurement. Rev Port Cardiol 28(7–8):775–783PubMedGoogle Scholar
  24. 24.
    Verberk WJ, Kroon AA, Thien T, Lenders JW, van Montfrans GA, Smit AJ, de Leeuw PW (2006) Prevalence of the white-coat effect at multiple visits before and during treatment. J Hypertens 24(12):2357–2363. CrossRefPubMedGoogle Scholar
  25. 25.
    Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Thygesen K, Alpert JS, White HD, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Chaitman BA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasche P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S (2012) Third universal definition of myocardial infarction. Eur Heart J 33(20):2551–2567. CrossRefGoogle Scholar
  26. 26.
    Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD (2018) Fourth Universal definition of myocardial infarction (2018). J Am Coll Cardiol. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Medical Outpatient Department, ESH Hypertension Center of ExcellenceUniversity Hospital BaselBaselSwitzerland
  2. 2.Department of Internal MedicineUniversity Hospital BaselBaselSwitzerland
  3. 3.Department of CardiologyUniversity Hospital BaselBaselSwitzerland

Personalised recommendations