Routine versus standardized blood pressure measurements: Agreement and association with cardiovascular disease
- 1Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
- 2Department of Public Health and Clinical Medicine Umeå University Östersund Sweden
Abstract
Background: Recommendations for blood pressure (BP) measurement are poorly followed in clinical practice, possibly leading to inaccurate BP estimates.
Objectives: To assess the agreement between routine and standardized BPs, and the association between BP level and cardiovascular disease (CVD) for each measurement type.
Methods: Standardized BPs were recorded in a screening program for middle‐aged people during 1992–2012 in Sweden. Intraindividual differences between standardized BP and routine BP from primary care were calculated. Association between BP level and composite CVD, and population‐attributable fraction (PAF) explained by BP, were determined through adjusted Cox regression for each measurement type.
Results: In 9567 participants, routine BPs were on average 4.0/1.7 mmHg higher than standardized BPs. Routine measurements frequently misclassified people into higher BP categories; 16% more had hypertension (≥130/80 mmHg), and 50% less had normal BP (<120/80 mmHg), compared with standardized measurements. Analysis of 19,720 participants found a stronger association between BP level and CVD for standardized than for routine measurements, with increased risk from ≥120/80 and ≥140/90 mmHg, respectively. Adjusted hazard ratio for ≥140/90 mmHg compared to <120/80 mmHg was 2.11 (95% confidence interval 1.77–2.51) for standardized BPs and 1.43 (1.15–1.77) for routine BPs. BP ≥120/80 mmHg explained 41.8% (32.0–50.1) of CVD events with standardized measurements and 19.3% (1.5–33.8) with routine measurements.
Conclusion: Routine BPs deviate from standardized BPs, resulting in significant misclassification and attenuated association with CVD, reducing the PAF for BP to less than half. Our findings emphasize the need for accurate BP measurement in clinical practice.
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BibTeX
@article{gastgivars2026routine,
title = {{Routine versus standardized blood pressure measurements: Agreement and association with cardiovascular disease}},
author = {Olivia Gästgivars and Joachim Ögren and Bo Carlberg and Mattias Brunström},
journal = {Journal of Internal Medicine},
year = {2026},
month = sep,
doi = {10.1111/joim.70164},
url = {https://doi.org/10.1111/joim.70164},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Routine versus standardized blood pressure measurements: Agreement and association with cardiovascular disease
AU - Olivia Gästgivars
AU - Joachim Ögren
AU - Bo Carlberg
AU - Mattias Brunström
PY - 2026
DA - 2026/09/24
JO - Journal of Internal Medicine
DO - 10.1111/joim.70164
UR - https://doi.org/10.1111/joim.70164
AB - Background: Recommendations for blood pressure (BP) measurement are poorly followed in clinical practice, possibly leading to inaccurate BP estimates. Objectives: To assess the agreement between routine and standardized BPs, and the association between BP level and cardiovascular disease (CVD) for each measurement type. Methods: Standardized BPs were recorded in a screening program for middle‐aged people during 1992–2012 in Sweden. Intraindividual differences between standardized BP and routine BP from primary care were calculated. Association between BP level and composite CVD, and population‐attributable fraction (PAF) explained by BP, were determined through adjusted Cox regression for each measurement type. Results: In 9567 participants, routine BPs were on average 4.0/1.7 mmHg higher than standardized BPs. Routine measurements frequently misclassified people into higher BP categories; 16% more had hypertension (≥130/80 mmHg), and 50% less had normal BP (<120/80 mmHg), compared with standardized measurements. Analysis of 19,720 participants found a stronger association between BP level and CVD for standardized than for routine measurements, with increased risk from ≥120/80 and ≥140/90 mmHg, respectively. Adjusted hazard ratio for ≥140/90 mmHg compared to <120/80 mmHg was 2.11 (95% confidence interval 1.77–2.51) for standardized BPs and 1.43 (1.15–1.77) for routine BPs. BP ≥120/80 mmHg explained 41.8% (32.0–50.1) of CVD events with standardized measurements and 19.3% (1.5–33.8) with routine measurements. Conclusion: Routine BPs deviate from standardized BPs, resulting in significant misclassification and attenuated association with CVD, reducing the PAF for BP to less than half. Our findings emphasize the need for accurate BP measurement in clinical practice.
SN - 0954-6820
SN - 1365-2796
ER -