Final Research Report

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Related Video

About the BP-Check Study
In this video from the Kaiser Permanente Washington Health Research Institute, Principal Investigator Beverly B. Green, MD, MPH, discusses the study and a research participant shares her experience as a patient and being a part of the study.

Journal Citations

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.

Peer-Review Summary

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

Project Information

Beverly B. Green, MD, MPH
Kaiser Permanente Washington Health Research Institute^
$2,802,649
10.25302/08.2021.CER.151132979
Blood Pressure Checks for Diagnosing Hypertension -- The BP-CHECK Study

Key Dates

July 2016
April 2021
2016
2021

Study Registration Information

^The original organization for the project was Group Health Cooperative.

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Last updated: April 20, 2022