Effects of Single and Multiple Blood Pressure Measurement Strategies on the Prediction of Prevalent Screen‐Detected Diabetes Mellitus: A Population‐Based Survey

Abstract

The authors investigated the effects of single and multiple blood pressure (BP) measurements during the same encounter on screen-detected diabetes risk. Data for 9018 Cameroo-nian adults from a community-based survey were used. Resting BP was measured three times 5 minutes apart. Logistic regressions were used to compute the odd ratio (OR) per standard deviation (SD) higher BP variables. Systolic BP, diastolic BP, and mean arterial pressure (MAP), but not pulse pressure, were related to prevalent diabetes. The highest OR (95% confidence interval [CI]) per SD higher pressure were recorded for MAP (OR, 1.16; 95% CI, 1.05-1.28) and systolic BP (OR, 1.15; 95% CI, 1.04-1.27). Estimates of the association were highest for the first, then third, and lastly the second BP measurements. Estimates from average BP measurements were not better than those from single measurement. Single BP measurement is more effective for diabetes risk screening than multiple measurements. Community-based diabetes strategies utilizing a single measurement are simple without compromising the yield. J Clin Hypertens (Greenwich). 2016;18:864-870. ª 2016 Wiley Periodicals, Inc. Higher-than-optimal blood pressure (BP) levels are major determinants of cardiovascular disease risk in diverse populations and settings. 1-3 Diabetes mellitus and other forms of dysglycemia are important public health problems and high blood pressure (BP) has been established as a major driver of the adverse health consequences of diabetes and dysglycemia. 4 Some interventions for controlling BP are also effective for controlling or reducing the risk of diabetes, and lowering BP indices are major targets of strategies for preventing or slowing the progression of diabetes complications. 1,3,5 High BP and dysglycemia tend to coincide, and it is established in routine clinical practice that the presence of one of these abnormalities in an individual should trigger investigations for the presence of the other. As an extension of the above, in the present era where diabetes screening is increasingly advocated, status of hyperten-sion and/or BP variables have been incorporated in multivariable models to predict the presence or future occurrence of diabetes. However, strategies for measuring BP in a routine setting and/or ascertaining the presence of hypertension varies, and can potentially be a deterrent to the adoption of multivariable models, particularly when BP measurement can be time-consuming. For instance, there is a consensus that BP should be measured at least twice during the same encounter to establish accurate BP levels. However, whether strategies based on a single BP measurement during a clinical encounter or the average of several measurements during the same encounter has similar effects on diabetes risk prediction is still uncertain. Previous studies mostly in Caucasian and to some extent Asian populations have evaluated the impact of single measurement, average of multiple measurements of BP, or usual BP levels on the risk of diabetes mellitus, with variable ...

Association of mean arterial pressure with 5-year risk of incident diabetes in Chinese adults：a secondary population-based cohort study

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