Standardized blood pressure better predicts risk

Routine clinic blood pressure readings overestimated blood pressure and predicted cardiovascular disease less accurately.
*Retrospective cohort study; Level 2b (OCEBM).

Citation

Gästgivars O, Ögren J, Carlberg B, Brunström M. Routine versus standardized blood pressure measurements: agreement and association with cardiovascular disease. Journal of Internal Medicine. 2026. doi:10.1111/joim.70164

Background

Blood pressure trials and guidelines rely on careful measurement, but everyday clinic readings often do not follow recommended methods. This study tested whether routine readings agree with standardized readings and whether each predicts later cardiovascular disease.

Patients

Middle-aged adults in Västerbotten County, Sweden, with standardized screening blood pressure and prior routine primary care blood pressure. For outcome analyses, those with prior myocardial infarction, ischemic heart disease, stroke, transient ischemic attack, or heart failure were excluded.

Intervention

Routine primary care blood pressure measurement, performed without specific study instructions.

Control

Standardized blood pressure measurement by trained nurses using a prespecified protocol.

Outcome

Agreement between measurement methods; first hospitalization or death from myocardial infarction, stroke, or heart failure.

Follow-up Period

Mean 12.6 years for cardiovascular outcomes.

Results

Finding Result
Routine versus standardized blood pressure 4.0/1.7 mmHg higher (CI not reported)
Hypertension classification, routine readings 16% more classified as hypertensive
Normal blood pressure classification, routine readings 50% fewer classified as normal
Cardiovascular risk at ≥140/90 mmHg, standardized readings HR 2.11 (95% CI 1.77 to 2.51)
Cardiovascular risk at ≥140/90 mmHg, routine readings HR 1.43 (95% CI 1.15 to 1.77)
Events attributed to blood pressure ≥120/80 mmHg, standardized readings 41.8% (95% CI 32.0 to 50.1)
Events attributed to blood pressure ≥120/80 mmHg, routine readings 19.3% (95% CI 1.5 to 33.8)

HR = hazard ratio.

Limitations

Observational design limits causal conclusions. Measurements were not simultaneous, although sensitivity analyses were reassuring. Data came from one Swedish region and older measurement practices, limiting generalizability. Routine measurement details and treatment changes were unavailable.

Funding

Public/nonprofit Swedish funding; one author reports industry honoraria.

Clinical Application

Use standardized office technique before diagnosing or intensifying hypertension, especially near lower treatment thresholds; routine readings may overdiagnose and misclassify risk.