How do minor changes in the definition of blood pressure control affect the reported success of hypertension treatment?

Beverly B. Green, Robert C. Kaplan, Bruce M. Psaty

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objective: In 1999, the first reporting year of the Health Plan Employer Data and Information Set, our organization noted a significant difference in the proportion of patients with controlled blood pressure (BP) when the target was changed from < 140/90 mm Hg to ≤ 140/90 mm Hg. We compared these data with a second larger dataset to determine if these findings were an isolated or common phenomenon and to determine what factors influenced this difference. Study design and methods: Subjects were drug-treated hypertensive patients, Blood pressure measurements were taken from outpatient medical records. Results: The percent of hypertensive patients with controlled BP levels was significantly greater (P≤.001) when the cutoff of ≤140/90 mm Hg was used rather than <140/90 mm Hg. When a single BP measurement was used to estimate control, the percent of patients with controlled hypertension increased 12.7% simply by changing the definition to include the level of systolic BP = 140 mm Hg or diastolic BP = 90. When multiple BP readings were used to estimate control, the difference was much less pronounced (2.7%). Conclusions: When evaluating the success of hypertension treatment, defining BP control as a BP of ≤140 mm Hg systolic and ≤90 diastolic mm Hg will result in significantly more people having controlled BP than when <140 mm Hg systolic and <90 mm Hg diastolie are used. This difference is most likely the result of end-digit preference. The use of multiple measures reduces this effect. Policy makers and guideline authors should consider these aspects when setting BP goals.

Original languageEnglish (US)
Pages (from-to)219-224
Number of pages6
JournalAmerican Journal of Managed Care
Issue number3
StatePublished - Mar 1 2003

ASJC Scopus subject areas

  • Health Policy


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