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Recommended standards for assessing blood pressure in human research where blood pressure or hypertension is a major focus

Journal of Human Hypertension volume 31, pages 487–490 (2017)Cite this article

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Standardized and rigorous methods for blood pressure (BP) measurement are necessary to ensure the comparability and accuracy of BP assessments for individuals due to the effects of measurement error, diurnal variation and short- and long-term variability.1, 2, 3, 4, 5, 6, 7, 8, 9, 10 Many studies have demonstrated substantive changes in BP related to methodological issues when the BP assessment did not satisfy the established standards.6, 8, 11, 12, 13 It is thought that a lack of rigor/standardization in assessing BP may reduce or mask the relationship between BP, lifestyle changes or antihypertensive medications and adverse outcomes. For example, the INTERHEART study assessed BP status solely by asking participants if they had been diagnosed with hypertension in many countries where awareness of hypertension diagnosis was low.14 Not surprisingly, the INTERHEART study found hypertension to be the sixth leading risk for acute myocardial infarction, while based on numerous studies, there is a consensus that increased BP is the leading risk for ischaemic heart disease.15 The INTERHEART findings could mislead policy makers that hypertension control is not as high a priority intervention as interventions on risks that ranked higher. Further, observations of non-BP-lowering effects of antihypertensive drugs may be attributed to inadequate assessment of BP or inadequate assessment of BP could limit the ability to detect cardiac effects of non-cardiovascular drugs or their interaction with other medications.16, 17, 18 Nevertheless, many investigators historically have not published the training and accuracy testing of those assessing BP and have not indicated the technical and methodological aspects of assessing BP in clinical research studies where BP was a major focus.19

An inTernational consoRtium for qUality resEarch on dietary sodium/salt (TRUE) was formed to make recommendations to improve the quality of research on dietary salt. Lack of standardization and quality of BP measurement was viewed as a factor, creating controversy about the relationship of dietary salt to increased BP and hypertension. Initially focussed on setting recommended standards for assessing BP in human studies on dietary salt, the mandate was expanded, recognizing low-quality BP assessment as a widespread issue with the potential to adversely impact all human BP research.

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Acknowledgements

The TRUE Consortium would like to acknowledge the contributions of Mark Niebylski, Kimbree Redburn and Aaron Lucko in supporting the TRUE consortium. Funding was provided by the Heart and Stroke Foundation (Canada)-Canadian Institute for Health Research Chair in Hypertension Prevention and Control with in kind support from the World Hypertension League; grant number PG-11-0531.

The members of the TRUE sodium expert committee are Drs Cheryl Anderson, Larry Appel, Norm Campbell (Chair), Mary Cogswell, Nancy Cook, Antti Jula, Mary L’Abbe, Graham MacGregor, Rachael McLean, Doreen Rabi, Mark Woodward and JoAnne Arcand and were supported by Tej Khalsa, Claire Johnson, Alex Leung, Birinder Mangat and Mark Niebylski. External blood pressure assessment experts who are not part of the TRUE sodium expert committee who contributed to this specific set of recommendations include Mark Gelfer, Pedro Ordunez, Bruce Alpert, Raj Padwal, Lyne Cloutier, George Stergiou, Eoin O’Brien, Don MacKay, Martin Myers, Joseph Flynn, Janusz Feber, Michael Rakotz, Fleetwood Loustalot and Janis Dionne.

Author information

Authors and Affiliations

  1. Libin Cardiovascular Institute of Alberta, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Alberta, Canada

    Norm Campbell

Consortia

TRUE Consortium

  • Stephen Daniels
  • , Francesco P Cappuccio
  • , Liu Lisheng
  • , Janusz Kaczorowski
  • , Antti Jula
  • , Alison Atrey
  • , Rhian Touyz
  • , Ricardo Correa-Rotter
  • , Michael Weber
  • , Jacqui Webster
  • , Branka Legetic
  • , Norm Campbell
  • , Graeme Hankey
  • , Temo Waqanivalu
  • , Cheryl Anderson
  • , Larry Appel
  • , Mary Cogswell
  • , Fleetwood Loustalot
  • , Nancy Cook
  • , Mary L'Abbe
  • , Graham MacGregor
  • , Rachael McLean
  • , Doreen Rabi
  • , Tej Khalsa
  • , Alex Leung
  • , Mark Woodward
  • , JoAnne Arcand
  • , Claire Johnson
  • , Mark Niebylski
  • , Mark Gelfer
  • , Pedro Ordunez
  • , Bruce Alpert
  • , Raj Padwal
  • , Lyne Cloutier
  • , George Stergiou
  • , Eoin O'Brien
  • , Don MacKay
  • , Martin Myers
  • , Joseph Flynn
  • , Janusz Feber
  • , Michael Rakotz
  • , Janis Dionne
  •  & Birinder Mangat

Corresponding author

Correspondence to Norm Campbell.

Ethics declarations

Competing interests

Specific conflicts of interest of each member of the TRUE Consortium can be found in Supplementary Appendix. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Additional information

Member organizations and their representatives in the TRUE Consortium The member organizations and their representatives in the TRUE Consortium are: Stephen Daniels – American Heart Association, Dallas, TX, USA Francesco P Cappuccio – British Hypertension Society, Edinburgh, UK Liu Lisheng – Chinese Regional Office of the World Hypertension League, Beijing, China Janusz Kaczorowski – Hypertension Canada, Markham, Ontario, Canada Antti Jula – International Association of National Public Health Institutes, Atlanta, GA, USA Alison Atrey – International Council of Cardiovascular Prevention and Rehabilitation, Toronto, Canada Rhian Touyz, Agustin Ramirez – International Society of Hypertension, Teddington, UK Ricardo Correa-Rotter – International Society of Nephrology, Brussels, Belgium Michael Weber – Journal of Clinical Hypertension, New York, NY, USA Jacqui Webster – World Health Organization Collaborating Centre for Population Salt Reduction, Sydney, NSW, Australia Branka Legetic – Pan American Health Organization/World Health Organization Technical Advisory Group on Cardiovascular Diseases, Geneva, Switzerland Norm Campbell (Chair) – World Hypertension League, Corvallis, OR, USA Graeme Hankey – World Stroke Organization, Geneva, Switzerland Temo Waqanivalu – World Health Organization, Geneva, Switzerland Cheryl Anderson – University of California, San Diego, CA, USA Larry Appel – Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Mary Cogswell, Fleetwood Loustalot – Center for Disease Control and Prevention, Atlanta, USA Nancy Cook – Brigham & Women’s Hospital Division of Preventative Medicine, Boston, MA, USA Mary L’Abbe – University of Toronto, Toronto, ON, Canada Graham MacGregor – Queen Mary University of London, London, UK Rachael McLean – University of Otago, Dunedin, New Zealand Doreen Rabi, Tej Khalsa, Alex Leung – University of Calgary, Calgary, AB, Canada Mark Woodward – University of Sydney, Sydney, NSW, Australia JoAnne Arcand – University of Ontario Institute of Technology, Oshawa, ON, Canada Claire Johnson – The George Institute for Global Health, New Town, NSW, Australia Mark Niebylski – World Hypertension League, Poplar, MT, USA Mark Gelfer – Copeman Healthcare Center, Vancouver, BC, Canada Pedro Ordunez – Pan American Health Organization, Washington, DC, USA Bruce Alpert – The University of Tennessee Health Science Center, Memphis, TN, USA Raj Padwal – University of Alberta, Edmonton, AB, Canada Lyne Cloutier – Montreal Heart Institute, Montreal, QC, Canada George Stergiou – University of Athens, Athens, Greece Eoin O’Brien – University College Dublin, Ublin, UK Don MacKay – Memorial University, St. Johns, Canada Martin Myers – Sunnybrook Health Sciences Center, Toronto, ON, Canada Joseph Flynn – Seattle Children’s Hospital, Seattle, WA, USA Janusz Feber – University of Ottawa, Ottawa, ON, Canada Michael Rakotz – Feinberg School of Medicine, Chicago, IL, USA Janis Dionne, Birinder Mangat – University of British Columbia, Vancouver, BC, Canada

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TRUE Consortium. Recommended standards for assessing blood pressure in human research where blood pressure or hypertension is a major focus. J Hum Hypertens 31, 487–490 (2017). https://doi.org/10.1038/jhh.2017.10

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