Difference in blood pressure, but not in heart rate, between measurements performed at a health centre and at a hospital by one and the same physician

Abstract

Background: Blood pressure (BP) has been found to vary between examiners, for example it is often higher when measured by a physician than by a nurse. Whether the location for the physician-measured BP is also a source of variation has, however, not been studied. Hence, we found it of interest to find out if the location used for examination was of any significance.Objective: To explore if BP and/or heart rate measured in the same subjects by the same general practitioner in the health centre and at the hospital, differed.Method: Twenty-five hypertensive and 25 age-matched normotensive middle-aged men had their office BP and heart rate recorded by one and the same female general practitioner (IE) who was well known to them, at both the health centre before ambulatory BP equipment was attached to the subject and at the clinical physiological department before an exercise test. The hypertensive patients performed an exercise test and ambulatory BP was measured before and after being treated.Results:The hypertensive patients’ office BP was lower at the health centre than at the hospital, both when they were untreated and after they were treated. The difference (systolic/diastolic (s.d.)) was 9.4/6.0 (7.4/2.7) mm Hg (P < 0.001 for systolic and diastolic bp), when they were untreated. corresponding figures when they were treated were 5.4/4.0 (9.4/4.7) mm hg, a significant difference in diastolic bp (P < 0.001). the normotensive subjects also had a lower office bp at the health centre than at the hospital. the difference (systolic/diastolic (s.d.) was 1.8/5.3 (7.0/5.0) mm hg (P < 0.001 for diastolic bp). heart rate did not differ between recordings in the health centre and in the hospital, either in the hypertensives or in the normotensives.Conclusion: Office BP differed significantly between measurements performed in the health centre and at the hospital. Hence, being examined at a hospital seemed to be a stronger stimuli in most patients than to be examined in a health centre. When diagnosing or evaluating treatment in hypertension, this may have implications.