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Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective ‘mystery shopper’ study in UK primary care
  1. Sarah L Stevens,
  2. Richard J McManus,
  3. Richard John Stevens
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Sarah L Stevens; sarah.stevens{at}


Objectives Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments.

Design (1) An online cross-sectional survey and (2) a prospective ‘mystery shopper’ study where patients agreed to report how BP was measured during their next appointment.

Setting Primary care.

Participants Patient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes.

Primary outcome Proportion of patients having BP measured according to guidelines.

Results 217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively).

Conclusions Current practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance.

  • primary care
  • hypertension
  • general diabetes
  • quality in health care

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  • Contributors All authors conceived and designed the study. SLS was responsible for the management of the study and carried out the statistical analysis. SLS drafted the paper which RJS and RJM then contributed to.

  • Funding This project is funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests RJM has received BP monitoring equipment for research purposes from Lloyds Pharmacies and Omron.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Medical Sciences Interdivisional Research Ethics Committee, University of Oxford (reference: MS-IDREC-C1-2015-095).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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