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(Stroke. 2001;32:2697.)
© 2001 American Heart Association, Inc.

Research Report

Are Two Really Better Than One?

Empirical Examination of Repeat Blood Pressure Measurements and Stroke Risk in the Renfrew/Paisley and Collaborative Studies

Carole L. Hart, MA; David J. Hole, MSc George Davey Smith, MD

From the West of Scotland Cancer Surveillance Unit (D.J.H.), Department of Public Health (C.L.H.), University of Glasgow, Glasgow, UK, and the Department of Social Medicine (G.D.S.), University of Bristol, Bristol, UK.

Correspondence to Carole Hart, Department of Public Health, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK. E-mail c.l.hart{at}udcf.gla.ac.uk

Abstract

Background and Purpose—— Blood pressure measured on 2 occasions in 2 large prospective cohort studies in Scotland was related to stroke, defined as stroke mortality or hospital admission for stroke. The purpose was to investigate whether 2 blood pressure readings gave a more accurate estimate of stroke risk over a long follow-up period than 1 reading.

Methods—— In the 1970s, the Renfrew/Paisley general population study investigated 3060 men and 3502 women and the Collaborative study investigated 2683 employed men on 2 occasions. The mean years between screening were 4 and 5, respectively. Blood pressure measured on the 2 occasions was related to stroke risk in 17-year and 21-year follow-up periods after the second screening, respectively.

Results—— For both systolic and diastolic blood pressure, the mean of the measures on the 2 occasions, the maximum of the 2 measures and the measure corrected for regression dilution was more strongly related to stroke over the follow-up periods than either single measure.

Conclusions—— Two blood pressure measurements seem better than 1 for indicating stroke risk. Underestimation using single measures will lead to both misclassification of the risk of disease for individuals and also the population-attributable risk of disease associated with elevated blood pressure.

Key Words: blood pressure • epidemiology • prospective studies • stroke prevention

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