{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T13:22:53Z","timestamp":1771680173582,"version":"3.50.1"},"reference-count":32,"publisher":"BMJ","issue":"1","funder":[{"name":"North York General Hospital Exploration Fund"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,12,18]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To study systematic errors in recording blood pressure (BP) as measured by end digit preference (EDP); to determine associations between EDP, uptake of Automated Office BP (AOBP) machines and cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective observational study using routinely collected electronic medical record data from 2006 to 2015 and a survey on year of AOBP acquisition in Toronto, Canada in 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Primary care practices in Canada and the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults aged 18 years or more.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Mean rates of EDP and change in rates. Rates of EDP following acquisition of an AOBP machine. Associations between site EDP levels and mean BP. Associations between site EDP levels and frequency of cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>707\u2009227 patients in Canada and 1 558 471 patients in the UK were included. From 2006 to 2015, the mean rate of BP readings with both systolic and diastolic pressure ending in zero decreased from 26.6% to 15.4% in Canada and from 24.2% to 17.3% in the UK. Systolic BP readings ending in zero decreased from 41.8% to 32.5% in the 3\u2009years following the purchase of an AOBP machine. Sites with high EDP had a mean systolic BP of 2.0\u2009mm Hg in Canada, and 1.7\u2009mm Hg in the UK, lower than sites with no or low EDP. Patients in sites with high levels of EDP had a higher frequency of stroke (standardised morbidity ratio (SMR) 1.15, 95%\u2009CI 1.12 to 1.17), myocardial infarction (SMR 1.16, 95%\u2009CI 1.14 to 1.19) and angina (SMR 1.25, 95%\u2009CI 1.22 to 1.28) than patients in sites with no or low EDP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Acquisition of an AOBP machine was associated with a decrease in EDP levels. Sites with higher rates of EDP had lower mean BPs and a higher frequency of adverse cardiovascular outcomes. The routine use of manual office-based BP measurement should be reconsidered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-024970","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T06:28:31Z","timestamp":1548397711000},"page":"e024970","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8957-0285","authenticated-orcid":false,"given":"Michelle","family":"Greiver","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada"},{"name":"North York General Hospital, Toronto, Ontario, Canada"},{"name":"Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumeet","family":"Kalia","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teja","family":"Voruganti","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babak","family":"Aliarzadeh","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahim","family":"Moineddin","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Hinton","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Dawes","sequence":"additional","affiliation":[{"name":"Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Medical School, University of St Andrews, St Andrews, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saddaf","family":"Syed","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"de Lusignan","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK"},{"name":"Royal College of General Practice Research and Surveillance Centre, St Andrews, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,1,24]]},"reference":[{"key":"2025121409442408000_9.1.e024970.1","unstructured":"World Health Organization, global health estimates. 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