End digit preference in blood pressure measurement in a hypertension specialty clinic in southwest Nigeria

Cardiovasc J Afr. 2012 Mar;23(2):85-9. doi: 10.5830/CVJA-2011-045.


Background: One of the observer errors associated with blood pressure (BP) measurement using a mercury sphygmomanometer is end digit preference (EDP) which refers to the occurrence of a particular end digit more frequently than would be expected by chance alone. Published reports, mainly from outside Africa, have shown a high prevalence ranging from 22 to 90% of end digit zero in BP readings taken by healthcare workers (HCWs). This study examined the prevalence of EDP and patients' and physicians' characteristics influencing the occurrence of EDP.

Methods: A retrospective review was undertaken of BP readings of 114 patients seen over a two-month period at our hypertension specialty clinic.

Results: Nurses and physicians displayed a high frequency of preference for end digit zero in systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. The preference for end digit zero was, however, higher for nurses than for physicians (SBP: 98.5 vs 51.2%, p < 0.001; DBP: 98.5 vs 64.3%, p < 0.001). Among the physicians, the consultant staff displayed the least preference for end digit zero compared to resident doctors. There was no statistically significant difference in gender, age, weight, height and BMI of those with BP readings with end digit zero compared with those with non-zero end digits.

Conclusion: The high prevalence of EDP for zero argues for the training, retraining and certification of HCWs in BP measurement and the institution of a regular monitoring and feedback system on EDP in order to minimise this observer error.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Pressure Determination / instrumentation*
  • Blood Pressure Determination / statistics & numerical data*
  • Clinical Competence
  • Diagnostic Errors*
  • Female
  • Hospitals, Special
  • Humans
  • Hypertension / diagnosis*
  • Male
  • Middle Aged
  • Nigeria
  • Nurses*
  • Observer Variation
  • Physicians*
  • Retrospective Studies
  • Sphygmomanometers / standards*
  • Young Adult