Underestimation of Blood Pressure and Stroke Risk by Manual Blood Pressure Measurement

ABSTRACT Background Hypertension guidelines recommend the use of automated BP devices over manual devices to reduce observer bias, such as terminal digit preference. We aimed to evaluate systematic differences in BP readings and the association with incident stroke according to type of measurement. Methods Using de-identified electronic health record data from Optum Labs Data Warehouse from primary care visits in 2024, we classified providers’ BP measurement method using proportion of odd terminal digit preference as a proxy for manual devices (defined as