SynthesisThe British journal of general practice : the journal of the Royal College of General Practitioners2014
Doctors record higher blood pressures than nurses: systematic review and meta-analysis.
Synthesis in The British journal of general practice : the journal of the Royal College of General Practitioners, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 5 syntheses or guidelines pooled it, 60 citations in OpenAlex.
- Revisiting Unattended Versus Attended Automated Office Blood Pressure Measurements: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2025Pooled it
- Nurse-Coordinated Blood Pressure Telemonitoring for Urban Hypertensive Patients: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2021Pooled it
- Optimizing observer performance of clinic blood pressure measurement: a position statement from the Lancet Commission on Hypertension Group.Journal of hypertension · 2019Guideline
- A comparison of blood pressure in community pharmacies with ambulatory, home and general practitioner office readings: systematic review and meta-analysis.Journal of hypertension · 2017Pooled it
- Predictors of the Home-Clinic Blood Pressure Difference: A Systematic Review and Meta-Analysis.American journal of hypertension · 2016Pooled it
- Comparison of unattended, attended and routine clinic systolic blood pressure measurements and determinants of blood pressure difference between attended and unattended BP.Journal of human hypertension · 2026Trial
- A bundled quality improvement program to standardize clinical blood pressure measurement in primary care.Journal of clinical hypertension (Greenwich, Conn.) · 2018Trial
- Trial
- Secondary hypertension for the generalist: When do you refer to hypertension specialist clinics, and how do you screen for secondary hypertension?Clinical medicine (London, England) · 2026Review
- Community Health Workers Equipped with an mHealth Application Can Accurately Diagnose Hypertension in Rural Guatemala.Global heart · 2025Article
- Virtual stressors with real impact: what virtual reality-based biobehavioral research can teach us about typical and atypical stress responsivity.Translational psychiatry · 2024Review
- Prevalence of interarm blood pressure difference is notably higher in women; the Viborg population-based screening program (VISP).BMC public health · 2024Article
- Patient reported outcome measures: The impact of environment on VHI-10 responses.Laryngoscope investigative otolaryngology · 2023Article
- Office blood pressure measurement: A comprehensive review.Journal of clinical hypertension (Greenwich, Conn.) · 2021Review
- Hypertension Prevalence Based on Blood Pressure Measurements on Two vs. One Visits: A Community-Based Screening Programme and a Narrative Review.International journal of environmental research and public health · 2020Review
- Visual Analog Pain Scores Reported to a Nurse and a Physician in a Postoperative Setting.Foot & ankle orthopaedics · 2020Article
- Variation between pragmatic and standardised blood pressure measurements in a Nigerian primary care clinic.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2020Article
- [Optimizing observer performance of clinic blood Pressure measurement: a position statement from the Lancet Commission on Hypertension GroupOtimização do desempenho do observador na medição clínica da pressão arterial: posicionamento do Grupo daRevista panamericana de salud publica = Pan American journal of public health · 2020Article
- Article
- Effect of repeat manual blood pressure measurement on blood pressure and stage of hypertension.Proceedings (Baylor University. Medical Center) · 2019Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe magnitude of the 'white coat effect', the alerting rise in blood pressure, is greater for doctors than nurses. This could bias interpretation of studies on nurse-led care in hypertension, and risks overestimating or overtreating high blood pressure by doctors in clinical practice.
aimTo quantify differences between blood pressure measurements made by doctors and nurses. DESIGN AND
settingSystematic review and meta-analysis using searches of MEDLINE, CENTRAL, CINAHL, Embase, journal collections, and conference abstracts.
methodStudies in adults reporting mean blood pressures measured by doctors and nurses at the same visit were selected, and mean blood pressures extracted, by two reviewers. Study risk of bias was assessed using modified Cochrane criteria. Outcomes were pooled across studies using random effects meta-analysis.
resultsIn total, 15 studies (11 hypertensive; four mixed hypertensive and normotensive populations) were included from 1899 unique citations. Compared with doctors' measurements, nurse-measured blood pressures were lower (weighted mean differences: systolic -7.0 [95% confidence interval {CI} = -4.7 to -9.2] mmHg, diastolic -3.8 [95% CI = -2.2 to -5.4] mmHg). For studies at low risk of bias, differences were lower: systolic -4.6 (95% CI = -1.9 to -7.3) mmHg; diastolic -1.7 (95% CI = -0.1 to -3.2) mmHg. White coat hypertension was diagnosed more frequently based on doctors' than on nurses' readings: relative risk 1.6 (95% CI =1.2 to 2.1).
conclusionsThe white coat effect is smaller for blood pressure measurements made by nurses than by doctors. This systematic difference has implications for hypertension diagnosis and management. Caution is required in pooling data from studies using both nurse- and doctor-measured blood pressures.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.