Evaluating measurement error in readings of blood pressure for adolescents and young adults

Readings of blood pressure are known to be subject to measurement error, but the optimal method for combining multiple readings is unknown. This study assesses different sources of measurement error in blood pressure readings and assesses methods for combining multiple readings using data from a sample of adolescents/young adults who were part of a longitudinal epidemiological study based in Cebu, Philippines. Three sets of blood pressure readings were collected at 2-year intervals for 2127 adolescents and young adults as part of the Cebu National Longitudinal health and Nutrition Study. Multi-trait, multi-method (MTMM) structural equation models in different groups were used to decompose measurement error in the blood pressure readings into systematic and random components and to examine patterns in the measurement across males and females and over time. The results reveal differences in the measurement properties of blood pressure readings by sex and over time that suggest the combination of multiple readings should be handled separately for these groups at different time points. The results indicate that an average (mean) of the blood pressure readings has high validity relative to a more complicated factor-score-based linear combination of the readings.