NEJM Paper on Ambulatory BP Measurement Retracted

Ivan Oransky, MD

January 30, 2020

The authors of a paper on the relationship between different types of blood pressure measurements and mortality have retracted it from the New England Journal of Medicine (NEJM) after they became aware of errors in their data.

The original paper found that "ambulatory blood-pressure measurements were a stronger predictor of all-cause and cardiovascular mortality than clinic blood-pressure measurements," the authors wrote. It made a bit of a splash, and has been cited 190 times, according to Clarivate Analytics' Web of Science, earning it a "hot paper" and "highly cited paper" designation.

The paper also caught the notice of one commenter on PubPeer, a forum for critiques of studies. And since its publication, the authors have "identified inaccuracies in the analytic database and data analyses underlying" the paper, according to a retraction notice published yesterday.

The paper's last author, Bryan Williams, MD, of University College London, United Kingdom, told Medscape Medical News by email: "This study involved linkage of the world's largest ambulatory blood pressure monitoring (ABPM) data set from the Spanish registry, with clinical outcome data to examine the relationship between ambulatory BP and mortality."

The first author of the paper, José R. Banegas, of Universidad Autónoma de Madrid in Spain, was responsible for developing the database and the statistical analysis, along with his statistician, Williams said. Banegas did not respond to a request for comment from Medscape Medical News.

Williams said that a reader's comments prompted an evaluation of the data, at which point "some errors in the original data tables were identified, which obviously concerned some [of] us." That, in turn, prompted the team to "undertake a review of the core data and the entire analysis with an independent statistical team," he said.

That evaluation "identified errors in the core data base linking the ABPM data to mortality, and this had led to errors in the resultant data tables," Williams said. "We immediately informed all authors and the NEJM of our concerns and concluded that the original data analysis was unreliable and notified the journal that the original paper should be retracted."

"We have subsequently asked for an investigation into the statistical errors by Dr Banegas and his statistician, and this is in its early stages and ongoing," Williams said. "In the meantime, working with the new independent statistical team we are in the process of validating the new data linkage of ABPM and mortality from the core data, and plan to repeat the analyses and reissue this important data as promptly as we can."

NEJM has retracted just 25 papers in its more than 200-year history. Its previous retraction came in December, for plagiarism of an image.

The original study was supported by the Spanish Society of Hypertension, Lacer Laboratories, Fondo de Investigaciones Sanitarias of Instituto de Salud Carlos III, and from Centro de Investigación Biomédica en Red of Epidemiology and Public Health. Williams reported research support from the University College London Hospitals Biomedical Research Centre; receiving consulting fees from Vascular Dynamics, Relypsa, and Novartis; honoraria from Daiichi Sankyo, Boehringer Ingelheim, Servier, and Pfizer; and serving as an advisor to HealthStats PTE, Singapore.

Originial article: N Engl J Med. Published April 19, 2018. Full text

Ivan Oransky, MD, is Medscape vice president, editorial, and cofounder of Retraction Watch.

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