Accurate measurement of blood pressure (BP) is crucial for effective patient risk assessment and the management of hypertension (HTN). Inaccurate readings can lead to missed or incorrect diagnoses, potentially harming patients by undertreating those with hypertension or unnecessarily medicating those without.
It is imperative to develop and implement precise equipment, procedures, and training to enhance the accuracy of BP measurement at the point of care, facilitating informed decision-making for therapeutic BP management and optimizing HTN control. Hypertension stands as the leading global risk factor for heart disease.
The study’s inclusion criteria encompassed adults aged 18 years or older proficient in English, willing and able to follow instructions, with an arm circumference of ≥18 cm and ≤42 cm, and no history of atrial fibrillation or renal dialysis shunt. Employing a three-group randomized clinical study with a cross-over design, Group A underwent BP readings on a fixed-height exam table and a position-adjustable exam chair.
Group B experienced readings in the reverse order, while Group C served as an independent estimate of the order effect. In cases where the difference between the lowest and highest systolic (SBP) or diastolic (DBP) readings exceeded 10 mmHg, a fourth reading was taken after 1 minute to replace any statistical outliers. The primary analysis focused on the difference in BP between readings on the table and those following the American Heart Association’s (AHA) recommended positioning in the chair.
Notably, BP readings on the table were significantly higher (7.0/4.5 mmHg) than those in the chair (p < 0.0001). This discrepancy persisted irrespective of the order of assessment, aligning with previous findings regarding the impact of factors like foot placement, back support, and cuff positioning on BP measurement accuracy.Â
Despite BP measurement’s critical role in treating leading causes of death, it is often relegated to a routine test conducted by nurses or medical assistants. Unlike other point-of-care diagnostic procedures, there tends to be a lack of attention to proper methods, techniques, and protocols for measuring BP accurately.
The clinical impact of correct technique is underappreciated, especially considering the updated AHA guidelines that lower BP thresholds for therapeutic intervention to 130/80 mmHg instead of the previous 140/90 mmHg. This shift has resulted in over 30 million additional patients in the United States being classified as hypertensive.
Meeting these lower targets often requires higher medication doses or additional pharmaceutical agents, heightening the risk of adverse events related to medications. The article emphasizes the paramount importance of accurate BP measurement in patient care and the potential consequences of inaccurate readings.
It underscores the need for rigorous adherence to proper techniques and protocols, especially given the evolving clinical standards for hypertension management. The study’s findings highlight the significant impact of positioning on BP readings, reinforcing the importance of adopting recommended practices for optimal patient outcomes in hypertension control.Â
Journal Reference Â
Bruce S. Alpert et al, Comparison of outcomes for routine versus American Heart Association-recommended technique for blood pressure measurement (CORRECT BP): a randomised cohort study, eClinicalMedicine (2023). DOI: 10.1016/j.eclinm.2023.102219. Â
