CORRECT BP study finds that proper patient positioning is critical for accurate BP measurements.
Blood pressure (BP) is a vital sign taken at nearly every doctor’s visit, and millions of patients have their BP measured each day. Properly taken, BP measurements are critical for doctors to improve the accuracy of disease diagnosis.
“Midmark Corporation researches important healthcare issues through its Better BP program to offer medical products designed to help improve clinical care,” said Dr. Tom Schwieterman, Chief Medical Officer and Vice President of Clinical Affairs for Midmark.
Midmark funded a study conducted by The Ohio State University (OSU) Department of Family and Community Medicine to test current American Heart Association (AHA) guidelines for proper patient positioning. The authors of the study are Bruce S. Alpert, Joseph E. Schwartz, Mira Shapiro and Randell K. Wexler.
Results of the CORRECT BP study confirm AHA-recommended patient positioning affects BP measurements and show that improper positioning can result in higher BP measurements. The authors and Midmark believe it is important for healthcare systems to understand the results for more effective care of their patients.
The impact of correct BP measurement
Something as seemingly minor as improper patient positioning can negatively affect BP measurements. As shown by the CORRECT BP study, AHA-recommended patient positioning can decrease BP measurements by 7.0 millimeters of mercury (mmHg) for systolic BP (top number) and 4.5 mmHg for diastolic BP (bottom number).
The 7.0/4.5 difference was statistically significant and clinically important. Improper positioning (a patient sitting on a chair or fixed-height table with their arm and feet unsupported) leads to incorrect BP results that could impact the clinical decisions of physicians. It is likely there are millions of people throughout the country that are not having their BP measured correctly.
Midmark has worked diligently to inform clinicians of the importance of Better BP and the results of the CORRECT BP study.
“What we’re finding is that the Better BP concept resonates with clinicians and others who understand that blood pressure is a critical part of the care chain. Midmark has been researching this concept for some time and we feel we’re creating real value in the marketplace,” said Dr. Schwieterman.
BP is one of the most important vital signs because it is such an important contributing factor to many chronic diseases and is also a risk factor for cognitive disorders. With BP, there is a real opportunity to reduce current trends, cost escalations, and the morbidity of the U.S. patient population.
“As a clinical team, through the CORRECT BP study, we found that once we dove into the past research on the topic, there were many studies on every individual aspect of blood pressure positioning, such as that the patient’s back needs to be supported, or a patient’s feet must be on the floor, or their arms must be supported with an armrest, or the cuff has to be at the right level,” said Dr. Schwieterman.
For instance, the 2015 SPRINT study published in The New England Journal of Medicine reported that reducing the BP treatment threshold from 140/90 to 130/80 was estimated to reduce cardiovascular events by more than 25%. The researchers for the study were selective and focused on specific patient preparation aspects – such as patient positioning, avoiding caffeine prior to measurement, and making sure that patients had a rest period and that they were comfortable before having their BP measured.
The information reported in the 2015 study was impactful, and if widely followed, had the potential to prevent one in every four heart attacks, strokes, and other vascular disorders. Once the SPRINT study was published, guidelines for how BP should be taken were revised across the nation.
In 2017, AHA published new guidelines for in-clinic BP measurement that largely mirrored the highly specific protocol for BP measurement defined in the study published in the New England Journal of Medicine. Many of the known causes for avoidable variation in point of care measurement were taken into account in the protocol, except for the known impact of white coat hypertension.
Individual aspects of proper BP measurement had been studied previously, but to see the affect on resting BP measurement when the most common causes of error were evaluated at the same time, rather than individually, Midmark supported further research the topic.
The CORRECT BP study was designed to determine the effects of poor positioning that occur when BP is taken with the patient sitting on a typical clinical exam room fixed-height table, where the feet are not flat on the floor, the back is not supported and the arm is not supported with the BP cuff at heart level. The results of this study support AHA-recommended guidelines for patient positioning when doing BP measurements.
Better BP and distributor reps
Midmark funded the CORRECT BP study to be conducted at OSU by Dr. Randy Wexler as the principal investigator. Dr. Wexler has a longstanding professional interest in BP management and is an experienced clinical researcher within the OSU Department of Family and Community Medicine. “We were confident Dr. Wexler and the other authors would ensure the study findings were unbiased and could be trusted by the medical professional community,” said Dr. Schwieterman. “As a peer-reviewed study published by a well-respected medical journal, we feel the CORRECT BP study is likely to be well received by clinicians who distributor reps share it with.”
Whenever a distributor rep is selling to a doctor, they have different categories that the product could fall into, said Dr. Schwieterman. “These can include equipment or supplies, infrastructure, or appealing to the deep-seated, if not emotional, focus a clinician places on how these products impact care and drive better population health results,” he said. “What Midmark has done is create a package that says to physicians when they set up an ecosystem with all these correct environmental needs, you’re also setting up the patient for success with their clinical care and clinical outcome which maps directly toward value-based care.”
Distributor reps can assure their customers that they are not only getting the best aesthetic, design, workflow, and barrier-free engagement with patients through Better BP practices and equipment, but also clinical results that are trustworthy and reliable. Focusing on those attributes, and the fact that Better BP ensures BP measurements can be better at the point of care, allows distributor reps to sell Better BP to physicians.
Midmark has resources for sales reps to assist them in conveying to doctors in the selling process how many people this study could impact if they implement Better BP practices.
Stated Dr. Schwieterman, “Millions of patients get their blood pressure measured at doctors’ visits every day, and the thought that Midmark could help increase the accuracy of this very important vital sign is very exciting. It impacts dealer reps that are calling on point of care practices on a daily basis.”
Editor’s note: Repertoire would like to thank Midmark for their assistance with this article.
Sidebar:
Key findings of the CORRECT BP study include:
- AHA-recommended positioning resulted in substantially lower BP values when compared to those readings obtained within routine clinical care where AHA-recommended positioning procedures for BP attainment were not followed.
- BP readings taken on a fixed-height exam table where the proper AHA protocol could not be achieved were significantly higher than readings taken using the proper technique with the patient seated in an exam chair with adjustable positioning options.
- Pooled systolic/diastolic BP readings taken on the exam table with incorrect positioning were markedly higher by 7.0/4.5 mmHg (both p<0.0001) than those taken in the exam chair.
- These significantly higher readings could result in misclassifying a patient as having hypertension
- The observed benefit of proper positioning is sufficient to change the classification of BP disorders for millions of patients from hypertensive to normal.
- The results support estimates that as many as 30 million or more Americans may be incorrectly classified as having hypertension.