How proper blood pressure measurement techniques can help contribute to more accurate hypertension diagnosis.
High blood pressure, also known as hypertension, is a critical, nationwide issue. Nearly half of U.S. adults have hypertension, according to the American College of Cardiology (ACC) and the American Heart Association (AHA). Hypertension occurs when the force of blood flowing through an individual’s blood vessels is consistently too high. If left untreated, the condition can cause heart disease, stroke, and other serious health complications.
Guidelines from the American Heart Association/American College of Cardiology outline four blood pressure (BP) categories that are based on the average of two or more in-office BP readings for a patient. These include normal BP (less than 120 mm Hg systolic BP (SBP) and less than 80 mm Hg diastolic (DBP), elevated (120-129 mm Hg SBP and less than 80 mm DBP), stage 1 hypertension (130-139 mm Hg SBP or 80-89 mm Hg DBP), and stage 2 hypertension (greater than 140 mm Hg SBP or less than 90 mm Hg DBP). High BP is typically symptomless and can quietly damage blood vessels, leading to severe health issues including heart failure, stroke, peripheral artery disease (PAD), abdominal, aortic aneurysm, CVD incidence and angina, myocardial infraction, and more.
After diagnosis in a hypertensive category, physicians should establish best practices to address a patient’s uncontrolled or high BP, according to the AMA, and create an action plan for further treatment.
Combatting hypertension
Timely diagnosis is key to addressing and treating high blood pressure. Hypertension can present in an individual in a variety of different ways, including sustained hypertension, white-coat hypertension, and masked hypertension.
Sustained hypertension occurs when an individual’s blood pressure is elevated regardless of the setting or circumstances, while white-coat hypertension is elevated blood pressure in a medical setting, but normal blood pressure when it is measured at home/during the day. On the other hand, masked hypertension occurs when an individual’s blood pressure is normal in a medical setting, but high when taken at home. White-coat and masked hypertension are inaccurate blood pressure readings caused by the external environment. Of the hypertensive population, 77.5 percent have sustained hypertension, according to the Centers for Disease Control and Prevention and Baxter, which is why it is important to regularly measure BP both at doctor’s appointments and at home.
The positive is that hypertension is manageable, but only one in four adults in the U.S. have hypertension under control, according to the CDC and a Baxter infographic titled “Combatting Hypertension Misdiagnosis with Your Technique.” Following the recommended guidelines for accurate blood pressure measurement includes maintaining proper measurement technique, averaging several readings over time, and using tools such as automated blood pressure devices. These “Three T’s:” technique, time, and tools, according to Baxter, serve to help improve the accuracy of blood pressure readings.
Blood pressure accuracy starts with proper technique when taking a patient’s vital signs. The wrong cuff size, incorrect cuff placement, improper patient positioning, not allowing the patient to rest, verbal conversation while testing, and measuring a patient with a full bladder, can all lead to incorrect BP measurements. Proper technique and the right tools can help physicians achieve more accurate BP results.
Proper BP technique
For better blood pressure readings, clinicians should prepare the patient in advance by asking them to avoid smoking, exercise, and caffeine for 30 minutes before the appointment, and have the patient use the restroom prior to the measurement. When measuring BP, the individual should be instructed to roll up their sleeve, refrain from talking and remain still, sit in a chair with back support, and uncross their legs with their feet flat on the floor.
Physicians should also choose the right cuff size for each individual patient and ensure the cuff’s proper placement. About 39 percent of people misclassified for hypertension were wearing a cuff size that was too small, and 22 percent missed as being hypertensive were wearing a cuff size that was too large, according to Baxter and an American Heart Association study titled “One size does not fit all: impact of using a regular cuff for all blood pressure measurements.”
Clinicians should start a BP measurement by first allowing the patient to rest for five minutes, then place the middle of the cuff on the patient’s bare upper arm over the brachial artery. Leave room for no more than two fingers between a patient’s arm and the cuff and rest the patient’s arm on a flat surface with the cuff at heart level.
Then, select the best method for the reading, as utilizing the proper tools reduces error associated with BP measurements, according to Baxter. Options include an automated office blood pressure (AOBP) device with BP averaging, as recommended by the AHA. Take at least three BP readings, one to two minutes apart.
Some AOBP devices can automatically take multiple readings or take unattended readings without a clinician in the room, allowing for those patients with white-coat hypertension to have a more comfortable environment. AOBP devices also allow for automated data collection and faster results for patients.
Finally, physicians should record each BP reading, calculate the average (under or overestimating BP can result in misdiagnosis), and share the results with the patient.
Physicians should consistently observe and reinforce the proper techniques for BP readings, be conscious of white-coat hypertension, check recorded BP reading for a terminal digit pattern, and consider trying automated vital sign readings.
Prevention and treatment
A small reduction in systolic blood pressure can be beneficial to a patient’s overall health. Just 20 mm Hg higher SBP and 10 mm Hg higher DBP are associated with doubling the risk of death from stroke, heart disease, or other vascular disease according to the CDC and Baxter.
However, just a slightly lower systolic BP has a significant health impact, according to Baxter, as 5 mm Hg lower systolic BP resulted in a 16.3% reduction in age-adjusted hypertension rates among adults 18+.
Physicians can encourage patients to reduce their hypertension risk by exercising regularly, eating healthily, and treating and controlling other conditions such as diabetes mellitus, dyslipidemia and hypercholesterolemia.
Patients should also quit smoking, limit alcohol consumption, and get enough sleep for their cardiovascular health. Early prevention, detection, and treatment can reduce an individual’s risk of hypertension, and healthy lifestyle choices such as these can help reduce the overall lifetime risk of high blood pressure.
Editor’s note: Repertoire would like to thank Baxter for its assistance with the article.
Notes:
US-FLC45-240066 (v1.0) 10/2024
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