How Proper Blood Pressure Measurement Technique Can Help Avoid Hypertension Misdiagnoses

Hypertension Is a Widespread Problem

Hypertension. It impacts approximately 103 million American adults.¹ Out of this hypertensive population, only 54% have their blood pressure under control—putting them at risk for a heart attack or failure, stroke, and kidney damage.^{2, 3} The higher your patients’ blood pressure, the greater the risk of experiencing these side effects.

The statistics are alarming, and so is the reality: blood pressure technique is notoriously easy to get wrong. Any of the following can lead to incorrect measurements:⁴

• Wrong cuff size
• Improper cuff placement
• Improper patient positioning
• Not allowing your patient to rest for five minutes before their blood pressure exam
• Conversation
• Full bladder

To correctly diagnose hypertension, you must eliminate or reduce these variables impacting your measurements.

New Guidelines from the American Heart Association

The American Heart Association recently released an updated scientific statement on blood pressure measurement. This new statement supports the use of automated oscillometric devices with blood pressure averaging capabilities instead of manual blood pressure measurements. Specifically, automated oscillometric devices help reduce the “white-coat effect.” They also deliver similar data to ambulatory blood pressure monitoring, which is the standard for out-of-office blood pressure measurement.^{5, 6}

Furthermore, the most important part of gathering accurate blood pressure measurements, regardless of method, is the initial and ongoing training of healthcare providers.⁵

Improving Blood Pressure Readings in Your Practice

Proper blood pressure measurement technique can help you achieve correct readings. How can you feel confident in your numbers every time? Follow these steps below to help you collect accurate BP measurements in your practice:^{5, 7}

Prepare your patient by asking them to:

• Avoid smoking, exercising and caffeine 30 minutes before blood pressure exam
• Empty their bladder
• Not talk and remain still during measurement
• Roll up their sleeve
• Sit in a chair that supports their back
• Uncross their legs and keep their feet flat on the floor

Choose the right blood pressure cuff size and ensure proper placement:

• Measure your patient’s bicep circumference
  • The wrong cuff size can lead to inaccurate readings:
    • The cuff bladder length should be ≥ 80% of the circumference
    • The cuff bladder width should be ≥ 40% of the circumference
• If your patient is in between sizes, use the larger cuff size
• Place the middle of the cuff on your patient’s bare upper arm, over the brachial artery
• Leave room for no more than two fingers between your patient’s arm and the cuff
• Rest your patient’s arm on a flat surface with cuff at heart level
• Allow your patient to rest for five minutes

Select the best method:

• Use an automated oscillometric device with BP averaging as recommended by the AHA
• Take at least three readings, 1-2 minutes apart
• Some automated oscillometric devices can electronically take multiple readings—with or without a clinician present—to achieve more accurate readings and help reduce the white-coat effect

Record your readings: 

• EMR-connected automated oscillometric devices, like the Welch Allyn Connex® Spot Monitor, can electronically transfer data to your patient’s chart
• Connectivity helps eliminate data-entry errors that may occur with manual transcription

Calculate the average:

• Under- or overestimating BP can result in a misdiagnosis
• Select automated oscillometric devices can electronically take multiple measurements and average blood pressure readings to ensure your patient’s true level is recorded

Share the results with your patient:

• These numbers should be provided verbally and in writing

Diagnose and initiate treatment:

• Confirm a hypertension diagnosis by using ambulatory blood pressure monitoring
• Classify your patient as having normal blood pressure, white-coat hypertension, sustained hypertension or masked hypertension
• Initiate a hypertension therapy plan

Encourage your patient to reduce their risk by:

• Exercising regularly
• Eating healthy
• Controlling other conditions like diabetes mellitus, dyslipidemia and hypercholesterolemia
• Quitting smoking
• Limiting alcohol consumption
• Getting enough sleep

Automated Blood Pressure Devices Can Help You Gather Accurate Blood Pressure Readings

Approximately 103 million American adults are hypertensive.¹ To prevent this alarming number from growing, accurate measurements are vital in diagnosing hypertension. Automated oscillometric devices can help you eliminate or reduce inaccurate blood pressure readings by providing helpful features such as BP averaging, EMR connectivity and more.

Check out the infographic below to learn how you can enable earlier diagnosis and treatment of hypertension in your practice.

References

1. American Heart Association. More than 100 million Americans have high blood pressure, AHA says. https://www.heart.org/en/news/2018/05/01/more-than-100-million-americans-have-high-blood-pressure-aha-says. Accessed December 4, 2018.

2. Centers for Disease Control and Prevention. High Blood Pressure. https://www.cdc.gov/bloodpressure/index.htm. Accessed July 17, 2019.

3. National Institutes of Health. National Heart, Lung, and Blood Institute. JNC 7 Express. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

4. Pickering, Thomas G., MD, DPhil, et. al: Recommendations for Blood Pressure Measurement in Humans and Experimental Animals. Circulation. 2005: 111:697-716.

5. Paul Muntner, Daichi Shimbo, Robert M. Carey, Jeanne B. Charleston, Trudy Gaillard, Sanjay Misra, Martin G. Myers, Gbenga Ogedegbe, Joseph E. Schwartz, Raymond R. Townsend, Elaine M. Urbina, Anthony J. Viera, William B. White, Jackson T. Wright Jr, and on behalf of the American Heart Association Council on Hypertension; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; and Council on Quality of Care and Outcomes Research. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Doi: 10.1161./HYP.0000000000000087. May 1, 2019.

6. Andreadis, Emmanuel A., Geladari, Charalampia V., Angelopoulos, Epameinondas T., Savva, Florentia S., Georgantoni, Anna I., Papademetriou, Vasilios. Journal of the American Heart Association. Attended and Unattended Automated Office Blood Pressure Measurements Have Better Agreement With Ambulatory Monitoring Than Conventional Office Readings. https://www.ahajournals.org/jaha/doi/10.1161/JAHA.118.008994. June 12, 2019.

7. Target: BP. Measure Accurately. https://targetbp.org/blood-pressure-improvement-program/control-bp/measure-accurately/. June 12, 2019.