Is It Time for a Blood Pressure Measurement “Bundle”?
The poor reliability of clinic-based blood pressure (BP) measurements is not news to any practicing primary care provider (PCP). Many studies have documented significant differences between BP values measured in the context of a clinic visit, a research study, at home, and using ambulatory monitors.1–3 For this very reason, some PCPs habitually repeat the BP measurements provided by their staff, something they wouldn’t necessarily consider for more reliable primary care measures like a patient’s body weight.
The study by Ray and colleagues in this issue of JGIM adds to the literature about the reliability of clinic-based BP measurements in a number of ways.4 First, the authors explore the magnitude of the differences between two BP values independently measured on 40 of their hypertensive patients - one measured by clinical staff at triage, and the other by research assistants using BP measurement methods recommended by the American Heart Association (AHA).5 Second, the authors use trai ...
- Hodgkinson J, Mant J, Martin U, Guo B, Hobbs FD, Deeks JJ, et al. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ. 2011;342:d3621. CrossRef
- Powers BJ, Olsen MK, Smith VA, Woolson RF, Bosworth HB, Oddone EZ. Measuring blood pressure for decision making and quality reporting: where and how many measures. Ann Intern Med. 2011;154(12):781–788. W-289-90.
- Kim JW, Bosworth HB, Voils CI, Olsen M, Dudley T, Gribbin M, et al. How well do clinic-based blood pressure measurements agree with the mercury standard? J Gen Intern Med. 2005;20(7):647–649. CrossRef
- Ray GM, Nawarskas JJ, Anderson JR. Blood Pressure Monitoring Technique Impacts Hypertension Treatment. J Gen Intern Med. 2011; doi:10.1007/s11606-011-1937-9.
- Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111(5):697–716. CrossRef
- Appel LJ, Miller ER 3rd, Charleston J. Improving the measurement of blood pressure: is it time for regulated standards? Ann Intern Med. 2011;154(12):838–840.
- Perencevich EN, Lautenbach E. Infection prevention and comparative effectiveness research. JAMA. 2011;305(14):1482–1483. CrossRef
- Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf. 2005;31(5):243–248.
- What is a bundle? Institute for Healthcare Improvement Website. Available at: http://www.ihi.org/knowledge/Pages/ImprovementStories/WhatIsaBundle.aspx. Accessed January 9, 2012.
- McGuckin M, Waterman R, Porten L, Bello S, Caruso M, Juzaitis B, et al. Patient education model for increasing handwashing compliance. Am J Infect Control. 1999;27(4):309–314. CrossRef
- VanLare JM, Conway PH, Sox HC. Five next steps for a new national program for comparative-effectiveness research. N Engl J Med. 2010;362(11):970–973. CrossRef
- Conway PH, Clancy C. Charting a path from comparative effectiveness funding to improved patient-centered health care. JAMA. 2010;303(10):985–986. CrossRef
- Speak Up Initiatives. The Joint Commission Website. Available at: http://www.jointcommission.org/speakup.aspx. Accessed January 4 2012.
- Anderson J, Gosbee LL, Bessesen M, Williams L. Using human factors engineering to improve the effectiveness of infection prevention and control. Crit Care Med. 2010;38(8 Suppl):S269–S281. CrossRef
- Spear ME. Ergonomics and human factors in health care settings. Ann Emerg Med. 2002;40(2):213–216. CrossRef
- Bischoff WE, Reynolds TM, Sessler CN, Edmond MB, Wenzel RP. Handwashing compliance by health care workers: The impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med. 2000;160(7):1017–1021. CrossRef
- Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med. 1999;130(2):126–130.
- Boyce JM. It is time for action: improving hand hygiene in hospitals. Ann Intern Med. 1999;130(2):153–155.
- Feldman RD. ACP Journal Club. Review: Home and clinic BP have limited accuracy compared with ambulatory BP for diagnosing hypertension. Annals of Internal Medicine. 2011;155(12):JC6–10.
- Powers BJ, Oddone EZ, Bosworth HB. Measuring blood pressure for decision making and quality reporting. Ann Intern Med. 2011;155(8):565–566.
- Halamka JD, Mandl KD, Tang PC. Early experiences with personal health records. J Am Med Inform Assoc. 2008;15(1):1–7. CrossRef
- Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560–2572. CrossRef
- The Eighth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8). National Heart Lung and Blood Institute Website. Available at: http://www.nhlbi.nih.gov/guidelines/hypertension/jnc8/index.htm. Accessed January 5, 2012.
- Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010;303(20):2043–2050. CrossRef
- Is It Time for a Blood Pressure Measurement “Bundle”?
Journal of General Internal Medicine
Volume 27, Issue 6 , pp 615-617
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Center for Evidence-based Practice, University of Pennsylvania Health System, 3535 Market Street, Mezzanine, Suite 50, Philadelphia, PA, 19104, USA
- 2. Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- 3. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- 4. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA