Abstract
BACKGROUND
In 2005 the American Heart Association (AHA) released updated recommendations for blood pressure (BP) monitoring in order to ensure accurate BP measurements.
OBJECTIVE
To determine if current methods of BP assessment in an ambulatory clinic result in significantly different BP measurements than those obtained by following the AHA recommendations and if these BP differences impact treatment decisions.
RESEARCH DESIGN
Randomized prospective analysis.
SETTING
University of New Mexico Hospital Adult Internal Medicine clinic.
PATIENTS
Forty adults with hypertension
METHODS
Patient BPs were measured using both the traditional triage method and the AHA-recommended method in cross-over fashion in random order. Two complete medical profile summaries were then constructed for each patient: one for each BP measurement obtained by each technique. These profiles were then reviewed by a panel of providers who provided hypothetical hypertension treatment recommendations.
RESULTS
Individual BP results varied greatly between the two methods. SBP readings differed by ≥5 mmHg in either direction for 68% of patients while 78% of patient’s DBP readings differed by ≥2 mmHg in either direction. Overall, 93% of patients had a BP difference of either ≥5 mmHg systolic or ≥2 mmHg diastolic. Five patients were determined to be at goal with the triage method, but were higher than their goal BP with the AHA method Significant differences were also seen in treatment recommendations for a given patient based on the differences seen between the two obtained BP readings. The number of patients with treatment variations between their two profiles ranged from 13% to 23% depending on the reviewing provider (p < 0.01 for all providers).
CONCLUSION
Inaccurate BP assessment is common and may impact hypertension treatment decisions.
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Acknowledgements
This study was not supported by any internal or external funding.
The authors would like to acknowledge the physicians and staff from the UNM Internal Medicine Clinic.
Conflict of Interest
None disclosed.
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Ray, G.M., Nawarskas, J.J. & Anderson, J.R. Blood Pressure Monitoring Technique Impacts Hypertension Treatment. J GEN INTERN MED 27, 623–629 (2012). https://doi.org/10.1007/s11606-011-1937-9
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DOI: https://doi.org/10.1007/s11606-011-1937-9