Automated BP vs Manual BP Measurement: Which is Better? (Part 1 of 2)

What’s a clinician to do? Debates about clinical trials, patient populations, and statistical analyses can seem hollow and distant when looking at an anxious patient in an exam room. At that moment, all that matters is what’s best for your patient. Yet clinically relevant data, and more importantly, rigorous discussion of that data, is the means to the end. Professional clinicians quite often need the former in order to effectively deliver the latter. To wit, two similar journal articles were recently published that arrived at two very different conclusions. Let’s take a look:

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Blood Pressure in your Medical Practice

Thanks to the increasing concern regarding cardiovascular disease, blood pressure (BP) is one of the more well-known vital signs. Just about everyone has had their BP measured in a clinic. In the last few years, many track their own BP with the widespread availability and affordability of home monitors. Although experts in cardiology regard ambulatory blood pressure monitoring (ABPM) as the gold standard, it is not as frequently used in regular medical practice as in-office or home BP. Each method has its benefits and disadvantages.

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Physician Acquired Blood Pressure Measurement is Higher than Nurse Acquired BP

There are several different types of mild and/or episodic hypertension that ambulatory blood pressure monitoring (ABPM) can help a physician diagnose. However, the summary data that ABPM provides, the average daytime or 24-hour blood pressure as two examples, provides significantly different information than the one or two measurements taken in a clinic. Although this difference is one of the reasons that ABPM correlates better to cardiovascular outcomes than in-clinic BP, making it the gold standard for BP measurement, there are few detailed guidelines on the targets or thresholds for ABP like there are for in-clinic BPs like the popular 120/80 as a threshold for normal BP and 140/90 for hypertensive.*

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Wrist versus Upper Arm Blood Pressure Measurement

Is wrist BP an acceptable way to guide treatment for obese patients?

For over 100 years, upper arm blood pressure (BP) measurement has been the gold standard method to guide treatment decisions. This is the recommended technique by both the American Heart Association (AHA) and the European Society of Hypertension (ESH).

For almost nearly as long, it has been well documented that inappropriate sizing of blood pressure cuffs can contribute significantly to errors in blood pressure measurement. Of the most common errors is "undercuffing", which occurs when using cuffs that are too small or too narrow for the patient's arm circumference.

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Blood Pressure Fluctuations: 'Warning Sign for Stroke'

Last week we addressed a report from the Institute of Medicine indicating that high blood pressure is not on the minds of the general public. However, in the most recent issue of the Lancet, a different view of hypertension was posted: what if your physician is looking at the wrong BP values? What if there is more to clinic blood pressure, or the measurement that your physician takes, than the average value?

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Back to the Basics of Blood Pressure

Almost everyone knows that blood pressure is one of the most important measurements in medicine. Every time a patient visits a physician's office or hospital, one of the first measurements taken is their blood pressure. Since blood pressure plays such a vital role in monitoring a person's overall health, I thought I would write about the basics of blood pressure and some of the terminology used in blood pressure measurement.

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10 Factors That Can Affect Blood Pressure Readings

Have you ever visited the doctor's office and discovered your blood pressure was higher than you expected? Most people do not realize their blood pressure is constantly changing minute by minute in response to mood, activity, body position, etc. In fact, simple changes can cause blood pressure to fluctuate between 5 and 40 mmHg. Here is a list of 10 factors that can temporarily cause significant deviations in your blood pressure measurements.

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Advantages of Automated Blood Pressure Measurement during Cardiac Stress Testing

Cardiac stress testing is commonly used to gauge how well the heart works and to identify if a patient is at risk for cardiovascular disease (CVD). During a cardiac stress test a patient walks on a treadmill or rides a stationary bike. As exercise intensity increases, the heart has to pump harder and use more oxygen. This mimics the strain placed on the heart when arteries are blocked or narrowed. Several parameters are monitored during the stress test including ECG waveforms, blood pressure, and oxygen saturation.

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Online Blood Pressure Measurement Resources

Since our initial blog post '10 steps to Accurate Manual Blood Pressure Measurement', we've had a few readers contact us seeking some more resources related to taking manual blood pressures and hypertension in general. Below are a couple of websites we've found helpful on these topics.

1. An easy to understand demonstration of blood pressure

The European Society of Hypertension (ESH) created a simple guide to everything blood pressure.  The animated menu covers everything from the physiology basics to treatment options.  It’s a great education tool for patients- click the link below to give it a try!

http://www.my-hypertension.org/blood-pressure-simple-guide/index_eng.htm

2. A video tutorial and technique test on blood pressure measurement from the British Hypertension Society (BHS)

The first section of this tutorial is a video of blood pressure measurement.

The remainder of this section allows you to test your accuracy by recording 34 blood pressure values and comparing your results with those obtained by 24 experienced observers. It's a simple and effective way to stay in practice with manual BP measurement

http://www.abdn.ac.uk/medical/bhs/tutorial/tutorial.htm

10 Steps to Accurate Manual Blood Pressure Measurement

Working for a company that develops blood pressure monitoring devices and technologies, I deal with blood pressure on some level every day. We make accurate and reliable blood pressure measurement our business...literally. So, it only makes sense that we should care about accurate blood pressure measurement from a fundamental perspective, which is the inspiration for my first blog post.

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