What is considered low blood pressure. How does a reading of 99/66 compare to normal ranges. What are the potential causes and symptoms of low blood pressure. When should you be concerned about low blood pressure readings.

Decoding Blood Pressure Readings: What Do the Numbers Mean?

Blood pressure is a vital sign that measures the force of blood pushing against the walls of your arteries as your heart pumps blood. It’s typically expressed as two numbers:

• Systolic pressure (the top number): Represents the pressure in your arteries when your heart beats
• Diastolic pressure (the bottom number): Indicates the pressure in your arteries between heartbeats

A blood pressure reading of 99/66 means that the systolic pressure is 99 mmHg (millimeters of mercury) and the diastolic pressure is 66 mmHg. But what does this reading signify in terms of your overall health?

Is 99/66 Considered Low Blood Pressure?

Generally, a blood pressure reading below 90/60 mmHg is considered low blood pressure, also known as hypotension. While 99/66 is not technically classified as hypotension, it’s on the lower end of the normal range. Here’s a breakdown of blood pressure categories:

• Normal: Less than 120/80 mmHg
• Elevated: 120-129/less than 80 mmHg
• High Blood Pressure (Hypertension) Stage 1: 130-139/80-89 mmHg
• High Blood Pressure (Hypertension) Stage 2: 140/90 mmHg or higher
• Hypertensive Crisis: Higher than 180/120 mmHg

A reading of 99/66 falls within the normal range but is closer to the lower end. For some individuals, this may be perfectly healthy, while for others, it could indicate an underlying issue.

Potential Causes of Lower Blood Pressure Readings

Several factors can contribute to lower blood pressure readings like 99/66:

1. Genetics: Some people naturally have lower blood pressure
2. Age: Blood pressure tends to rise as we get older
3. Physical fitness: Athletes and those who exercise regularly often have lower blood pressure
4. Medications: Certain drugs, such as diuretics or beta-blockers, can lower blood pressure
5. Medical conditions: Conditions like heart problems, endocrine disorders, or dehydration can affect blood pressure
6. Pregnancy: Blood pressure often drops during the first 24 weeks of pregnancy

It’s important to note that a single reading of 99/66 doesn’t necessarily indicate a problem. Blood pressure fluctuates throughout the day, and factors like stress, physical activity, and even the time of day can influence readings.

Symptoms Associated with Low Blood Pressure

While a blood pressure of 99/66 isn’t classified as low, some individuals might experience symptoms associated with lower blood pressure. These can include:

• Dizziness or lightheadedness
• Fainting (syncope)
• Blurred vision
• Nausea
• Fatigue
• Lack of concentration
• Cold, clammy skin
• Rapid, shallow breathing
• Depression

If you consistently have blood pressure readings around 99/66 and experience these symptoms, it’s advisable to consult with a healthcare professional.

When Should You Be Concerned About Low Blood Pressure?

Low blood pressure becomes a concern when it causes symptoms or is indicative of an underlying health issue. Here are some scenarios where you should seek medical attention:

• If you experience frequent symptoms of low blood pressure
• If your blood pressure suddenly drops significantly from your normal range
• If low blood pressure is accompanied by severe symptoms like chest pain, shortness of breath, or loss of consciousness
• If you have a history of heart disease, diabetes, or other conditions that can affect blood pressure

Remember, what’s considered low for one person might be normal for another. Your doctor can help determine whether your blood pressure readings are cause for concern based on your individual health profile.

Managing and Monitoring Your Blood Pressure

If you’ve received a blood pressure reading of 99/66 or consistently have readings on the lower end of normal, here are some steps you can take:

1. Regular monitoring: Keep track of your blood pressure readings over time to establish your normal range
2. Stay hydrated: Dehydration can lead to lower blood pressure
3. Balanced diet: Ensure you’re getting enough nutrients, especially salt if you don’t have high blood pressure
4. Exercise regularly: Physical activity can help regulate blood pressure
5. Avoid sudden position changes: Stand up slowly to prevent dizziness
6. Review medications: Discuss your medications with your doctor, as some can lower blood pressure

Consistent monitoring and lifestyle adjustments can help manage your blood pressure effectively.

The Impact of Age on Blood Pressure Readings

Age plays a significant role in determining what’s considered a normal blood pressure reading. As we age, our blood vessels naturally become less elastic, which can lead to higher blood pressure. Here’s a general guide to blood pressure ranges by age:

• Children (3-5 years): About 116/76 mmHg
• Children (6-9 years): About 122/78 mmHg
• Children (10-12 years): About 126/82 mmHg
• Teenagers: About 136/86 mmHg
• Adults (20-40 years): 95-135/60-80 mmHg
• Adults (41-60 years): 110-145/70-90 mmHg
• Adults (61 and older): 95-145/70-90 mmHg

Given these ranges, a blood pressure of 99/66 might be perfectly normal for a young adult but could be considered low for an older individual. It’s crucial to interpret blood pressure readings in the context of age and overall health.

The Role of Lifestyle in Maintaining Healthy Blood Pressure

While some factors affecting blood pressure are beyond our control, lifestyle plays a crucial role in maintaining healthy levels. Here are some key aspects to consider:

Diet and Nutrition

A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help maintain healthy blood pressure. The DASH (Dietary Approaches to Stop Hypertension) diet is particularly recommended for blood pressure management. Key dietary considerations include:

• Reducing sodium intake
• Increasing potassium-rich foods
• Limiting alcohol consumption
• Avoiding excessive caffeine

Physical Activity

Regular exercise is crucial for maintaining healthy blood pressure. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week. Activities can include:

• Brisk walking
• Jogging
• Cycling
• Swimming
• Dancing

Stress Management

Chronic stress can contribute to high blood pressure. Implementing stress-reduction techniques can be beneficial:

• Meditation
• Deep breathing exercises
• Yoga
• Regular sleep schedule
• Engaging in hobbies

By adopting these lifestyle changes, you can help regulate your blood pressure and maintain it within a healthy range, whether you’re dealing with low blood pressure like 99/66 or trying to prevent high blood pressure.

Understanding Blood Pressure Variations

Blood pressure isn’t static; it fluctuates throughout the day in response to various factors. Understanding these variations can help you interpret your readings more accurately:

Circadian Rhythm

Blood pressure typically follows a daily pattern, known as the circadian rhythm:

• Lowest during sleep
• Rises sharply upon waking
• Peaks in the middle of the afternoon
• Gradually decreases in the evening

Short-term Factors

Several factors can cause temporary spikes or drops in blood pressure:

• Physical activity
• Emotional stress
• Meals
• Alcohol consumption
• Full bladder
• Temperature changes

Given these variations, a single reading of 99/66 may not be representative of your typical blood pressure. It’s important to take multiple readings at different times of the day to get a more accurate picture of your blood pressure profile.

When to Seek Medical Advice for Blood Pressure Concerns

While a blood pressure reading of 99/66 isn’t typically cause for immediate concern, there are situations where medical advice should be sought:

Consistent Low Readings

If you consistently get readings around 99/66 or lower, especially if accompanied by symptoms, consult a healthcare provider. They can help determine if this is your natural baseline or if it indicates an underlying issue.

Sudden Changes

A sudden drop in blood pressure, even if it’s still within normal range, can be concerning. If you notice a significant change from your usual readings, seek medical advice.

Symptoms of Hypotension

If you experience symptoms of low blood pressure such as dizziness, fainting, or confusion, regardless of your blood pressure reading, it’s important to consult a doctor.

Medication Effects

If you’re on medication for high blood pressure and your readings drop to around 99/66 or lower, your doctor may need to adjust your dosage.

Pregnancy

Blood pressure often decreases during pregnancy. If you’re pregnant and notice consistently low readings, discuss this with your obstetrician.

Remember, your healthcare provider is the best resource for interpreting your blood pressure readings in the context of your overall health. Regular check-ups and open communication with your doctor are key to maintaining optimal blood pressure levels.

UMD Urgent Medical Care » What Is A Normal Blood Pressure Reading?

You can get a blood pressure reading with various blood pressure monitors at Urgent Care NYC. These include a wrist monitor, an ambulatory blood pressure monitor, or the good old fashioned kind complete with inflatable ball and mercury bubble. No matter which monitor you use, however, a normal blood pressure reading will always fall within a certain range. To understand what makes up a normal blood pressure reading, it’s important to know what blood pressure is. The heart pumps blood through the four heart chambers and into major arteries that transport blood throughout the body via the circulatory system. Each time the heart muscle contracts, it creates pressure known as systolic blood pressure. This pressure is measured to produce the first numbers got through a blood pressure reading. When the heart muscle relaxes, between beats, is the moment that systolic blood pressure can be measured.

Blood Pressure Range

For most healthy people, blood pressure falls within a certain range. Those who suffer from stress, high cholesterol or obesity often have increased heart rates that are known as high blood pressure. On the other end of the range, some people also suffer from low blood pressure, but this is almost always because of illness or blood loss. Extremely low blood pressure can cause shock and in the end, death.

A normal blood pressure reading almost always falls within the 120 to 130 beats per minute range. If someone is in excellent physical condition, the heart rate will beat at 120 or less beats per minute, systolic pressure. The diastolic pressure in a normal blood pressure reading will be between 80 -90 beats per minute. You may see a normal blood pressure reading written as 124/84, for example. An even better normal blood pressure reading is anything under 120 and less than 80, like 118/78, for example. This reading points to the normal blood pressure reading of a normal, active adult.

Some adults have blood pressure readings that are a little higher than normal for the general population, but not for them. A high, though still normal blood pressure reading, may measure from 130-139 for systolic pressure to 85-89 for diastolic.

Blood Pressure in Children

Children will display different blood pressure readings, according to urgent care NYC. A normal blood pressure reading for young children, those between 3 and 5 for example, are around 116/76. A young teenager may show a normal blood pressure reading of around 136/86. Children between these ages can show a normal blood pressure reading of between 122 and 136 for systolic pressure and 78-90 diastolic pressures. Something to remember is that children have normal blood pressures in ranges that are lower than adults.

But even so, a child is at as much risk of developing high blood pressure as an adult if lacking proper diet and exercise. High risk children also include those suffering from medical conditions or those taking medications that may raise blood pressure.

Union Square urgent care NYC

Remember that no one’s blood pressure is always the same. Sometimes, readings showing a high blood pressure may result from stress, illness or even anger. Knowing what a normal blood pressure reading is will help you see blood pressure readings that are not so normal. Union Square urgent care NYC provides parents with the opportunity to get top-notch medical treatment for their child’s non-life threatening, mild illness or injury. Union Square urgent care NYC is open for 7 days and no appointment is necessary. The services offered by Union Square urgent care NYC are affordable as compared to a visit at the hospital emergency room. From advance diagnostic testing, to a specialist follow up, a reliable medical care center offers unparalleled services. For more information, call us at 212-242-4333

What is Normal Blood Pressure? — Shingletown Medical Center

Medical Articles

Aug 15

Written By

High blood pressure can damage your blood vessels, heart, lungs and kidneys. Keeping your blood pressure within the normal range is important. But what’s normal? That depends on your age and other factors.

Blood Pressure Readings

Blood pressure is expressed in terms of two numbers. The top number is systolic blood pressure. This is the highest pressure and occurs when your heart actually beats. The second number is the diastolic. This reading shows blood pressure when your heart relaxes. Your blood pressure varies throughout the day. It is lower at night and rises shortly before you wake up. It peaks in the middle of the afternoon and then drops in the evening.

High and Low Blood Pressure

The generally accepted standard for “normal” blood pressure is 90/60 to less than 120/80. If your blood pressure is consistently lower than 90/60, you have low blood pressure. Blood pressure between 120/80 and 140/90 is still considered normal. However, most doctors will recommend lifestyle changes if you are in that range. Above 140/90 is considered high blood pressure, or hypertension. Medications may be recommended for blood pressures in this range or above.

Aging, Sex and Blood Pressure

Blood pressure normally increases with age. This may be a protective effect to ensure the body gets adequate nutrients and oxygen. A healthy child of three might have a reading of 80/34. A healthy adult of 60 might have a reading closer to 134 over 87. Women normally have readings about 10 points lower than men.

Factors That Affect Blood Pressure

Many things affect your blood pressure. These tend to cause increased readings:The three “S” rule – stress, smoking and sleep apnea increase blood pressure. Genetics and family history – high blood pressure and heart disease often run in families. Chronic kidney disease- damaged kidneys can’t filter blood properly. Obesity and lack of exercise increase the risk of high blood pressure. Salt – about one-quarter of the population is sensitive to salt.

What’s Normal for Me?

To determine what your normal blood pressure is, you must track it over time. A home blood pressure cuff is an inexpensive way to do this. Take readings at different times of day. Three or four readings a day will give you a good picture. Always follow directions and sit quietly for at least 5 minutes before taking a reading. After a month, average your readings. This is your normal blood pressure. Remember, people are different – your athletic brother and young child will have different readings than yours. If your readings are consistently high, visit your health care provider. The staff at Shingletown Medical Center is proud to provide first-class care for you and your family.

More than 700 million people live with untreated hypertension

More than 700 million people live with untreated hypertension

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• More than 700 million people live with untreated hypertension

WHO/Noor/Sebastien Liste

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The first comprehensive analysis of global trends in hypertension prevalence, detection, treatment and control, led by Imperial College London and the World Health Organization, published today in The Lancet, published today in The Lancet, reveals the number of hypertensives among adults aged 30 years –79years has increased from 650 million to 1. 28 million people. Almost half of these people did not suspect that they had hypertension.

Hypertension significantly increases the risk of heart, brain and kidney disease and is one of the leading causes of morbidity and mortality in the world. It is easily detected by measuring blood pressure at home or at a health facility and often responds well to inexpensive drugs.

The study was conducted by a global network of physicians and researchers and covered the period from 1990 to 2019. Recorded blood pressure and treatment data were analyzed covering more than 100 million people aged 30-79 years from 184 countries, which together account for 99% of the world’s population; thus, this is the largest review of the global dynamics of hypertension to date.

After analyzing a gigantic amount of data, the researchers found that between 1990 and 2019, the overall incidence of hypertension in the world has changed little, but its burden has shifted from rich countries to low- and middle-income countries. While in rich countries the incidence of hypertension has declined and is now generally at its lowest levels, rates have risen in many low- and middle-income countries.

As a result, Canada, Peru and Switzerland were among the countries with the lowest prevalence of hypertension in 2019, while the highest rates among women were in the Dominican Republic, Jamaica and Paraguay, and among men in Hungary, Paraguay and Poland (data in for country breakdowns and rankings, see Notes to Editors).

Although the percentage of people with hypertension has changed little since 1990, the number has doubled to 1.28 billion, driven primarily by the growth and aging of the population. In 2019There were more than 1 billion people with hypertension in low- and middle-income countries (82% of all hypertensives in the world).

Serious disparities in diagnosis and treatment coverage

Although hypertension can be easily detected and relatively easily treated with inexpensive drugs, the study found significant gaps in diagnosis and treatment coverage. About 580 million hypertensive patients (41% of women and 51% of men) were unaware of their disease because they had never been diagnosed.

The study also showed that more than half of people with hypertension (53% of women and 62% of men), or a total of 720 million people, do not receive the treatment they need. Blood pressure was controlled, i.e. within the normal range due to the effective use of drugs, in less than one in four women and one in five men with hypertension.

Majid Ezzati, one of the lead authors of the study and Professor of Global Environmental Health at the Department of Public Health at Imperial College London, noted: drugs, so many people with high blood pressure in the world are still not getting the therapy they need is a public health failure.”

Men and women are most likely to be prescribed drugs to effectively treat and control hypertension in Canada, Iceland and the Republic of Korea, where more than 70% of hypertensive patients were on treatment in 2019. Compared to this, men and women in sub-Saharan Africa, Central, South and South-East Asia and the Pacific Islands had the lowest chances of getting drugs. In several countries in these regions, treatment rates were less than 25% for women and 20% for men, reflecting the enormous global disparity in hypertension care.

Encouragingly, some middle-income countries have been able to scale up treatment and even outpace most high-income countries in terms of treatment and control. For example, treatment coverage in Costa Rica and Kazakhstan is currently higher than in most upper-middle-income countries.

“Although treatment and control of hypertension has improved since 1990 in most countries, there has been no significant change in most countries in sub-Saharan Africa and the Pacific Islands. It is imperative that international donors and national governments take priority action to ensure equity in the treatment of this disease, which poses a serious threat to public health around the world,” said Dr Bin Zhou, Research Fellow at the Faculty of Public Health at Imperial College London and Head of Analysis.

New WHO guidelines for the management of hypertension

Another document released today, WHO Guidelines for the Pharmacological Treatment of Hypertension in Adults, contains new recommendations to help countries better manage hypertension.

“The new global hypertension management guidelines are being released for the first time in 20 years and provide the most up-to-date, relevant and evidence-based recommendations for prescribing antihypertensive drugs in adults,” said Dr Taskin Khan, of the WHO Department of Noncommunicable Diseases.

The guidelines include blood pressure parameters at which drug therapy should be started, principles for choosing a drug or combination of drugs, blood pressure targets, and frequency of blood pressure checks. In addition, the guidelines set out the basic mechanisms for the involvement of physicians and other health care workers in improving the detection and management of hypertension.

“The need for better control of hypertension cannot be overstated. By following the recommendations of these new guidelines, expanding and facilitating access to blood pressure medicines, identifying and treating comorbidities such as diabetes and pre-existing heart disease, promoting healthier diets and regular physical activity, and more strictly regulating tobacco products countries can save lives and reduce public health costs,” said Dr Bente Mikkelsen, Director of the WHO Department of Noncommunicable Diseases.

NOTES TO EDITORS

treatment and control from 1990 to 2019: a pooled analysis of data from 1201 representative population studies involving 104 million people] prepared by the NCD Risk Factors Collaborative Initiative (NCD-RisC) and published in The Lancet. DOI: 10.1016/S0140-6736(21)01330-1.

Data was obtained from 1201 studies involving 104 million people aged 30-79 years in 184 countries and recording blood pressure and treatment data.

Hypertension was defined as: systolic blood pressure ≥140 mmHg. Art., diastolic blood pressure ≥90 mm Hg. Art. and/or taking medications for hypertension.

The Republic of Korea referred to in this press release is referred to in the publication as “South Korea”.

Imperial College London

Imperial College London is one of the world’s leading universities. With 20,000 students and 8,000 employees, the college is dedicated to solving the most pressing problems in science, medicine, technology and business.

According to The Times: Higher Education magazine, Imperial College ranks fifth in the world for international activity, with academic interactions in more than 150 countries. For its exceptionally developed culture of entrepreneurship and connection with the professional environment, Reuters named the college the most innovative university in the United Kingdom.

Imperial College staff, students and alumni are participating day in and day out in the fight against COVID-19. The college employs nearly 2,000 members of the public interest professions and is at the forefront of epidemiology, coronavirus virology, vaccine development, and diagnostics. More than a thousand Imperial College staff and students volunteer to help the nation’s National Health Service. http://www.imperial.ac.uk/

World Health Organization

The World Health Organization (WHO), guided by the interests of the well-being of all people and based on the achievements of science, guides and supports the efforts of the global community to give everyone, wherever they are, an equal chance for a safe and healthy life. WHO is the UN health agency that brings countries, partners and people together in 150+ locations around the world to address the most pressing issues, leading the global community to respond to health emergencies, prevent disease, address the root causes of health problems and expanding access to medicines and health care. Our mission is to promote health, keep the world safe, and reach vulnerable populations with services. www.who.int/en

Top ten countries with lowest prevalence of hypertension in 2019

WOMEN

9037 4

9039 0 Spain

9 0386

Place	Country	Prevalence as % of population
1.	Switzerland	17%
2.	Peru	18%
3. 9039 1	Canada	20%
4.	Taiwan Province of China	21%
5.	21%
6.	Republic of Korea	21%
7.	Japan	22%
8.	United Kingdom	23%
9.	China	24%
10.	Iceland	24%

MEN

9 0386

9 0390 Cambodia

Place	Country	Prevalence as % of the population	Eritrea	22%
2.	Peru	23%
3. 9039 1	Bangladesh	24%
4.	Canada	24%
5.	Ethiopia	25%
6.	Solomon Islands	25%
7.	Papua New Guinea	25%
8.	Lao People’s Democratic Republic	26%
9.	26%
10.	Switzerland	26%

Ten countries with the highest prevalence of hypertension in 2019

WOMEN

90 390 Haiti

90 390 Botswana

Place	Country	Prevalence as % of population
1.	Paraguay	51%
2.	Tuvalu	51%
3.	Dominica	50% 90 391
4.	Dominican Republic	49%
5.	San Tomé and Principe	48%
6.	Jamaica	48%
7.	48%
8.	Iraq	48%
9.	Eswatini	47%
10.	47%

MEN

90 378

9039 0 4.

903 86

9Serbia

904 69

Place	Country	Prevalence as % of population
1.	Paraguay	62%
2.	Hungary	56%
3.	Poland	55%
Argentina	54%
5.	Lithuania	54%
6.	Romania	53%
7.	Belarus	52%
8.	Croatia	51%
50%

Top ten countries with highest treatment rates for hypertension in 2019

women with hypertension 9Republic of Korea 77% 2. Costa Rica

9 0390 76% 3. Kazakhstan 74% 4. United States of America 73% 5. Iceland 72% 6. 903 91

Venezuela 71% 7. El Salvador 71% 8. Portugal 71% 903 90 9. Canada 71% 10. Slovakia 70%

MEN

9039 0 71%

WOMEN 90 287

Seat	Country	Treatment coverage as % of total men with hypertension 9Canada	76%
2.	Iceland
3.	Republic of Korea	67%
4.	United States of America	66%
5.	Kazakhstan	66%
6.	Malta 903 91	65%
7.	Costa Rica	63%
8.	Germany	61%
9. 9039 1	Czech Republic	59%
10.	Singapore	59%

Ethiopia

903 79

Rank	Country	Treatment coverage as % of women with hypertension
1.	Rwanda 9039 1	11%
2.	Niger	15%
16%
5.	Vanuatu	16%
6.	Tanzania	17%
7.	Solomon Islands	17%
8.	Madagascar	19%
9.	Mozambique	19%
10.	Kenya	21%

MEN

9 0379

903 90 Solomon Islands

Seat	Country	Treatment coverage as % of total men with hypertension
1.	Rwanda	10%
2.	Kenya	10%
3.	Mozambique	10%
4.	Vanuatu	11%
5.	11%
6.	Niger	12%
7.	Madagascar	13%
8.	Uganda	13%
9.	Togo	14%
10.	Burkina Faso	14%

there was the largest increase in the prevalence of hypertension

WOMEN

903 90 Haiti

Place	Country 9 0381	Growth in percentage points (1990-2019)
1.	Kiribati	13
2.	Tonga	13
3.	Tuvalu 9039 1	12
4.	Indonesia	12
5.	Brunei Darussalam	10
6.	9
7.	Jamaica	9
8.	Myanmar	9
9.	Samoa	9
10.	Uzbekistan 90 391	9

MEN

9 0390 4.

Rank	Country	Growth in percentage points (1990–2019)
1.	Uzbekistan	15
2.	Argentina	13
3.	Paraguay	10
South Africa	10
5.	China	10
6.	Brunei Darussalam	9
7.	Tajikistan	8
8.	Jamaica	8
9.	Dominican Republic	8
10.	Tuvalu	8

Ten countries with the largest decline in hypertension between 1990 and 2019

WOMEN

Rank	Country	Decrease in percentage points (1990-2019)
1.	Germany	18
2. 9 0391	Spain	14
3.	Japan	13
4.	Singapore	12
5.	Russian Federation	12
6.	Italy	12
7.	Austria	11
8.	United Kingdom	11
9.	Israel	11
10.	Sweden	10

MEN

9 0390 Switzerland

Rank	Country	Decline in percentage points (1990–2019)
1.	Germany	19
2.	14
3.	United Kingdom	13
4.	Finland	12 9 0391
5.	Canada	12
6.	Luxembourg	10
7.	Norway	10
8.	Austria	9
9.	Italy	8
10.	Malawi	8

9028 6 Top ten countries with the largest increases in treatment coverage between 1990 and 2019

WOMEN

Rank	Country	Growth in percentage points (1990–2019)
1.	Republic of Korea	46
2.	Taiwan Province of China	38
3.	South Africa	36
4.	Costa Rica	35
5.	Poland	35
6.	Venezuela 903 91	35
7.	Serbia	33
8.	Brunei Darussalam	33
9.	Singapore	33
10.	Colombia	33

MEN

Rank	Country	Growth in percentage points (1990– 2019)
1.	Republic of Korea	50
2.	Canada	46
3.	Costa Rica	40
4.	Germany	39
5.	Iceland	39
6.	Taiwan Province of China	37
7.	Kazakhstan	37
8.	Poland	36
9.	Switzerland	36
10.	Norway	34

Survival of knowledge of blood pressure measurement technique among medical students in preparation for primary accreditation | Klimenko

Arterial hypertension (AH) is the most important risk factor for the development of cardiovascular (myocardial infarction, coronary heart disease, chronic heart failure), cerebrovascular (ischemic or hemorrhagic stroke, transient ischemic attack) and renal (chronic kidney disease) diseases [1 -3] and to this day remains the leading cause in the structure of mortality worldwide [4]. The prevalence of hypertension in adults is 30-45% [5]. In the Russian Federation, among men aged 25–65 years, the prevalence of hypertension is slightly higher (reaching 47% in some regions), and ~40% among women [6].

Given the above, timely and correct diagnosis of hypertension is extremely important for the earliest possible selection of the necessary treatment, the timely implementation of adequate therapeutic and prophylactic strategies in order to improve the patient’s prognosis, quality and life expectancy [7].

Measurement of blood pressure (BP) is the most common medical procedure [8]. The Kaiser Permanente Northern California study of finding and formulating strategies for the best control of BP demonstrated that a critical factor in achieving control of hypertension is the correct measurement of BP by healthcare professionals [9]. Error in blood pressure measurement by at least 5 mm Hg. can lead to incorrect classification of patient pressure in 84 million people worldwide and, accordingly, to errors in management tactics [10]. So, for example, if the seemingly simplest point of the methodology is violated – the position of the patient’s hand at the level of the heart – the measurement error can be from 4 mm Hg. up to 23 mm Hg, which cannot be considered insignificant [10]. If the patient sits cross-legged when measuring blood pressure, the error in determining systolic blood pressure can be 2-8 mm Hg. upwards [2].

Thus, it is obvious and indisputable that the skill of correctly measuring blood pressure is one of the leading skills among students and graduates of medical universities [11].

The aim of our study was to assess the students’ residual knowledge of non-invasive BP measurement skills.

Material and methods

The study included 148 graduate students of the Medical Institute who were trained on the basis of the Accreditation and Simulation Center in 2018/2019yy academic year in preparation for primary accreditation. According to the curriculum in the autumn semester, students got acquainted with the structure of an objective structured clinical exam, the number of stations, the number of manual skills, the features of performing skills according to the checklists developed by the expert council of the federal methodological center for accreditation [12], and passed the test. At the test lesson, the control was carried out on the correct performance of a manual skill – measuring blood pressure, the result was assessed in the form passed (70 points and above) or not passed (<70 points) in accordance with the Order of the Ministry of Health of the Russian Federation dated 02.06.2016 No. 334n “On approval of the Regulations on accreditation specialists." Details and points for assessing the skill - measuring blood pressure - are presented in detail and step by step in the passport of the “Dispanserization” station in the section “primary accreditation”, the list of practical skills in the specialty “General Medicine” on the website of the federal methodological center for accreditation [12]. Subsequently in the spring semester 2018/2019academic year, as part of the accreditation preparation cycle, the residual knowledge of students was assessed using the same items of the same checklist. Due to the fact that the skill of measuring blood pressure is only a part of the passport of the “Medical examination” station, during the initial accreditation, the data of the autumn semester offset were not included in the analysis as initial data. In our study, the knowledge of students was assessed on the principle of “input control”, due to the fact that in the autumn semester all students demonstrated and received credit at the “Medical examination” station, and taking into account the fact that blood pressure measurement is the most frequently performed skill in different clinical departments during practical training of students. The students did not know about the upcoming control of knowledge, during the classes they were asked to voluntarily take part in the study.

The sequence of actions was based on the points of the checklist – skill-measuring blood pressure – part of the passport of the station “Medical examination” [12]. It should be noted that this station includes an assessment of several manual skills (hygienic treatment of the hands of medical personnel, general examination, palpation, percussion and auscultation of the lungs and heart, etc.). Therefore, especially for our study, we used from the checklist of the “Medical examination” station only the items related to the measurement of blood pressure. During the briefing, the students were told that they were seeing the patient for the first time, so it was necessary to perform a greeting and self-presentation, as well as final actions (cleaning the equipment, final communication with the patient (Table 1)).

Table 1

Checklist for measuring blood pressure, which assessed the correctness of the skill in the study [12]

A completed checklist item was assessed as 1 point, an item not completed was 0 points, so , each student had the opportunity to score a maximum of 50 points. The main criterion for the “survivability of knowledge” is the fulfillment of the maximum number of checklist items.

To train students and assess skills, a simulator for measuring blood pressure with wireless control and a control tablet computer BT-CEAB2 (South Korea) was used. This simulator makes it possible to palpate the great vessels of the upper limb, listen to Korotkoff sounds, and monitor some indicators (for example, cuff inflation rate, cuff pressure) using a tablet connected to the device via Bluetooth (Fig. 1).

Fig. 1. Wireless blood pressure monitor BT-CEAB2.
Image of the simulator from the site http://www.btinc.co.kr/ceab2_en/

This device allows you to set certain values ​​of blood pressure and determine the measurement accuracy in percent, but this was not the purpose of our study. Evaluation of the performance of each item of the manual skill checklist – blood pressure measurement – was carried out by the teacher during the demonstration by the student (Table 1).

It should also be mentioned that in the conditions of working with simulation equipment, some checklist items (for example, communication with the patient, re-measurement of blood pressure on the second arm) should have been simply spoken, indicating the need for their implementation.

Results

According to the results of our observation, none of the students demonstrated the fulfillment of all 50 points of the manual skill checklist – blood pressure measurement. The number of completed checklist items ranged from 15 (30%) to 49 (98%). On average, 33 checklist items were completed (66%), 74% of students (n=109) completed more than half of the checklist items (Fig. 2).

Fig. 2. Compliance of the items of the checklist for measuring blood pressure by students.

When analyzing the checklist items themselves, 99% (n=146) completed the greeting item, 92% (n=136) demonstrated self-presentation, 80% (n=118) clarified the patient’s personal data, 87% (n=129) found the site of the radial artery pulsation, 39% (n=57) – measured blood pressure on the other arm again, 60% (n=89) – demonstrated a small rate of pressure decrease in the tonometer cuff (2-3 mmHg per second).

Analyzing all 50 items of the skill checklist – BP measurement and taking into account the recommendations on BP measurement of the American Heart Association [13], we subsequently identified the key parameters of BP measurement and analyzed their demonstration by students. These parameters include items from 20 to 43 of the checklist inclusive (Table 1). The results obtained are presented in table 2.

According to the literature, the most common errors in measuring blood pressure include: incorrect selection of the size of the tonometer cuff or its complete absence, talking during manipulation, auscultation errors, which can be caused by an incorrect location of the phonendoscope membrane, too sharp a decrease in pressure in the tonometer cuff [ 10].

As can be seen from Table 2, only 61% of the subjects (n=91), 49% (n=73) did not place the head of the stethophonendoscope under the cuff, 60% (n=89) depressurized the cuff at the recommended rate.

Table 2

The results of the key points of the checklist by students and the population, incl. At the same time, errors in the measurement technique cause an incorrect assessment of blood pressure and, as a result, an incorrect method for titrating antihypertensive drugs, with the determination of further incorrect patient treatment tactics.

Our observation demonstrated the lack of fulfillment of all 50 points of the checklist by all students, the lack of fulfillment by half of the students of the key significant points of the checklist, such as fitting the cuff in accordance with the circumference of the shoulder, placing the head of the stethophonendoscope under the cuff, reducing pressure in the cuff at a certain rate, which have a significant impact on the objectivity of measuring blood pressure numbers. Data similar to ours were obtained in a study conducted in Chicago in 2015 with the participation of 159students, where only 1 subject completed all the required skills (11 out of 11) [14]. In this study, students were required to measure blood pressure in a simulated patient (actor) with no additional prior training. The measurement was carried out with an automatic tonometer, the main evaluated parameters were the preparation of the patient for the study (posture, please do not talk during the measurement), the correct selection of the tonometer cuff, the correct application of the cuff, the measurement of blood pressure on both arms – i. e. key points influencing the diagnosis and / or further clinical management of the patient in practice.

In a study by Pezeshki MX, et al., students measured blood pressure before and after two weeks of training [15]. In this study, skills were assessed on 16 items. According to the results of the authors, before the trainings, the majority of students failed to complete the required items, and 9 out of 16 items were completed by <20% of the subjects. After the classes, 14 out of 16 items were completed by >70% of students [15].

Taking into account the results obtained by us and all of the above, it seems most optimal to conduct trainings on measuring blood pressure using simulation equipment, without harm to the patient, with the ability to demonstrate the skill multiple times, at any convenient time for the student, with the ability to view a video recording of this performed manual skill with subsequent analysis and analysis of each item of the checklist, with the possibility of performing not only in preparation for accreditation, but also in the process of training at clinical departments of therapy. Taking into account the relevance of the correct measurement of blood pressure, the most common and frequently encountered manual skill in the practice of various categories of medical workers, and the impact of the results of these measurements on the tactics of managing any patient (not only cardiological) [7][8], additional training is important for all students, regardless of their further specialization.

The results of our study demonstrated the low survival rate of students’ knowledge; a small number of completed checklist items – manual skill – blood pressure measurement, while it should be borne in mind that one of the main directions in the development of higher medical education is to strengthen the practical aspect of training future doctors while maintaining the proper level of theoretical knowledge. In general, the organization of clinical training of students seems to be very complex and is the cornerstone in the work of any university, regardless of its status, size and level of subordination. A university teacher has to maneuver between the ever-increasing requirements of new state educational standards for the professional competencies of graduates, on the one hand, and unresolved problems of clinical departments, on the other. All this makes it difficult to prepare already at the initial stages of clinical training and has become especially aggravated recently in the era of a pandemic.

For reliable mastering of the skill, it is necessary to widely introduce methods, programs, standards into the practical training of students at each stage in accordance with the discipline being studied. It is advisable to include in the program of practical training not only the training itself, but also the current and final certification using simulators and simulators with a certain frequency [15]. In addition, we should not forget that the effectiveness of simulation training depends not only on the set of specific equipment, but also on the organization of the training itself, while the structure of the lesson itself is especially important – the presence of a visual illustrated briefing, active control of debriefing, the availability of control materials, in including setting the standard for performing a skill (checklist), from using the unique opportunity to perform a skill through multiple repetitions to the final control (bypassing the stage of many years of experience), as well as from the personal attitude of the teacher to simulation teaching methods, as an important stage of learning between preclinical and clinical [16] . For example, the skill of measuring blood pressure, according to the current programs of medical universities (specialty “General Medicine”), is analyzed in detail in the second year of study as part of the course of propaedeutics of internal diseases in accordance with GEF3+. In the future, in the cycles of therapy, cardiology, childhood diseases, it is implicitly considered that students have completely mastered the skill and their attention is not focused on the measurement technique itself. Taking into account the results obtained by us, it would probably be advisable to check the demonstration of this manual skill by a student before starting a cycle lesson using simulation equipment, followed by a detailed analysis of each item of the checklist when demonstrating the video recording. And at the end of the cycle, among other manual skills, include the skill of measuring blood pressure for certification. As a result, thanks to repeated repetition and detailed analysis of video recordings of this skill of a particular student, it would be possible to bring the performance to automatism.

Thus, simulation training should not currently be considered as a separate skill or discipline, but should be developed and implemented in parallel with practical training in clinical settings. Such an integrative training format allows reducing risks for patients, increasing the confidence of future doctors in their actions, objectively assessing the progress and results achieved for each of the students and, as a result, significantly improving the effectiveness and quality of medical care provided. And, accordingly, as it is implemented, the application of this approach will help improve the prognosis and quality of life of each of the patients.

Conclusion

Thus, the survivability of students’ knowledge regarding the methods of measuring blood pressure for six months after a detailed analysis and passing the test session remains not entirely satisfactory, but, unfortunately, comparable with the results of foreign colleagues [13][14]. Given the undoubted importance of accurate blood pressure measurement in the daily clinical practice of most physicians [8, 10], the data obtained confirm the need for additional training both on simulators and in conditions more close to real ones, incl. with simulated patients.

Relationships and Activities : all authors declare no potential conflicts of interest to disclose in this article.

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