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Hypertension measurement: Changes You Can Make to Manage High Blood Pressure

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Changes You Can Make to Manage High Blood Pressure

Fighting back against the “silent killer”

High blood pressure (HBP, or hypertension) is a symptomless “silent killer” that quietly damages blood vessels and leads to serious health problems.

While there is no cure, using medications as prescribed and making lifestyle changes can enhance your quality of life and reduce your risk of heart disease, stroke, kidney disease and more.

Know your numbers

Is your blood pressure in a healthy or an unhealthy range? The best way to know is to get your blood pressure checked.

If you’re diagnosed with high blood pressure, you should monitor your blood pressure regularly. Maintaining an awareness of your numbers can alert you to any changes and help you detect patterns. Tracking your results over time will also reveal if the changes you’ve made are working. Download a printable blood pressure log (PDF).

Blood Pressure Chart
BLOOD PRESSURE CATEGORY SYSTOLIC mm Hg (upper number) and/or DIASTOLIC mm Hg (lower number)
NORMAL LESS THAN 120 and LESS THAN 80
ELEVATED 120 – 129 and LESS THAN 80
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 1 130 – 139 or 80 – 89
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 2 140 OR HIGHER or 90 OR HIGHER
HYPERTENSIVE CRISIS (consult your doctor immediately) HIGHER THAN 180 and/or HIGHER THAN 120

Make changes that matter:

Managing blood pressure is a lifelong commitment

If you have high blood pressure, it’s vital that you listen to your doctor. Remember: You’re a part of your healthcare team. You and your doctor are partners.

Educate yourself about HBP and learn how to monitor your blood pressure at home. Armed with this information, you can commit to living heart healthy.

By adopting a heart-healthy lifestyle, you can:

You can fight high blood pressure

While heart disease is still the No. 1 killer in the United States and around the world, death rates have decreased significantly. Earlier and better treatment of high blood pressure has played a key role in that decrease.

Measuring Blood Pressure: MedlinePlus Medical Test

What do the results mean?

Your results, also known as a blood pressure reading, will contain two numbers. The top or first number is the systolic pressure. The bottom or second number is the diastolic pressure. High blood pressure readings are also labeled by categories, ranging from normal to crisis. Your reading may show your blood pressure is:

Blood Pressure Category Systolic Blood Pressure Diastolic Blood Pressure
Normal Less than 120 and Less than 80
High Blood Pressure (no other heart risk factors) 140 or higher or 90 or higher
High Blood Pressure (with other heart risk factors, according to some providers) 130 or higher or 80 or higher
Dangerously high blood pressure – seek medical care right away 180 or higher and 120 or higher

If you’ve been diagnosed with high blood pressure, your provider may recommend lifestyle changes and/or medicines to control your blood pressure. Your provider may also recommend that you regularly check your blood pressure at home with an automated blood pressure monitor. An at-home blood pressure monitor usually includes a blood pressure cuff and a digital device to record and display blood pressure readings.

Home monitoring is not a replacement for regular visits to your provider. But it can provide important information, such as whether treatment is working or your condition may have worsened. Also, home monitoring may make the test less stressful. Many people get nervous about getting their blood pressure taken at a provider’s office. This is called “white coat syndrome.” It can cause a temporary rise in blood pressure, making the results less accurate.
For more information about home monitoring of blood pressure, talk to your provider.

If you were tested for low blood pressure, a blood pressure reading of 90 systolic, 60 diastolic (90/60) or lower is considered abnormal. Treatments for low blood pressure may include medicines and making certain changes to your diet.

Blood Pressure Measurement – an overview

Casual (Clinic) Blood Pressure Measurement

Blood pressure measurements that are taken intermittently in the clinical setting are usually referred to as “casual” or “clinic” measurements. The most established method is the auscultatory measurement, classically performed with the mercury sphygmomanometer, but largely replaced in recent years by aneroid manometry due to safety concerns about the use of mercury. Satisfactory accuracy of aneroid manometry depends heavily on regular servicing of the devices, which is often not achieved in clinical practice.6–9 For auscultatory measurements the fifth Korotkoff sound has been established as diastolic BP in all children of all ages since the 1980s.10

A problem inherent to auscultatory measurements is significant observer bias. Even experienced, well-trained observers tend to round figures and approximate the measured towards expected and target values. The phenomenon of terminal digit preference is common even in specialized hypertension centers and in clinical trial settings.11–13 For the purposes of clinical trials, observer bias can be overcome by use of “random zero” devices, which blind the examiner with respect to the absolute BP value until the end of the measurement, but are generally too complicated for everyday use.14

In recent years, automated oscillometric BP devices have gained popularity in clinic and home settings alike. Oscillometric measurements reduce observer bias due to greater automation, and are more convenient to use, particularly in smaller children. Freeing the attention of the examiner from the manometer display towards distraction of the child can be a key component of successful BP measurements in toddlers. In this context, the ability to adjust inflating pressures is an important feature of newer devices to avoid lengthy unpleasant arm compression in infants. However, values obtained by oscillometry may vary significantly from the auscultatory technique, as rather than recording Korotkoff sounds, the pressure at which the greatest oscillation occurs is taken to be the mean arterial pressure (MAP). Systolic and diastolic values are calculated via algorithms, which are company-owned trade secrets, and therefore cannot be verified or standardized independently. The correlation of oscillometric to auscultatory and intra-arterial measurements therefore needs to be evaluated on a model-by-model basis using the rigorous standards of the British Hypertension Society (BHS) and Association for the Advancement of Medical Instrumentation (AAMI)15,16 or the newer guidelines of the European Society of Hypertension (ESH).17 For instance, the Dinamap 8100 has been found to measure on average approximately 10 mm Hg higher than auscultation.14 Another important drawback of oscillometric measurements in children is the fact that to date reference values have been obtained from much smaller population samples than for auscultatory measurements.4,18,19

Hence, the choice between auscultatory and oscillometric measurements demands weighing the advantages of accuracy and experience against ease and practicability. The JNC’s fourth report recommends auscultation as the preferred method for diagnosing hypertension in children, mainly on the grounds that reference values are based on this method. It is proposed that oscillometric measurements above the 90th percentile should be repeated by auscultation.4

However, in addition to device-related limits to accuracy, single casual BP measurements have poor reproducibility.20,21 This is due both to the natural variation of BP over time, as well as the “white-coat effect,” the response to the medical setting. White-coat hypertension occurs in up to 45% of children.22–25 Taking at least three readings at every session is therefore strongly recommended.1,2,4 In addition, BP should be measured on several separate occasions if clinic BPs alone are used for diagnosis and treatment of hypertension. Vollmer et al.26 found that three to five clinic visits were necessary to achieve a similar reproducibility of clinic measurements compared to ambulatory BP measurement in detecting changes of BP.

New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension

High blood pressure should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90 – based on new ACC and American Heart Association (AHA) guidelines for the detection, prevention, management and treatment of high blood pressure.

The new guidelines – the first comprehensive set since 2003 – lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. The new definition will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, with the greatest impact expected among younger people. Additionally, the prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45, the guideline authors note. However, only a small increase is expected in the number of adults requiring antihypertensive medication.

“You’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure,” said Paul K. Whelton, MB, MD, MSc, FACC, lead author of the guidelines. “We want to be straight with people – if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.”

Blood pressure categories in the new guideline are:

  • Normal: Less than 120/80 mm Hg;
  • Elevated: Systolic between 120-129 and diastolic less than 80;
  • Stage 1: Systolic between 130-139 or diastolic between 80-89;
  • Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
  • Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

The guidelines eliminate the category of prehypertension, categorizing patients as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89). While previous guidelines classified 140/90 mm Hg as Stage 1 hypertension, this level is classified as Stage 2 hypertension under the new guidelines. In addition, the guidelines stress the importance of using proper technique to measure blood pressure; recommend use of home blood pressure monitoring using validated devices; and highlight the value of appropriate training of health care providers to reveal “white-coat hypertension.” Other changes include:

  • Only prescribing medication for Stage I hypertension if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk (using the same risk calculator used in evaluating high cholesterol).
  • Recognizing that many people will need two or more types of medications to control their blood pressure, and that people may take their pills more consistently if multiple medications are combined into a single pill.
  • Identifying socioeconomic status and psychosocial stress as risk factors for high blood pressure that should be considered in a patient’s plan of care.

In a corresponding analysis of the guidelines’ impact, Paul Muntner, PhD, et al., suggests “the 2017 ACC/AHA hypertension guideline has the potential to increase hypertension awareness, encourage lifestyle modification and focus antihypertensive medication initiation and intensification on US adults with high CVD risk.”

The new ACC/AHA guidelines were developed with nine other health professional organizations and were written by a panel of 21 scientists and health experts who reviewed more than 900 published studies. They are the successor to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7), issued in 2003 and overseen by the National Heart, Lung, and Blood Institute (NHLBI). In 2013, the NHLBI asked the AHA and ACC to continue the management of guideline preparation for hypertension and other cardiovascular risk. The guidelines were published in the Journal of the American College of Cardiology and Hypertension. For a wide array of ACC-developed tools, resources and commentary for both clinicians and patients, visit the ACC’s High Blood Pressure Guidelines Hub.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Homozygous Familial Hypercholesterolemia, Lipid Metabolism, Nonstatins, Hypertension, Stress

Keywords: AHA17, AHA Annual Scientific Sessions, Antihypertensive Agents, Blood Pressure Monitoring, Ambulatory, White Coat Hypertension, Blood Pressure, Risk Factors, Prehypertension, National Heart, Lung, and Blood Institute (U. S.), Prevalence, Cardiovascular Diseases, Stress, Psychological, Hypertension, Stroke, Systole, Hypercholesterolemia, Myocardial Infarction, Diabetes Mellitus, Renal Insufficiency, Chronic, Hospitalization, Social Class, Life Style, Health Personnel, Cholesterol

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Blood Pressure Measurement: Retrospective and Prospective Views | American Journal of Hypertension

Abstract

Measurement of the arterial blood pressure (BP) is a time-honored, vital piece of medical information whose accuracy is seldom questioned. This review identifies the unappreciated weakness of the early validation data that compared the cuff to intra-arterial BP’s. Unfortunately, the inaccuracy of the auscultatory systolic (SBP) and diastolic (DBP) measurements are necessarily transmitted to the arithmetically calculated mean (MBP) and pulse pressures (PP). The errors in cuff SBP have limited recent efforts to measure central SBP noninvasively because of the need for cuff pressure calibration of the recorded peripheral pulses. Furthermore, cuff DBP’s routinely overestimate intra-arterial values adding to the error in the calculation of central PP—a recognized cardiovascular risk predictor.

Validation data for the newer automatic oscillometric SBP and DBP measurements are little better. Oscillometric devices, however, offer some improvement in their recognition of the MBP, a measurement made independently of the SBP and DBP. The algorithms used to identify the SBP and DBP by the oscillometric device manufacturers are proprietary and differ from one another. Thus, the accuracy of the commercial devices cannot be compared or standardized. A data base listing those devices that have been “validated” against the inaccurate auscultatory method is available, but many commercial devices are not listed.

In addition to the SBP and DBP, there is increasing interest in the information contained within the arterial and aortic pulses. Values such as pulse augmentation and amplification ratios are independent of calibration requirements and add risk assessment information beyond that of the BP itself.

American Journal of Hypertension, advance online publication 24 February 2011; doi:10.1038/ajh.2011.22

In 1733, the Rev. Stephen Hales cannulated the carotid artery of a supine but unanesthetized horse and connected it, using the wind pipe of a goose, to a vertical glass tube. The blood rose to a level of 9 feet 6 inches—or ~213mmHg—one of the first direct measurements of the blood pressure (BP). Multiple developments in both direct and indirect BP measurements that followed over the years have been elegantly summarized in a monograph by Geddes in 19701 and in a detailed history of the BP measurement by O’Brien and Fitzgerald in 1994.2 Among these developments were the description of the air-filled occluding arm cuff by Riva-Rocci3 and the auscultatory sounds by Korotkoff. 4 For the many years that followed, the wealth of information available from the entire arterial pulse was limited to the systolic (SBP) and diastolic blood pressure (DBP) along with calculation of the mean blood pressure (MBP) and pulse pressure (PP). Despite these limitations, the widespread use of the auscultatory method for the indirect measurement of the brachial artery (BA) BP has been of inestimable value in the diagnoses of hypertension, hypotension, the effectiveness of antihypertensive therapy, and the assessment of cardiovascular risk (CV). Reliance on the values of SBP and DBP generated by this technique has led to increasingly sophisticated epidemiological studies and improved classifications of hypertension severity. Its world wide and long term use has lent an aura of respectability and infallibility to the BP that is unchallenged perhaps, by no other clinical measurement.

Without diminishing the past contributions and the present value of the indirect BP measurement, it may be time to revisit its shortcomings and therefore re-evaluate its usefulness as a CV risk predictor. This paper also reviews recent efforts to improve the arterial BP measurement and how the arterial pulse wave form can be further analyzed to provide CV risk prediction in addition to that of BP alone.

The Standard Auscultatory Method

The present standard technique for indirect BA pressure measurements has been well described5 and validated against the “gold standard” of intra-arterial measurements.6 Although these comparisons are not trouble-free, the Association for the Advancement of Medical Instrumentation (AAMI) in its American National Standard6 summarized the results of 173 subjects in five studies that validated the cuff/stethoscope method against the intra-arterial method. For SBP, the average differences between the two methods in the five studies ranged from 0.9 to 12.3mmHg with standard deviations that ranged from 1.3 to 13.0mmHg (Figure 1). For DBP, the average differences ranged from 8.3 to 18mmHg with standard deviations that ranged from 1.1 to 9.3mmHg (Figure 2). The wide range of pressure differences and standard deviations suggest a lack of uniformity among the studies, in how they applied the “standard method.” Because there is no better alternative for indirect BP measurement, these unimpressive data have been accepted as appropriate validation for the cuff/stethoscope method and have supported the auscultatory method as the basis for clinical decision making for many years. But a critical look shows that the trusted cuff/stethoscope method is inaccurate. The reasons for the inaccuracy are multiple and include both observer errors and methodological errors. Some common observer errors are digit preferences, inattention, too rapid cuff deflation and hearing deficits. Methodological errors involve selection of a single beat for measurement when there are beat-to-beat variations in the pulses and sequential rather than simultaneous comparisons. A more inclusive list of these problems is available.5

References used by Association for the Advancement of Medical Instrumentation

5 to validate cuff auscultatory vs. intra-arterial systolic blood pressure measurements. Plotted values indicate average differences for each reference. Horizontal lines with brackets indicate standard deviation of the differences (where available).

Figure 1.

Figure 1.

References used by Association for the Advancement of Medical Instrumentation5 to validate cuff auscultatory vs. intra-arterial systolic blood pressure measurements. Plotted values indicate average differences for each reference. Horizontal lines with brackets indicate standard deviation of the differences (where available).

References used by Association for the Advancement of Medical Instrumentation

5 to validate cuff auscultatory vs. intra-arterial diastolic blood pressure measurements. Plotted values indicate average differences for each reference. Horizontal lines with brackets indicate standard deviation of the differences (where available).

Figure 2.

Figure 2.

References used by Association for the Advancement of Medical Instrumentation5 to validate cuff auscultatory vs. intra-arterial diastolic blood pressure measurements. Plotted values indicate average differences for each reference. Horizontal lines with brackets indicate standard deviation of the differences (where available).

Since it is convenient, safe, and eliminates the mercury column, the automatic oscillometric technique is now gradually replacing the cuff/stethoscope method. Because the cuff/stethoscope method is also noninvasive, easy, safe, and permits the study of large numbers of patients when compared to the direct intra-arterial method, the AAMI chose to use the auscultatory, rather than the intra-arterial method, as the “gold standard” against which oscillometric devices were validated. Relaxation of the validation standard has permitted the comparison of SBP and DBP of many oscillometric devices from multiple manufacturers to the relatively inaccurate auscultatory method with resultant claims of “validation.”7 The AAMI in reviewing “a large body of literature” recommends when comparing any new automatic device with the cuff/stethoscope method, average differences no greater than ± 5mmHg and standard deviations no greater than 8mmHg in groups of no less than 85 subjects.6 Consideration of these criteria reveals that a few values may deviate as much as 20mmHg (mean difference of 5mmHg + 2s.d.) from the standard pressure and still remain within approved validation limits. These criteria are retained in the AAMI’s most recent publication.8

In 1990 the British Hypertension Society also compared oscillometric device measurements against those generated from the inaccurate cuff/stethoscope method rather than the intra-arterial technique. 9 They justified this choice by arguing that the two methods measured different pressures, that the auscultatory method was used clinically and that intra-arterial validation was ethically unacceptable. Using the auscultatory method for validation, the oscillometric devices were graded as follows: grade A was met when 80% of the oscillometric values were within 5mmHg of the cuff/stethoscope values, grade B when 90% of the values were within 10mmHg, and grade C when 95% of the values were within 15mmHg of the cuff/stethoscope values. In 1993, these standards were relaxed to: 60, 85, and 95% of the cuff/stethoscope values for Grades A, B, and C respectively.10 In 2002, the validation procedures were re-visited by the Working Group on BP Monitoring of the European Society of Hypertension and then upgraded in 2010.11 This group also chose to use the cuff/stethoscope method as the gold standard. They justified their choice by reasoning that the oscillometric values should be similar to those of the familiar auscultatory method, a method that oscillometry is gradually replacing. Their most recent validation procedures have become necessarily more complex but they still include averaging pairs of auscultatory BP’s for comparison with automatic values and describe only pass/fail categories. To pass, 73, 87, and 96% of the automatic measurements must lie within 5, 10, and 15mmHg of the auscultatory values. Although the British and European criteria are described as more stringent than those of the AAMI, the data from all three systems indicate a degree of accepted inaccuracy that is seldom acknowledged. A discussion of the individual pressures follows.

Systolic Pressure

Generally, the AAMI6 has described the intra-arterial BA SBP as 3–4mmHg higher than the auscultatory BA SBP. By ignoring this small difference, the auscultatory BA pressures have served as surrogates for aortic pressures. But, the peripheral SBP has been known for many years to be higher than it is in the central aorta. This peripheral pulse amplification results from progressive stiffening of the peripheral arterial walls, from progressive reduction of the arterial diameter and, most importantly, from reflected waves that amplify the peripheral SBP more than the central SBP (Figure 3). To complicate matters, the magnitude of the peripheral/central SBP differences becomes smaller with aging as the central aortic walls stiffen. But even with aging, the peripheral SBP usually remains 5mmHg higher than the central SBP. Detailed explanations of this phenomenon have been well described.12 But for purposes of calculating cardiac work, or assessing cardiac and central nervous system risk, it is desirable to know the central aortic SBP—the pressure against which the heart pumps and that seen by the cerebral vasculature—rather than the BA SBP. But, direct measurements of central aortic pressure are impractical for clinical work or epidemiological studies and other means to estimate central pressures noninvasively have been proposed. There are four methods that hold promise for this purpose, but none are without problems.

Reflected waves in the arterial tree. Heavy dashed lines represent incident waves. Light dashed lines represent reflected waves. Solid lines represent recorded waves. Pulses on the left represent those in the central aorta. Pulses on the right represent pulses in peripheral arteries.

Figure 3.

Figure 3.

Reflected waves in the arterial tree. Heavy dashed lines represent incident waves. Light dashed lines represent reflected waves. Solid lines represent recorded waves. Pulses on the left represent those in the central aorta. Pulses on the right represent pulses in peripheral arteries.

  1. The Syphymocor device (AtCor Medical, West Ryde, Australia) is commercially available and has been used in many large studies to provide estimates of central aortic SBP’s with valuable results. 13,14,15,16 Using this device, the radial artery is applanated with a high frequency transducer and these pulses calibrated using BA pressures (auscultatory or oscillometric). Stable radial pulses are then ensemble averaged and, using a generalized transfer function, converted to an aortic pulse with reported aortic SBP, DBP, and MBP.17 When the radial pulses are calibrated with intra-arterial or aortic pressures, the predicted aortic pressures are similar to those directly recorded from the aorta.18,19,20 However, when the radial arterial pulses are calibrated noninvasively with BA cuff pressures (as they would be in routine clinical use) the results are less reliable21,22,23 since calibration errors are transferred in part to the predicted values.24 Calibration is further complicated by applying BA SBP to radial pulses thus ignoring the estimated 6–8mmHg pulse amplification between BA and radial arteries.25,26 One report finds the predicted aortic values to be no more valuable than the cuff BA pressures alone. 27

  2. Van Bortel et al. described a noninvasive method for recording the distension waves of the carotid artery.28 These waves were similarly calibrated with BA cuff pressures and in 100 subjects the carotid pulses predicted the aortic PP with grade A accuracy (British Hypertension Society). The SBP and DBP were not evaluated. Although carotid distention waves are easier to record than applanated carotid pulses, to our knowledge, this technique has not been applied clinically.

  3. The secondary systolic wave in the calibrated applanated radial pulse has been found to closely approximate the aortic SBP.29,30 This method proposes that the magnitude of the reflected systolic wave determines both the secondary radial wave and the aortic peak systolic pressure and that one can represent the other. These peaks are often visually recognizable on the radial pulse trace but in many cases, computer calculations are necessary to detect subtle changes in pulse slope needed to identify the second radial peak. This complexity may account for its infrequent clinical use.

  4. Since the carotid and central aortic SBP’s are similar, the carotid SBP could be used as a surrogate for the aortic SBP. The carotid SBP can be estimated noninvasively by applanating both the carotid and either the radial or brachial pulse. The peripheral DBP is measured using the cuff method and the MBP is calculated by integration of the applanated pulse. Since radial DBP’s and MBP’s are similar to aortic DBP and MBP,30,31 they are used to calibrate the applanated carotid pulse, thus permitting calculation of the carotid SBP and PP. Described in 1992,32 this method has been used in numerous clinical studies with valuable results.33,34,35 Although theoretically attractive and clinically feasible, the generated carotid SBP values have not been rigorously validated against directly recorded aortic pressures.

These methods to estimate central pressures are all indirect and require additional time, expertise, and money. Validation of their results against directly measured aortic values are mixed, all of which suggests that none are suitable at present for routine clinical use.

Diastolic Pressure

Initially, an elevated DBP was the preferred pressure for predicting target organ damage. But as therapy improved and the population aged, the predictive power of an elevated DBP was lost to the SBP.36 In the general population, the SBP rises throughout life. The DBP also rises until age 50–60 after which it progressively falls because of progressive aortic stiffness.37,38 Later in life therefore, a lower DBP is an indicator of aortic stiffness and, along with an elevated SBP, increases the PP—an accepted predictor of CV risk. In contrast to the SBP, the peripheral DBP is not amplified and is within 2mmHg of the aortic DBP.30,31 Therefore, an accurate BA DBP should closely reflect the aortic DBP and would be very useful.

The early AAMI validation reported that the cuff diastolic pressure was consistently higher than the intra-arterial DBP6 (Figure 2) and the largest difference was in patients with isolated systolic hypertension.39 A more recent study40 confirmed a 10mmHg overestimation of the aortic DBP by the cuff auscultatory DBP. The cuff DBP thus fails to faithfully sense the age related reduction in DBP—a matter of some concern, since coronary blood flow is largely dependent on the aortic DBP. Therapy of isolated systolic hypertension further reduces the DBP as well as the SBP, leading to a revived interest in the much debated “J curve.” Although controversial, concern about DBP reduction has led to the recommendation in Joint National Committee 7 that the cuff DBP be reduced no further than 55 or 60mmHg.41 This seems reasonable since the aortic DBP may be 10mmHg or more lower.

Thus far however, hope that the oscillometric DBP will be more accurate than the auscultatory DBP has waned since several recent studies have shown that oscillometric BA DBP’s perform no better than auscultatory DBP’s in predicting aortic or intra-arterial values. 21,27,42

Pulse Pressure

Since SBP’s and DBP’s from previous validation studies are readily available, it is unclear why none of the agencies have published validation data for the PP. Considering that the auscultatory SBP underestimates and the auscultatory DBP over estimates the intra-arterial pressures, the auscultatory PP’s should be systematically lower than the intra-arterial values. This supposition has been confirmed.40 If, as has been shown, the BA PP is a valuable CV risk predictor,43,44,45,46 it seems likely that the central PP should be even better and that the difference or ratio between peripheral and central PP (pulse amplification) might be the best.40,47

Mean Blood Pressure

The MBP has found little use clinically, due in part to the fact that it is not measured and must be calculated when using the auscultatory method. But it has considerable physiological significance as the time weighted integral of the pressure pulse about which the SBP and DBP oscillate. The MBP is determined in large measure by the peripheral vascular resistance and when elevated, it is the primary hemodynamic abnormality in essential hypertension. The MBP has also been reported as a CV risk factor48,49,50,51 that shares importance with the better recognized PP. MBP is attractive since, like the DBP, it is not amplified and an accurate peripheral measurement should therefore closely reflect the aortic MBP. At the BA, the MBP is most often calculated as 1/3 the PP plus the DBP. Many alternative formulas for its calculation have also been proposed to improve accuracy. These include the use of a geometric MBP utilizing the square root of the SBP × DBP,52 changing the correction factor from 0.33 to 0.453,54 or keeping the 0.33 factor but incorporating the heart rate into the formula.55 These alternatives face a common problem in that they all are calculated from, and are dependant on, measurement of the inaccurate auscultatory SBP and DBP. Furthermore, these formulas assume a constant arterial wave shape, but wave shape is known to vary, not only from patient to patient but from time to time in the same patient.56 It is well known, for example, that the triangular arterial pulse wave becomes more isosceles in shape with aging. If wave shape is inconstant, then no arithmetic formula can always accurately predict the MBP in any patient at any given time.

A similar problem is present when the MBP is calculated from the integrated radial arterial pulse that is in turn dependent on cuff SBP and DBP calibrations. The errors in the radial artery MBP and cuff DBP are then transferred to the calibration of the carotid pulse when the calibrated carotid pulse is used to estimate the aortic SBP.

All may not be lost. The measurement of MBP by the cuff oscillometer is independent of the measurement of both SBP and DBP (vide infra) but is not free of problems. The usual device algorithm identifies the MBP as the lowest cuff pressure at maximum cuff oscillation, but maximum cuff oscillations may occur over a spectrum of cuff pressures. Nonetheless, this method appears free of many of the drawbacks of other MBP measurements and may offer the most reliable cuff estimate of the aortic pressure.57

Risk Prediction

It is widely accepted that higher BA BP’s confer higher CV risks, but there has been uncertainty regarding which of the four clinically recordable BP’s offers the best risk prediction. DBP fell by the wayside as a predictor when Franklin et al.36 in 2001, using the Framingham data base, showed that an elevated DBP began to lose its predictive value above age 50. Furthermore, in older patients, Franklin et al.36,45 and others43,46 have also shown that DBP is inversely related to CV risk—again implicating progressive aortic stiffness as a CV risk. BA MBP (steady pressure) has made a strong showing as a risk predictor,48,49,50,51 but appears to have been overtaken by PP (pulsatile pressure) as the best pressure predictor measured from the BA. 43,44,45,46 More recently, estimates of central PP have been shown to predict CV risk better than BA PP. To this end, some groups have calculated aortic pressures using the Sphymocor device13,14,15,16 and others by estimating carotid PP.33,35 But the most persuasive evidence favoring central over peripheral PP for risk prediction was published by Jankowski et al.,40 who measured aortic pressures directly. This entire topic has been extensively reviewed.47,58 However, adoption of central PP as a risk predictor to influence therapeutic decision making in routine clinical practice has not yet occurred.

Oscillometric BP Measurements

Commercially available devices to measure the BA BP have been available since the 1970’s and have been steadily replacing the auscultatory method and the open mercury columns. Their popularity is based on avoidance of the problems of auscultation, ease of use and confidence that the digital displays are accurate. But the detection of SBP and DBP by oscillometry is an engineering challenge. The device must be able to detect small pressure changes within the cuff (oscillations) simultaneously over a spectrum of much higher cuff pressures necessary to compress the artery. Of the three displayed pressures, the MBP is the most accurate and the most uniformly measured by the manufacturers (vide supra). In principle, the SBP is detected by an increase in oscillation amplitude as blood first flows past the deflating cuff. Similarly, DBP is recognized when cuff oscillations return to baseline. Recognition of the cuff pressure at the arterial SBP and DBP therefore requires the detection of some change in the oscillations at these points. Such changes include increase or decrease in the oscillation amplitude, rate of change of the amplitude, change in the wave form of the oscillations, some preselected change in oscillation amplitude, etc. But, there is no standardized algorithm for identifying either the oscillometric SBP or DBP. Each device manufacturer has its own algorithm for BP detection, all are proprietary and unavailable for independent study.7 Other problems with the measurement include errors related to irregular cardiac rhythms, variations in the rate of cuff deflation, volume of air within the cuff, and compressibility of the BA. Because of the difficulty in recording intra-arterial pressures, most oscillometric devices have also been compared to BA pressures obtained by the auscultatory method. “Validation” studies have been published for many of the devices but many have not, leaving the consumer uninformed regarding the accuracy of the unvalidated devices. Some rationality has been brought to this area by the establishment of an independent data base (www.dableducational.org), whose function was recently described by O’Brien and Atkins.59 Validation data are submitted to the data base by the manufacturer that in turn compares their results to the requirements of the three validating organizations. If these requirements are satisfied, the device is listed in the table of approved devices. At this writing, there were 22 approved devices in the table of Automated Devices for Clinical Use. Unapproved devices are not on this list and many unvalidated devices are probably available commercially. A pulse simulator that makes available >200 arterial wave forms recorded from 124 patients has been described as an alternative to intra-arterial validation60 but the authors believe that further development in this field is required before such a device can replace clinical trials. The field needs independent studies that compare the different device algorithms for accuracy so that a standard approach to oscillometric BP measurement can be established. With manufacturers competing for customers, such a study will be difficult to mount.

Other Aspects of BP Recording

This review has focused on the measurement of the high and low points of the arterial pressure pulse—the SBP and DBP. Ease in making these two measurements has led to indifference to the additional information available from more complex analyses of arterial pulses. Measurement of the difference or ratio between peripheral and central SBP and PP allows for the calculation of pulse amplification, now recognized as a marker of CV risk.35 The directly recorded or applanated pressure pulses, along with simultaneous flow pulses, can be subjected to Fourier analysis leading to the subsequent calculation of the characteristic impedance, a value that relates to the stiffness of the arteries through which the pulse travels.61 Visually observed or computer detected changes in pulse upstroke can identify the arrival, amplitude, and timing of the wave reflected from the periphery.58 The percent contribution of the reflected wave amplitude to the overall PP called the augmentation index is then calculable. All these measurements relate to aortic stiffness and are estimates of CV risk but all estimates would be improved by more accurate BP measurements from which they are drawn.

Summary

This review looks at how the peripheral BP is measured and points out the inaccuracies of the many methods involved. The lack of better alternatives has led to an uncritical acceptance of that which is readily available. The oscillometric method offers greater convenience but, at the moment, is probably no better than the auscultatory method which it is gradually replacing. Peripheral BP measurements must be more accurate before better noninvasive estimates of the central aortic pressures can be made. Newer information available from the arterial pulse wave will not replace the BP but it may improve risk estimations when added to that obtained from the BP itself. Korotkov sounds may be disappearing but a more accurate replacement is not yet apparent.

Disclosure:

The authors declared no conflict of interest.

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I. Accurate Measurement of Blood Pressure

Revised/new recommendations for 2020

  • The recommended measurement frequency for ABPM is at 20- to 30-minute intervals throughout the day and night.

Most studies with data linking ABPM to clinical outcomes used a 24-hour BP measurement frequency of 30 minutes or less. In addition, the minimum recommended number of good-quality readings is 20 daytime and 7 night-time readings. Depending on the duration of sleep, 7 good-quality readings might not be achievable if intervals are less frequent than 30 minutes. Moreover, the greater the number of readings, the more precise the average BP. ABPM should be performed according to a standard protocol.

  • HBPM should be considered in adults with inadequately controlled BP.

Home systolic BP (SBP)/diastolic BP (DBP) values 135/85mm Hg or higher are considered high. This is supported by prognostic studies that showed an increased risk of cardiovascular events above or near this threshold.

HBPM should be performed according to a standard protocol. Despite varied measurement protocols, HBPM has been shown to predict health outcomes better than office BP measurements (OBPMs). Although single home readings were shown to be predictive of stroke in a large population, multiple BP readings are required for accurate risk prediction within individuals. BP readings taken on the first day in a series of measurements are higher than those on subsequent days, and with respect to duplicate readings, first readings are consistently higher than second readings in the morning as well as in the evening.

In the Efficacy of Self-Monitoring of Blood-Pressure, with or Without Telemonitoring, for Titration of Antihypertensive Medication (TASMINh5) study 1182 hypertensive patients were enrolled across 142 primary care clinics in the United Kingdom and randomized to hypertension medication titration on the basis of self-monitoring HBPM), self-monitoring with telemonitoring, or usual care (clinic-measured BP). BP targets varied according to patient characteristics but were uniformly 5/5 mm Hg lower for HBPM. At 12 months, the average clinic SBP was lower in both HBPM groups by 3.5-7.5 mm Hg, compared with the usual care group. The number of medications used was higher by on average 0.11-0.13 for the HBPM groups. There was no difference in safety outcomes. A shorter (6-month) trial showed similar results, whereas studies that used a common target for HBPM and OBPM did not show benefit of HBPM. On the basis of the improvement in BP control using HBPM over 12 months, it is recommended that HBPM be considered in those with inadequately controlled hypertension.

In studies of patients with chronic kidney disease, HBPM independently predicted the development of end-stage renal failure. The use of HBPM can increase patient adherence.32-34 Using population-based home BP measure-ments from the Ohasama study (N ¼ 128 subjects), it was reported that patients with white coat hypertension followed for 8 years were more likely to develop home hypertension than normotensive patients without white coat hypertension (47% vs 22%, respectively; odds ratio, 2.86; 95% confidence interval [CI], 1.90-4.31). Furthermore, there seems to be a considerable diagnostic agreement between home and ambu-latory BP in most of the subjects with and without hypertension.

Patients with a diagnosis of hypertension but with stable normotensive BP averages, “long-term observation” might be achieved with 1 week of HBPM every 3 months. Patients who have difficulty remembering to take medication might benefit from daily home BP measurement and patients with diabetes can benefit from frequent HBPM.

Recommendations

  1. Health care professionals who have been specifically trained to measure BP accurately should assess BP in all adult patients at all appropriate visits to determine car-diovascular risk and monitor antihypertensive treatment (Grade D).
  2. Use of standardized measurement techniques and independently validated equipment for all methods (automated OBPM [AOBP], OBPM, ABPM, and HBPM) is recommended (Grade D; see Supplemental Table S1 for recommended techniques). Unless speci-fied otherwise, measurement using electronic (oscillo-metric) upper arm devices is preferred over auscultation (Grade C). Devices that are appropriate for the individual and have met the ISO-81060 pro-tocol (Association for the Advancement of Medical Instrumentation: Non-invasive sphygmomanometers – Part 2: Clinical investigation of automated measure-ment type. ANSI/AAMI/ISO 81060-2/ANSI-AAMI, 2nd ed. Arlington, VA: AAMI 2013; see https://www. iso.org/standard/57977.html) should be used. For HBPM, patients should be encouraged to use devices with data recording capabilities or automatic data transmission to increase the reliability of reported HBPM (Grade D).
  3. In patients with large arm circumferences when standard upper arm cuffs cannot be used, validated wrist devices (used with arm and wrist supported at heart level) may be used for BP estimation (Grade D).
  4. Four approaches can be used to assess BP:

    i. AOBP is the preferred method of performing OBPM (Grade D). The BP value calculated and displayed by the device should be used. When using AOBP (see the Rec-ommended Technique for Automated Office Blood Pressure section in Supplemental Table S1), displayed mean SBP 135 mm Hg or DBP 85 mm Hg is high (Grade D).

    ii. When using OBPM, the first reading should be dis-carded and the latter readings averaged (see the Recom-mended Technique for Office Blood Pressure Measurement section in Supplemental Table S1). Mean SBP between 130 and 139 mm Hg or mean DBP between 85 and 89 mm Hg is high-normal, and mean SBP 140 mm Hg or DBP 90 mm Hg is high (Grade C).

    iii. Using ABPM, mean awake SBP 135 mm Hg or DBP 85 mm Hg or mean 24-hour SBP 130 mm Hg or DBP 80 mm Hg are high (Grade C).

    iv. Using HBPM, mean SBP 135 mm Hg or DBP 85 mm Hg are high and associated with an increased overall mortality risk (Grade C). HBPM values should be on the basis of a series comprised of the mean of duplicate measures, for morning and evening, for a 7-day period. First day home BP values should not be considered (Grade D).

    Key Messages

    Out-of-office BP measurements are essential to rule out white coat hypertension in subjects with and without diabetes and to diagnose masked hypertension, when suspected.

How to get the most accurate blood pressure measurement

As a standard part of many physicians’ office workflows, measuring blood pressure may seem like a normal routine. However, seemingly minor issues can impact BP measurement, artificially inflating a patient’s blood pressure by anywhere from two to 40 mmHg. It is important to reevaluate your blood pressure measurement process, while also speaking with patients about how to manage their high BP.

If a patient talks during the measurement, for example, or if the patient’s feet aren’t flat on the floor, there’s a chance that blood pressure measurement will give a falsely high reading. This could lead to a prescription for an unnecessary, potentially harmful, medication. At the same time, other factors can contribute to unidentified and untreated hypertension, which can be deadly.

Tips for addressing hypertension are available through Target: BP™, a joint initiative between the AMA and American Heart Association (AHA) to improve blood-pressure control and build a healthier nation.

Target: BP’s Improvement Program outlines a practical, evidence-based approach to improving BP control for your patients by focusing equally on three critical areas:

  • Measuring blood pressure accurately, every time. Accurate measurement and recording of BP is essential to categorize level of BP, ascertain BP-related CVD risk, and guide management of high BP.
  • Acting rapidly to address high blood pressure readings. Take rapid action and follow treatment protocols to bring BP under control.
  • Partnering with patients to promote self-management of high BP. Improve adherence to treatment and lifestyle changes through collaborative communication and follow-up visits.

Taking the checklist approach to blood-pressure management can help ensure quality care in screening for and treating patients with high BP, as well as preventing the development of heart disease and stroke down the road.

Target: BP offers annual, recurring recognition for all participating sites that achieve hypertension control rates of 70 percent or higher among their adult patient population year over year. In 2018, nearly 800 organizations have been recognized for their efforts focusing on blood pressure control within the populations they serve.

An AMA membership means you’re motivating millions to control hypertension. When the nation’s health is on the line, you can count on the AMA to be part of the solution.

How to measure blood pressure correctly at home

Self-monitoring of blood pressure at home is widely used. Home blood pressure measurements are very useful – they allow the doctor to more accurately assess the true blood pressure level and correctly prescribe antihypertensive drugs for long-term treatment of patients with hypertension.

These measurements are important because they provide information about the blood pressure level over long periods of time during which the patient does not visit the doctor and is in his usual environment.

Measurement conditions

– Rest for at least 5 minutes before taking blood pressure measurements.

– At least 30 minutes before measuring blood pressure, you must refrain from smoking and drinking caffeine (coffee, cola, tea).

During the measurement, one should sit leaning against the back of a chair, and the motionless arm should lie comfortably on the table.

– Do not talk while measuring.

– The cuff should be wrapped around the forearm with the center of the inflatable bag just above the brachial artery, and the bottom edge of the cuff should be about 2-3 cm above the elbow bend.

– The cuff inflatable bag must be at the level of the heart during the measurement.

– Legs should not be crossed when measuring.

– Feet should be on the floor.

– The bladder must be emptied before measuring blood pressure.

– The shoulder should not be squeezed by clothing (all the more, measurement through clothing is unacceptable).

Failure to comply with these conditions may lead to high blood pressure:

after taking coffee – by 11/5 mm Hg.Art.

alcohol per – 8/8 mm Hg. Art.

smokers at – 6/5 mm Hg. Art.

with an overflowing bladder – by 15/10 mm Hg. Art.

in the absence of back support – systolic at 6-10 mm Hg. Art.

in the absence of a hand support – by 7/11 mm Hg. Art.

Which tonometers are better to use

For home blood pressure measurement, there are several types of devices available on the market:
– Auscultatory method: mercury devices, aneroid (“dial”) and electronic (“hybrid”) devices for measuring blood pressure are used simultaneously with a stethoscope.

– Electronic automated devices for measuring blood pressure at shoulder, wrist and fingers.

Electronic shoulder-level blood pressure monitors, whether semi-automatic (manual cuffs inflate by squeezing a bulb) or automatic (battery or mains powered) are preferred for self-measurement of blood pressure at home. These devices are easy to use, require minimal training, and many are affordable.

Preferred are tonometers with memory, which automatically store each measurement (with date and time) and the average of all measurements prior to the doctor’s visit.

Wrist devices are less accurate and not recommended unless shoulder blood pressure measurement is impossible or very difficult.

Finger devices not recommended.

Mercury blood pressure monitors require extensive training and have been banned in some countries for environmental reasons.Aneroid devices also require preparation and regular calibration. The use of these devices should be limited to patients in whom automatic measurements are impossible or inaccurate.

Not all home blood pressure monitors available on the market have been adequately tested. Up-to-date information on device testing should be provided by a physician.

Selecting the correct cuff and the size of the patient’s arm is essential for accurate measurement.The cuff inflatable bag should cover 80-100% of the shoulder circumference. The use of small cuffs can lead to an overestimation of blood pressure, while the use of large cuffs can lead to an underestimation of blood pressure. Therefore, if your arm has a circumference of <24 cm or> 32 cm, make sure that the device is equipped with a small or large cuff, respectively.

How often should blood pressure be measured at home?

For an initial assessment of hypertension and the assessment of the effects of taking antihypertensive drugs, blood pressure at home should be measured for at least 3, and preferably 7 days.

Daily blood pressure measurements should be carried out both in the morning (immediately after waking up and before taking the drug during treatment) and in the evening. In each case, re-measurement should be carried out 1 minute later.

The average of all measurements shall be calculated after discarding the measurements of the first day.

This 7-day schedule should be followed before each follow-up visit to the doctor.

For long-term observation, it is advisable to take home measurements less frequently.

Measurement under stress can be misleading and should be avoided

Excessive use of home blood pressure measurement should be avoided to self-adjust treatment (take additional pills or change dose).

The results should be recorded in the log immediately after each measurement, unless the device stores in memory the blood pressure values ​​with the date and time of each measurement or has a built-in data transmission system.

What are the norms of blood pressure when measuring at home?

As mentioned above, repeated measurements over several days should be averaged to obtain a reliable picture of blood pressure levels at home.

Mean systolic blood pressure below 130 mm Hg. and diastolic below 80 mm Hg. is considered normal home blood pressure, and systolic pressure is 135 mmHg. and above and / or diastolic 85 mm Hg.Art. and higher – high home blood pressure.

Interpretation of blood pressure measurements

The average of several blood pressure measurements at home over several days complements the measurements in the doctor’s office and helps the doctor to make an accurate diagnosis.

Home blood pressure measurements can vary significantly from measurement to measurement. Blood pressure can be very high, especially during stressful situations, panic, severe pain, etc.or rather low, for example, after a long rest or after intense exercise. “One-off” measurements are of little value and cannot provide an indication of the “normal” home blood pressure level. High blood pressure in one measurement should not be alarming unless very high values ​​persist after a sufficient period of rest or are accompanied by severe symptoms (eg, shortness of breath, chest pain, weakness in an arm or leg, difficulty speaking).

Increasing self-control of blood pressure at home is not in itself an indication for treatment. Your doctor will advise you when and what treatment is indicated.

In some cases, self-measured blood pressure at home may be significantly lower than the measurements obtained at the doctor’s appointment. This phenomenon is not uncommon and is known as white coat hypertension. On the other hand, in some cases, blood pressure may be low in the doctor’s office, while self-measured blood pressure at home is high (latent hypertension).These situations require careful medical evaluation. Additional examinations and repeated monitoring of blood pressure at home or on an outpatient basis for 24 hours may be required in order to decide if treatment is necessary.

Non-invasive methods for studying the dynamics of blood pressure | Ivanov

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90,000 High pressure. 5 tips on how to measure blood pressure correctly

According to the recommendations of the World Health Organization, normal blood pressure figures should not exceed 140/90 mm Hg.Art. If the tonometer regularly shows values ​​above these numbers, this is already a reason to consult a doctor. At the same time, it should be borne in mind that, among other things, the age and weight of a person, the presence of bad habits or chronic diseases affect the level of blood pressure.

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Advice No. 3. We measure the pressure while sitting, the hand lies on the surface

During the measurement of blood pressure, it is advisable to sit upright, leaning against the back of a chair. The arm at the elbow should be bent 90 degrees and lie on some surface, the legs should not be crossed.The pose is comfortable and comfortable. Before turning on the tonometer, you need to relax and calm down. During the procedure, you cannot talk and move.

You should not smoke 30 minutes before the start of the measurement (by the way, after a smoked cigarette, the pressure level can be increased within 2 hours), you should not drink tea and coffee, or take alcohol. All this can provoke an increase in blood pressure. Before the measurement, you should also go to the toilet (a full bladder can give an error of 10-15 mm Hg.Art.).

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Advice No. 4. Nasal and eye drops – cancel

Not really, but two to three hours before measurement. The fact is that nasal and eye drops belong to a number of sympathomimetics, which, even with local action, can, albeit slightly, increase blood pressure. These drugs include:

  • nasal drops, which have a vasoconstrictor effect;
  • eye drops;
  • preparations for the treatment of bronchial asthma;
  • a number of medicines intended for the treatment of neuropsychiatric disorders.

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Advice No. 5. After sports – rest

If the measurement of pressure was preceded by physical activity, you need to rest and relax for about half an hour. Let your blood pressure and pulse return to normal.

Measurement of blood pressure

Measurement of blood pressure (BP) – the main and very important method for the diagnosis and control of arterial hypertension. Every patient should know how to measure blood pressure correctly.

11 of my rules for measuring blood pressure:

  1. Always measure your blood pressure at the same time of day;
  2. Sit quietly for 5 minutes before measuring pressure. Even a slight mental stress leads to an increase in blood pressure by 5 mm Hg. After significant physical or emotional stress, the rest period should be at least 15 minutes;
  3. Measure pressure while sitting.Free your hand from clothes, place it on the table, at the level of the heart;
  4. Buy an automatic blood pressure monitor with a shoulder cuff;
  5. Do not smoke for 30 minutes, do not drink coffee or strong tea an hour before measuring blood pressure;
  6. Place the lower edge of the cuff 2 cm above the level of the elbow. The cuff should be the same size as your hand. The cuff should fit snugly around the shoulder without causing pain;
  7. Do not talk or move while measuring pressure. The slightest movement increases blood pressure by 10 mm Hg;
  8. For the first time, measure the pressure on 2 hands, then measure the pressure on the arm where the pressure is higher;
  9. Measure blood pressure 2-3 measurements with a pause per minute.If the difference in readings is more than 5 mm Hg, take another additional measurement. Record the minimum value in your diary;
  10. To rule out orthostatic hypotension (lowering blood pressure when standing up) in elderly people with dizziness receiving antihypertensive drugs, measure blood pressure 2 minutes after standing up;
  11. Enter the measurement results in the diary. Do not stop measuring blood pressure, even if the pressure numbers are normal during treatment. Self-measurement of pressure will help you, together with your doctor, to control the course of arterial hypertension, to adjust the treatment.

How to measure blood pressure correctly

Why is blood pressure measurement so important?

Since high blood pressure is not always noticeable, a person can live with such pressure for many years. However, if left untreated, high blood pressure can lead to serious illnesses that are only recognized when the first effects begin. The danger can only be recognized with regular monitoring of blood pressure. Self-measurement of blood pressure in a familiar setting reflects blood pressure under normal conditions, as opposed to measurements made by a doctor in a clinic.

Why do I get different readings when I measure my blood pressure several times a day?

Since the heart rate changes constantly throughout the day, one blood pressure measurement shows one value at a single moment. From heartbeat to heartbeat, human pressure changes about 100,000 times a day. Only regular measurements at the same time of day and under the same conditions can give comparable indicators and can be used to compare different blood pressure values.

Why should BP always be measured at the same time of day?

Many functions of the human body are subject to daily biorhythms that have similar characteristics when environmental conditions are similar. So blood pressure is subject to constant daily biorhythms: it rises in the morning, shortly before getting out of bed, falls in the afternoon and rises again when evening comes. The lowest blood pressure is observed at night. In order to compare blood pressure readings one with another, measurements must be made at the same time.Measurements taken in the morning cannot be compared with evening readings.

Why does my doctor get completely different results than I do at home?

Blood pressure readings can be compared with one another only if both measurements were taken when you were in a relaxed state and always at the same time of day. Studies have shown that 25% of people have higher readings in the doctor’s office than at home. This phenomenon has been called the “white coat effect” or “white coat hypertension.”This is not a disease, since high blood pressure in this case is due to a stressful situation and nervousness during a visit to the doctor. However, such elevated blood pressure readings may be the first indicator of impending hypertension.

My blood pressure monitor gives different results all the time.

Blood pressure is not a constant value, as it depends on the mental and physical condition at a particular moment, time of day and measurement conditions.Therefore, you must measure blood pressure under the same conditions, i.e. try to measure blood pressure at the same time of the day and rest at least 5 minutes before. However, for many people, the pressure rises even though they rest. In this case, it is recommended to measure blood pressure two or three times at intervals of 1 minute and take the average between these measurements. If you are still confused by something, contact your local RosTest office or Metrological laboratory to check your device.

What can I do to prevent external factors from influencing the measurement results?

  1. Avoid alcohol and nicotine for one hour before measurement.
  2. Do not drink coffee immediately before measurement.
  3. The bladder must be empty before measurement. A full bladder raises the pressure by about 10 mmHg.
  4. Do not measure blood pressure if you are experiencing stress, pain, or fear. These factors can alter BP.
  5. Make sure the cuff is correctly fitted during measurement. When measuring blood pressure at the shoulder, the border of the cuff should be 2.5 cm above the bend of the elbow.When measuring blood pressure at the wrist, place the cuff 1 cm above the wrist fold.
  6. When measuring blood pressure at the wrist or shoulder, make sure that the measurement site is at the level of the heart – if the position is shifted by 1.5 cm, – the pressure increases by 1 mmHg.
  7. Relax your arm muscles while measuring. Muscle tension increases the pressure by approximately 10 mmHg.
  8. Do not speak during measurement. A conversation during measurement can increase the pressure by 6-7 mm Hg.Art.
  9. The upper arm should not be pinched by clothing when measuring blood pressure on the shoulder. It is best to remove all clothing from the shoulder.
  10. Before measuring on the upper arm, make sure that you have fitted the cuff correctly. If you can slip 2 fingers under the cuff at the top and bottom, you can start measuring. If the cuff is too loose or too tight, the results will be either too high or too low, respectively.
  11. Rest for at least 1 minute before taking another measurement.
  12. Remember that blood pressure is subject to circadian rhythms and can change depending on the time of day and the needs of the body at a particular moment. To obtain comparable results, the best solution is to measure the pressure at the same time of day.

What does high blood pressure mean?

The World Health Organization (WHO) has adopted a new classification of blood pressure levels:

Optimum level <120/80
Normal <130/85
Mild hypertension 140-159 / 90-99

Moderate hypertension 160-179 / 100-109

Severe hypertension> 180 and> 110 90 003

Is it possible to measure with an oscillometric method with a pacemaker?

In principle, oscillometric measurement is possible in patients with an implanted pacemaker.However, the work of the pacemaker is not captured by the function of determining the pulse of the electronic tonometer. If you get meaningless results or the “ERR” symbol on the screen during the measurement – this is not due to the physiological heart rate, which is set by the pacemaker. In these cases, oscillometric blood pressure measurement is problematic and it is better to measure blood pressure using the Korotkoff method (with a stethoscope or microphone). In any case, you should consult your doctor.

What should be done if a person has a pathological rhythm disorder? How to measure blood pressure?

It is not possible to give general recommendations as there are a large number of different heart rhythm pathologies that must be considered individually.In principle, oscillometric instruments can accurately measure pressure when pulse signals are discernible. In some arrhythmias, eg irregular heart rate, absolute arrhythmia, oscillometric measurement is not possible due to “lost” and very irregular pulse signals. In this case, a stethoscope should be used. With milder forms or rare episodes of arrhythmia, oscillometric measurement is possible. In case of doubt, measurements should be taken several times at 1-minute intervals and the average of several measurements should be taken.However, each case is different and the details should be discussed with your doctor.

What to look for when measuring blood pressure during pregnancy?

High blood pressure during pregnancy is noted in about 10% of expectant mothers. Such cases need to be identified and carefully treated. Self-measurement of blood pressure during pregnancy is recommended for every pregnant woman and should be performed both by a doctor during the consultation and at home.

Can I change the dosage of drugs based on my blood pressure readings?

Finding the right combination of suitable drugs for the hypertensive patient requires an individualized treatment plan. You should never independently change the dosage of the drug taken and prescribed by the doctor. Regular readings of your blood pressure provide your doctor with valuable information to optimize your individual treatment plan. Record your measurements carefully in a blood pressure diary and discuss possible drug dosage changes with your doctor.

Should I see a doctor regularly if I measure my blood pressure myself at home?

Regular measurements of blood pressure at home will allow your doctor to assess the profile and dynamics of your blood pressure over several weeks or months and thereby allow an optimal change in the therapy plan. Measuring blood pressure at home is not a substitute for required doctor visits.

Why is it necessary to record indicators in a personal BP diary?

A single blood pressure measurement is only a one-time reading and does not provide an accurate picture of blood pressure levels over the course of a day or several days.Therefore, you should measure your blood pressure two or three times a day, always at the same time. Record the results along with the date and time and medications taken in your blood pressure diary. Long-term BP readings will provide your doctor with a valuable basis for tailoring individual therapy.

Why may the first blood pressure reading differ from the previous one?

This is due to the “habituation” of the artery to compression. However, it should be borne in mind that the first blood pressure measurement result is rarely true.

Which model is better for an elderly person with hypertension?

Automatic model for measuring blood pressure on the shoulder (but not on the wrist). In older adults, the BP measured at the wrist may differ from the BP measured at the brachial artery due to atherosclerosis.

When measuring pressure several times in a row, each subsequent reading is lower than the previous one.