Because of their lower cost and because they are not used in the office setting, there are no standardized protocols for calibrating HBPM devices once they have left the manufacturer. An HBPM device validated in a specific population may not always provide an accurate measure of BP for a specific individual.
However, this approach may be appropriate for some individuals in whom it is suspected that home BP readings may be inaccurate despite the use of a validated device. Accurately measuring BP is essential for the proper diagnosis of hypertension and monitoring the effect of antihypertensive treatment. In addition, BP is a component of CVD risk prediction equations that, in turn, are used to guide the decision to initiate statins, pharmacological antihypertensive medication, and aspirin therapy.
A list of summary points from each section is provided in Table In the office setting, the use of oscillometric devices provides an approach to obtain a valid BP measurement that may reduce the human error associated with auscultatory measurements. The use of a validated AOBP device that can be programmed to take and average at least 3 BP readings should be considered the preferred approach for evaluating office BP.
Finally, we cannot overstate the importance of using only validated devices, routinely calibrating and maintaining BP measurement devices, and having BP measured by healthcare providers who have been properly trained and retrained. Figure 3. Detection of white-coat effect or masked uncontrolled hypertension in patients on drug therapy.
Writing Group Disclosures. This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. Reviewer Disclosures. This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit.
The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.
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Measurement of blood pressure in humans: a scientific statement from the American Heart Association. DOI: The expert peer review of AHA-commissioned documents eg, scientific statements, clinical practice guidelines, systematic reviews is conducted by the AHA Office of Science Operations. Home Hypertension Vol. View PDF.
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Wright Jr Jackson T. Wright Jr Search for more papers by this author. Abstract The accurate measurement of blood pressure BP is essential for the diagnosis and management of hypertension. Hearing: The observer must be able to hear the Korotkoff sounds. Questionnaires or interviews can be used to assess knowledge of the BP measurement methodology.
Retraining of healthcare professionals every 6 mo to 1 y should be considered. Shirtsleeves should not be rolled up because this may create a tourniquet effect. Individual cuffs should be labeled with the ranges of arm circumferences; lines should be added that show whether the cuff size is appropriate when it is wrapped around the arm.
Information on cuff selection for patients with morbid obesity is provided in the Obese Patients section. When BP measurements are taken in the supine position, the cuffed arm should be supported with a pillow. In the seated position, the right atrium level is the midpoint of the sternum or the fourth intercostal space.
The cuffed arm should be held up by the observer or resting on a table at heart level. If the arm is held up by the patient, BP will be raised. Have the patient relax, sitting in a chair with feet flat on floor and back supported.
The patient should be seated for 3—5 min without talking or moving around before recording the first BP reading. A shorter wait period is used for some AOBP devices. The patient should avoid caffeine, exercise, and smoking for at least 30 min before measurement.
Neither the patient nor the observer should talk during the rest period or during the measurement. Remove clothing covering the location of cuff placement.
Measurements made while the patient is sitting on an examining table do not fulfill these criteria. Step 2: Use proper technique for BP measurements 1. Use an upper-arm cuff BP measurement device that has been validated, and ensure that the device is calibrated periodically. Use either the stethoscope diaphragm or bell for auscultatory readings. At the first visit, record BP in both arms. Separate repeated measurements by 1—2 min. For auscultatory determinations, use a palpated estimate of radial pulse obliteration pressure to estimate SBP.