• Number of readings
    • Take 2 readings at least 1 minute apart in the morning before taking antihypertensive medications and 2 readings at least 1 minute apart in the evening before bed
  • Duration of monitoring
    • Preferred monitoring period is ≥7 days with a minimum of 3 days
    • Monitoring conducted over consecutive days is ideal
  • Analyzing readings
    • The average of all readings should be calculated for each monitoring period

Summary of Scientific Statement on the Measurement of BP in Humans

  • BP components
    • Several BP components, including SBP, DBP, pulse pressure, and mean arterial pressure, are associated with cardiovascular disease (CVD) risk
    • Most guidelines use SBP and DBP to define hypertension
  • BP measurement in the office
    • While the auscultatory BP method has been the traditional approach, it is being increasingly replaced by the oscillometric method
    • Aneroid sphygmomanometers require frequent calibration (every 2-4 weeks for handheld devices and every 3-6 months for wall-mounted devices)
    • Automated office blood pressure (AOBP) devices should be considered for measuring office BP
    • Office BP should be measured ≥2 times per visit
    • Even when AOBP is being used, clinician training is integral for accurate BP measurement
  • 24-h ABPM
    • ABPM is the preferred approach for assessing out-of-office BP
    • The main indications for ABPM are to detect white-coat hypertension and masked hypertension
    • ABPM is the preferred approach to assess nocturnal hypertension, which is common among black patients
  • HBPM
    • HPBM can be used to assess out-of-office BP when ABPM is not available or accepted by the patient. It can be used to detect white coat hypertension and masked hypertension
    • Many HBPM devices have not been validated; clinicians should only recommend devices that have been validated
    • By itself, HBPM has a limited effect on BP control, but it is effective in reducing BP when used in conjunction with supportive interventions
    • Encourage patients to use HBPM devices that automatically store readings or transmit them to their clinician
  • Special BP measurement techniques
    • While devices that measure BP at the wrist have been validated, they face many challenges in obtaining an accurate reading
    • A preliminary analysis of wireless BP monitors showed poor accuracy
  • BP measurements in other settings
    • Measurements conducted by trained pharmacists may be an alternative to HBPM
    • Kiosks used to measure BP often do not have cuffs that fit large arms
  • BP measurement ins pecial populations
    • Children
      • Oscillometric and auscultatory methods are both acceptable for screening BP measurements
      • BP should betaken in the right arm
    • Pregnant patients
      • BP measurement devices need to be validated among pregnant women due to the hemodynamic and vascular changes that occur
      • A systematic review has reported devices that have been validated for pregnant women
    • Obese patients
      • Tronco-conical shaped BP cuffs may be useful.
      • If a patient’s arm circumference exceeds the largest arm cuff available, a thigh cuff can be used
      • If a thigh cuff does not fit, BP can be measured at the wrist.
    • Older adults
      • Sitting and standing BP measurements can identify orthostatic hypotension
      • ABPM may identify white-coat hypertension, hypotension in the postprandial state and after awakening in the morning
  • BP variability
    • Short-term BP variability has low reproducibility and is not associated with risk for CVD events
    • Visit-to-visit variability is associated with risk for CVD events
    • Calcium channel blockers and thiazide-type diuretics are associated with lower visit-to-visit variability of BP

“Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements,” the researchers wrote.

Reference

Muntner P, Shimbo D, Carey RM, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. [published online March 4, 2019]. Hypertension. doi:10.1161/HYP.0000000000000087

This article originally appeared on The Cardiology Advisor