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Can Blood Pressure Monitoring Impact Hypertension Treatment? Blood pressure is a measurement of the force against the walls of one’s arteries as the heart pumps blood through the body. When a person has a blood pressure reading of 140/80 mmHg or higher most of the time, he or she is said to have developed hypertension, or more commonly known as high blood pressure. The upper reading 140 is the systolic blood pressure and the lower reading 80 is the diastolic blood pressure. A person’s blood pressure is considered normal when the blood pressure is lower than 120/80 mmHg most of the time. If the blood pressure reading is higher than 120/80 but below 140/90 mmHg, it is known as pre-hypertension. A person with pre-hypertension is more likely to develop hypertension. People with hypertension are at a higher risk of getting numerous medical disorders including heart disease, stroke and kidney failure. As there is no symptoms, hypertension is also called the ‘Silent Killer”. Most hypertensive patients find out their conditions only when doctors check their blood pressures. Patients diagnosed with hypertension will most likely be prescribed with medications to bring the blood pressure down to the normal range. In addition, their blood pressure will regularly be monitored. This makes blood pressure monitoring important for hypertensive patients.
Unfortunately, failure of some doctors or clinicians to stick to official recommendations for blood pressure monitoring causes a number of patients being misclassified. This no doubt could have an impact on the decisions on treatments. Researchers from the University of New Mexico College of Pharmacy reported that 93 percent of patients had different blood pressure readings when routine blood pressure monitoring in clinics was compared with measurements based on the latest guidelines. Their findings were published online on December 8, 2011 in the ‘Journal of General Internal Medicine’, published by Springer. To ensure accurate and consistent blood pressure measurements, the American Heart Association (AHA) had released in 2005 updated recommendations for blood pressure monitoring. Reading such as body position, arm position, inter-arm differences, cuff size and cuff placement can affect the reading. There were 40 hypertensive patients involved in the study. Their blood pressure readings were obtained by the traditional method routinely used in clinics and by the AHA-recommended method. In addition, the researchers also gathered past medical history, medication list, drug allergies, vital signs, presence or absence of pain, physical examination and laboratory findings so as to produce 2 medical profiles for each patient. 3 physicians who provided hypothetical hypertension treatment recommendations were asked to review these profiles. It was found that individual blood pressure measurements varied greatly between the 2 monitoring methods. They discovered that as many as 93 percent of patients had a significant blood pressure difference between the 2 readings (either over 5 mmHg systolic or over 2 mmHg diastolic), with implications for potential cardiovascular events. Out of 10 possible technical errors (as defined by the AHA), the average number of errors per patient using traditional monitoring method was 4. The most common one was the absence of measurements on both arms. Researchers suspected that it was possible that doctors or clinicians wanted to save time during measurements. The time to measure blood pressure using the AHA method was more than 8 minutes compared to 2 minutes using the traditional method. According to the hypertension medication treatment decisions provided by the 3 physicians, 45 percent of patients would have received different treatments based on their 2 blood pressure measurements. Based on the findings, researchers concluded that inaccurate blood pressure assessment is common and might impact hypertension treatment. It is paramount that the clinicians need to be educated on the AHA recommendations for accurate blood pressure measurements and encouraged to strictly follow them in order to get a more accurate reading. This could naturally result in improved hypertension management decisions.
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