Issues and Challenges of Blood Pressure Management
High blood pressure is linked to increased risk of stroke, coronary artery disease, and damage to organs, such as heart and kidneys. Therefore, managing blood pressure is highly important, as even a small reduction in blood pressure can have major benefits. For example, a reduction of just 10mm in systolic blood pressure (BP) is linked to a 50%-60% decrease in risk of death via stroke, and 40%-50% decrease in risk of death via complications of coronary artery disease.
Although the benefits of controlling blood pressure are more obvious in those who are unwell, or with underlying health issues, the majority of people with blood pressure issues fall into the category of “moderate” risk. The sheer number of people who fall into this category, mean that any advances in treatment has the potential to make a big impact on the global burden caused by complications of high blood pressure.
Management of blood pressure becomes even more vital in those at higher risk of heart or vascular issues, such as type 2 diabetics.
One of the issues that complicate efforts to manage blood pressure is ensuring accurate measurement of patient blood pressure. Unfortunately, the recommended method for BP measurement is not always followed due to time constraints in the modern clinical setting.
It is normal for blood pressure to vary, therefore blood pressure readings from three separate visits should be compared and assessed, before a diagnosis of hypertension, or high blood pressure, is made. An exception to this rule is when blood pressure is exceptionally high.
Caffeine, smoking or exercise should be avoided for at least 30 minutes before a blood pressure reading.
Recommendations for Measuring Blood Pressure
Where possible, the blood pressure should be measured in both sitting and standing positions. This will not be possible for some hospitalized or disabled patients, however, when possible, ensure the patient is comfortable and settled, with feet on the floor and back supported. Let the arm rest in a horizontal position, and then allow the patient to sit for at least ten minutes, before taking a reading in each arm.
Ensure the BP cuff is at the level of the heart, and the cuff in use is the appropriate size for the patient, to ensure an accurate reading. The section of the cuff that inflates should go around at least 80% of the upper arm circumference.
Initially, take a reading from both arms, and use the arm with higher reading for future measurements. Although the BP can differ in each arm, this should not be more than 10mm Hg.
A standing BP measurement can then be taken, after allowing the patient to stand for 1-3 minutes.
Additional Recommendations for Measuring Blood Pressure in Older People
Extra precautions should be taken with older people, due to the stiffening of their arteries, which can cause artificially high blood pressure readings. This situation, known as pseudo-hypertension, should be investigated in older patients, via arterial probe, who do not respond to standard treatment, yet show no signs of organ damage. Be aware that some elderly patients on a number of medications may have elevated blood pressure after a meal.
If using a stethoscope, the measurement at which the sound of the pulse can first be detected if the systolic BP, even if the sound disappears and then reappears again. These sounds may go unnoticed if the cuff is not inflated enough.
Maintenance of Equipment
In order to avoid inaccurate readings and medication errors, it is important that blood pressure monitors be regularly serviced and calibrated. Aneroid, or manual monitors should be checked and calibrated at least every 6 months. To avoid losing accuracy, digital monitors should also be checked and calibrated regularly.