Accurate blood pressure recording: Is it difficult?

Abstract

BACKGROUND: Blood pressure (BP) measurement is a routine procedure but errors are frequently committed during BP recording. AIMS AND SETTINGS: The aim of the study was to look at the prevalent practices in the institute regarding BP recording. The study was conducted in the Medicine Department at Government Medical College, Chandigarh, a teaching institute for MBBS students. METHODS: A prospective, observational study was performed amongst the 80 doctors in a tertiary care hospital. All of them were observed by a single observer during the act of BP recording. The observer was well versed with the guidelines issued by British Hypertension Society (BHS) and the deviations from the standard set of guidelines issued by BHS were noted. The errors were defined as deviations from these guidelines. STATISTICAL METHODS: The results were recorded as percentage of doctors committing these errors. RESULTS: In our study, 90% used mercury type sphygmomanometer. Zero error of the apparatus, hand dominance was not noted by any one. Every one used the standard BP cuff for recording BP. 70% of them did not let the patient rest before recording BP. 80% did not remove the clothing from the arm. None of them recorded BP in both arms. In out patient setting, 80% recorded blood pressure in sitting position and 14% in supine position. In all the patients where BP was recorded in sitting position BP apparatus was below the level of heart and 20% did not have their arm supported. 60% did not use palpatory method for noticing systolic BP and 70% did not raise pressure 30-40 mm Hg above the systolic level before checking the BP by auscultation. 80% lowered the BP at a rate of more than 2 mm/s and 60% rounded off the BP to nearest 5-10 mm Hg. 70% recorded BP only once and 90% of the rest re inflated the cuff without completely deflating and allowing rest before a second reading was obtained. CONCLUSION: The practice of recording BP in our hospital varies from the standard guidelines issued by the BHS.

End digit preference in blood pressure measurement in a hypertension specialty clinic in southwest Nigeria

“…However, many publications have pointed out the lack of formal training and assessment in BP measurement during undergraduate and postgraduate medical training, and this could have been responsible for our findings 9,19,24-26. In fact, Gonzalez-Lopez et al 24 pointed out that inadequate knowledge of BP measurement is unlikely to improve during specialised postgraduate training since the skill is not taught during this period because of the assumption that the relevant skill should have been acquired earlier on during undergraduate training.…”

“…Although protocols for measuring BP are well described and standardised,2-5 inaccuracies of measurement do occur from the use of faulty or malfunctioning equipment, improper technique, or observer errors or bias 5-9. Observer biases described in clinical practice and trials include duplication of previous BP recordings, rounding off to or below pre-set cut-off values for the diagnosis or control of hypertension and rounding off BP values to a particular end digit 5-20…”

Improving General Practitioners’ Knowledge Regarding Blood Pressure Measurement in Selected Cities of Pakistan Through Workshop

“…Half of the GPs from this study were not allowing the rest period, which is comparable with an Indian study that showed that 70% of the consultants and residents did not let patients rest before measurement. 18…”

Variabilidad en las medidas de tensión arterial realizada por estudiantes de 5.º y 6.º de medicina

“…En un estudio observacional en la Westminster School de Londres, el 33% de 80 médicos internos residentes declaró no habérsele enseñado la toma de la TA; posteriormente, se comprobó que la tomaban de forma incorrecta [8]. De interés en el estudio mencionado, no se hallaron diferencias debidas a lateralización, mientras que sí se detectan en el nuestro.…”