Nonadherence to Recommended Guidelines for Blood Pressure Measurement

Abstract

Accuracy of blood pressure readings, both in the physician's office and at home, is crucial in properly managing hypertension. Few studies have investigated adherence to measurement guidelines. This study focused on two important aspects of blood pressure measurement: waiting time before measurement and number of readings taken. A total of 103 patients completed self‐report questionnaires about office and home blood pressure measurements, with 77% reporting that physician measurements were obtained without waiting, and 56% reporting that only one reading was obtained. The proportions were even higher when measured by a nurse/technician, 96% and 81%, respectively. Home readings were taken without waiting by 60%, and 40% reported taking only a single reading. Most patients received no measurement instructions. Nonadherence to measurement guidelines is common, and may be affecting the validity of readings obtained both in physicians' offices and at home, with significant and potentially harmful effects on treatment decisions.

Reliability of single office blood pressure measurements

“…In daily practice, patients report that 77% of physicians took a first measurement without waiting and 56% of physicians took only one measurement 32. Similar numbers have been reported for home measurements, where 60% of patients took their first measurement without waiting and again 40% only measured once 32.…”

Diagnosing Hypertension in Primary Care Clinics According to Current Guidelines

“…Recent studies indicate that only 10% to 17% of clinicians provide HBPM training that is even minimally adherent to guidelines for accurate measurement, [22][23][24] and fewer than 20% of patients may be sufficiently adherent to the recommended HBPM technique to ensure reliable HBPM. 14,25,26 Compared with ABPM, HBPM requires a substantial commitment to training by both clinics and patients, and it may require individual, face-to-face instruction for optimal results. 13,14,26 Our assessment of Utah primary care clinics found similar concerns about their current delivery of patient training to facilitate accurate HBPM.…”

“…14,25,26 Compared with ABPM, HBPM requires a substantial commitment to training by both clinics and patients, and it may require individual, face-to-face instruction for optimal results. 13,14,26 Our assessment of Utah primary care clinics found similar concerns about their current delivery of patient training to facilitate accurate HBPM. Only 27.6% had a written policy for training patients in HBPM, 36.6% distributed written HBPM instructional materials, and just 48.8% had designated a team member to provide individual HBPM instruction.…”

Are Patients' Blood Pressure Levels Being Routinely Measured in Medical Offices?

“…Although there is a great deal of data assessing BP measurement techniques, [14][15][16][17][18][19][20] few studies have assessed whether the measurement was actually performed. 13,21,22 There is also a marked difference between the studies published on the subject.…”