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Advice from the BP Measurement Experts

New Advice on What Constitutes High Blood Pressure

 

Man frustrated with home BP device

Blood Pressure experts offer new advice based on a recent study conducted by the ACP/AAFP, which shows that the threshold for hypertension in healthy patients may not be as low as what the SPRINT study of 2015 concluded.

 

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Home Blood Pressure Devices Wrong 70% Of The Time

 

Man frustrated with home BP device

A recent study published in the American Journal of Hypertension shows the majority of blood pressure devices sold and used in people’s homes are potentially inaccurate as much as 70% of the time. Since lots of people measure their blood pressure at home to track their cardiovascular health, this study is understandably noteworthy. But what else can we learn from it?

 


 

You Get What You Pay For

First, let’s talk a little bit about oscillometry. Oscillometry is the general method that most automatic blood pressure devices use to measure blood pressure. This is true for devices in the home, in doctor’s offices, and even in hospitals. As the study pointed out, while the oscillometric method is commonplace, there are differences between devices from different manufacturers because of the mathematical formulas and algorithms used to calculate systolic and diastolic blood pressure values. The math is proprietary, and most private companies that have their own oscillometric technology—including SunTech—guard those calculations very closely.

Why? Well, the simple answer is that the math behind better-performing technologies is based on actual clinical research conducted over long periods of time—in SunTech’s case, decades. This research, and the analysis of the resulting data, is a significant and expensive undertaking that can provide an important commercial advantage when it comes to a device’s clinical accuracy. So if companies had to share their data with the rest of the world, what would be the incentive to conduct all of that research in the first place? So, proprietary data can result in devices with better clinical performance, which is better for physicians and patients. I say ‘can’ because it’s no guarantee, as this study clearly illustrates.

 

If the Cuff Fits...

One other fact about this study merits some additional digital copy. The authors discuss several potential reasons for the reported inaccuracy of almost 70% of the home blood pressure devices analyzed. But there is one that the authors mention briefly that could actually explain a lot. And that’s the blood pressure cuff itself. Now, it’s pretty common for folks to call the entire device—digital box, hose, and fabric that wraps around the arm and inflates--a ‘BP cuff’. But what I’m talking about is just the part that goes on the arm. That’s the actual blood pressure cuff.

Blood pressure cuff sizes are incredibly important for any oscillometric blood pressure device. The math behind these devices assumes that the correctly sized cuff will be used on the patient. See, because of the physics around how non-invasive blood pressure is measured, there’s no such thing as a ‘one size fits all’ blood pressure cuff. To be accurate, the cuff must be sized correctly according the circumference of the patient’s upper arm, for a variety of reasons. The researchers in this study reported that the mean arm circumference of study participants was a bit less than 33cm, and that increasing arm circumference was a statistically significant predictor of an inaccurate measurement.

Now, 33cm is on the high side for most standard, adult-sized blood pressure cuffs. Since home blood pressure devices typically include only a single cuff, manufacturers generally pick a very middle-of-the-road size for the cuff, hoping that it will cover the majority of arm sizes. But in the case of this study, the mean arm circumference is already pushing the upper limit of a middle-of-the-road adult cuff. So it should come as no surprise that as arm circumference increases, accuracy suffers. The researchers didn’t publish any data on the sizes of the BP cuffs that were used with the home BP devices, and I think that would have been helpful.

But the point here is that that size matters when it comes to BP cuffs and oscillometric devices. It matters a lot. It might even matter more than the math inside the device—although that matters too. So if you find yourself in need of a home blood pressure device, the first thing that you need to do is make sure that the cuff that comes with it is the right fit for your arm. Your doctor can help you figure this out if you bring it with you to the doctor’s office. If the cuff isn’t the right size, contact the manufacturer and see if they have a cuff that is.

In fact, even when you are having your blood pressure measured in a doctor’s office, it’s not a bad idea to ask the clinician taking your BP to double-check the sizing of the cuff to your arm, as other studies have shown that using the incorrectly sized cuff in clinical settings is commonplace as well.

 

Maybe We’re Barking Up The Wrong Tree?

While data that points to inaccuracies with home blood pressure devices is important, for professionals in the medical world, it’s not exactly news. And while asking how to make home BP devices better is fine, we should also be asking if there are more accurate alternatives to home BP. And the answer is yes. 24-hour Ambulatory Blood Pressure Monitoring (ABPM) is widely considered to be the gold standard for assessing a patient’s blood pressure.

Unfortunately, the reimbursement for ABPM in the United States is currently quite low, and only valid for diagnosing white coat hypertension. In other countries, like the U.K., ABPM is becoming recognized as an important tool for treating general hypertension, and is therefore being treated as such by government and private payers.

At SunTech, our goal is to continue to evolve our Oscar 2 ABPM devices to make them more patient friendly, and allow them to deliver more valuable clinical data, so that clinicians can make better diagnoses and treatments. It doesn’t happen overnight, but we’ll get there.

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Training Day — How to Measure Blood Pressure

Cartoon of a young male nurse pointing to a play button

No clinician would argue that blood pressure measurement is an important part of most patient consultations. But an increasing body of clinical evidence seems to indicate that improper blood pressure technique is fairly common.

In an effort to contribute to the conversation of proper blood pressure technique, we’ve created a clinical training video unlike any other. It’s entertaining and funny, but also grounded in the best practices supported by the American Heart Association and the latest clinical research.

If you enjoy watching, feel free to pass it along to any clinical professional who measures blood pressure. Share it! Tweet it! But at the very least…make sure you watch it!

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Errors in Manual BP Readings make Automated the Way to Go!

Manual Sphygmomanometer and Cuff

So for the last 100+ years, clinicians have been using the auscultatory method for determining a patient’s blood pressure. This method is used every day to determine if a patient needs medication or some other clinical intervention for high blood pressure. Performed correctly, it’s considered by many in the profession to be the ‘gold standard’ for measuring blood pressure. But it’s that phrase ‘performed correctly’ that’s the kicker.

A recent policy statement from the World Hypertension League calls into question the accuracy of many auscultatory BP measurements taken today. Huh? If it’s worked for over one hundred years, how is it possible that auscultatory measurements are now being deemed inaccurate?

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The Material World of BP Cuffs

The Material World of BP CuffsSo what’s in a fabric?  And why do manufacturers come up with so many choices?

Choosing the correct fabrics for medical products can be a bit more complicated than selecting the right material for a pair of jeans. Medical device manufacturers spend a lot of time considering things like where the product will be used, how often it will be used, what it will be cleaned with, who will be using it and how it interacts with human tissue.

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Blood Pressure Measurement Technique— A Candid Discussion

Audio Series by SunTech MedicalLet’s be clear. I work for the marketing department of a medical device manufacturer, so I earn my paycheck by promoting this company and its products to the clinical community and developing new products that we can successfully convert into $$$. But is it possible to achieve these goals as well as actually helping people to get and stay healthy? Let me put it this way—if it weren’t, I’d quit.

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Meaningful Use Incentives Becoming Less Meaningful

Healthcare providers are frustrated with EMRIs it just me, or are healthcare providers becoming increasingly fed up with all of the new, fancy-schmancy healthcare IT 'solutions' that seem to be proliferating faster than ever before? Meaningful Use incentives have been the catalyst for the adoption of electronic medical records at an unprecedented rate, but some clinicians, administrators, and facility managers are beginning to question the value of what they've bought into as they struggle to electronically capture patient information—things like blood pressure, temperature, exam results, and other vitals.

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5 Observations about EMR Integration and Interoperability

EMR IntegrationIt’s no secret that information technology is quickly becoming one of the most important components of the healthcare system, and device interoperability with the EMR is undoubtedly a key piece of the HIT puzzle. Here are five observations about EMR integration and interoperability that should help shed some light on the importance and complexity of this issue.

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Should Manual BP Get the Boot

Manual BP MeasurementThere's a bit of a debate going on in October's issue of the Journal of Hypertension about the best way to measure blood pressure. Everyone agrees that it should be done using a cuff placed over the brachial artery, but the similarities sort of end there.

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Increasing Time Between BP Screenings: Not Such a Dynamite Idea

DynamiteMost folks being treated for hypertension are quite familiar with routine BP measurement because their doctor measures and discusses their blood pressure data with them at almost every visit. Many patients will even monitor their own BP at home on a regular basis. Shucks, even people with completely normal BP (<120mmHg systolic, <70mmHg diastolic) are never surprised when a nurse slaps a BP cuff on their arm anytime they visit a doctor's office. Taking BP has simply become 'par for the course' during most any clinical office visit for just about everyone.

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Study Shows Off-Roading Can Improve Blood Pressure

ATV could help lower bpLooking for a good excuse for some outdoor adventure? A clinical study published in the European Journal of Applied Physiology found that regularly riding motorized off-road vehicles, like ATV's and dirt bikes, can improve health-related fitness, improve quality of life, and even reduce blood pressure. It goes without saying that for speed-crazed gearheads, tearing around the countryside like a banshee is fun. But who knew that it could also be so...well...healthy? As for me, I think a new ATV is just what the doctor ordered. Happy trails, everyone!

 

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5 Myths About Vital Signs Automation and EHR's

Electronic Medical RecordsAnyone who has been a patient in a doctor’s office knows what it’s like to get their blood pressure (“hold still while I inflate this cuff”), body temperature (“put this under your tongue”), and weight (“don’t worry, I’m sure your clothes add a few pounds”) measured. Historically, the nurse would write all of the measurements down on a paper chart for the doctor to review, and the chart would later go into the patient’s permanent file. But really, paper and pen are so 20th Century. Aren’t they?

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Deflating Expectations

deflateWe’ve written quite a bit here on the SunTech blog about BP technique. And guess what? We’re going to talk about it again! Maybe it’s not the most fascinating topic in the world of non-invasive blood pressure, but I think there are few as important to the successful treatment of high blood pressure. I must not be the only one, because studies that look at blood pressure technique continue to be published at a pretty good clip.

One of the more recent ones is aptly titled, “Blood Pressure Monitoring Technique Impacts Hypertension Treatment”. Authored by Ray et al and published in the Journal of General Internal Medicine, this study compared the way that BP’s are normally taken during triage check-in on a population of 40 patients at the New Mexico Hospital Adult Internal Medicine Clinic. A study investigator observed the technique used by the clinician, and then took the patient’s BP using the AHA recommendations for blood pressure measurement published in 2005.

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Medical Billing Codes Gone Wild!

Orcas spit water at viewersHere on the SunTech blog, we normally aim to provide valuable clinical information and helpful tips related to all things blood pressure. But allow me to wax philosophical for a moment, because…well, you’ll see why.

Right. So, for many of us who work in health-care or a health-care related field, there is significant meaning to be found in doing a job that can positively affect people’s well-being. It’s great to wake up every day knowing that you will indirectly or directly help to cure illnesses, heal wounds, save lives, and treat burns due to water skis on fire…wait, huh?

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Information Overload: Relevant BP Measurement Data

Overwhelmed DoctorI don’t know about you, but I am bombarded daily with more information than I can possibly process or make use of. Yet each day dawns requiring that I sift through it all, applying only what is relevant or helpful to me and my family, and at times the whole process can be exhausting. The miracle of the information age is also its curse. ‘Connected’ devices are proliferating at an astonishing pace, inexorably finding their way into our living rooms, dens, kitchens, bedrooms, vehicles, and belt clips. Not that this is necessarily a bad thing, but how many Twitter messages can a sane person realistically absorb in a given day? And more importantly, which ones are really useful?

This same phenomenon is happening today in health care...

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3 Practical Tips for Acquiring Representative BP Measurements

BP Measurement TipsQuite a lot has been said in clinical circles about the best way to assess a person’s blood pressure. Manual? Oscillometric? During office visits? At home? Over 24-hours? Average? Trend? Peak? At times, the debate has gotten pretty hot. In a recent issue of the journal Hypertension, Drs. George Stergiou and Gianfranco Parati published an editorial that proposes a more practical approach.

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SunTech's Blood Pressure Technology Logs Over 2 Decades of Space Exploration

SunTech Accutracker II on NASA flightTraditionally, we try not to engage in excessive self-promotion on the SunTech Blog. But last month marked the 24th anniversary of SunTech’s first journey into space, and we’d like to let our readers know about this important and interesting chapter in our history. In the pre-dawn darkness of January 12, 1986, the space shuttle Columbia blasted off from launch pad 39A at the Kennedy Space Center, carrying with it a special version of the SunTech Accutracker II ABPM device. When Columbia landed successfully at Edwards Air Force base after 98 orbits, it may have marked the end of mission STS-61C, but it was just the beginning of SunTech’s foray into space-based research.

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Blood Pressure Monitoring in Critically Ill Patients

­­bp for icu patientsWhen it comes to treating critically-ill patients in hospitals, you’d think there’d be consensus on how to monitor their blood pressure. But a recent article appearing in the Journal of Critical Care Medicine casts some doubt on that assertion.

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Clinician Beware of Smartphone Health Apps

iStethoscopeDo you have a smartphone? Have you downloaded any apps that help you track or measure your own vital signs information—like blood pressure, heart rate, or glucose level? If you’re a health care professional, maybe you’ve downloaded apps that help you measure and stay informed about your patients’ vitals.  Either way, mobile healthcare-related apps are creating significant buzz within the mobile computing industry. Figures vary for the size of the home health and telehealth markets, but nobody questions that the number is in the billions of dollars, and such sweet numbers inevitably attract lots of bees.

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Automated BP vs Manual BP Measurement: Which is Better? (Part 2 of 2)

Doctor, nurse, and patientIn my last post, I discussed the importance of informed debate in helping determine effective clinical practice. Specifically, I mentioned two recent journal articles about automated oscillometric blood pressure devices that arrived at two different conclusions. In that post I also provided some comments from the SunTech perspective. Today, I’ll share the perspectives of an experienced, practicing physician on the subject of automated BP devices versus manual sphygmomanometers.

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