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Advice from the BP Measurement Experts

New Guidelines for Measuring Blood Pressure from the American Heart Association

 

American Heart Association Logo

The American Heart Association just released a scientific statement on blood pressure (BP) measurement that outlines new guidelines for accurately measuring blood pressure. This is the first time the AHA has made significant updates to their recommendations since 2005. In the statement they describe and compare different methods of measuring BP and make many recommendations. What are the key points that a physician should learn from this new paper?

 

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Blood Pressure Averaging in the SPRINT Study

 

checking blood pressure

In my last blog, I introduced some of the claims and confusion around the NIH Sprint study but today I’d like to clear up the main point of confusion and discuss the actual blood pressure (BP) reading technique used to obtain the SPRINT study’s “research readings”.

We will be examining the SPRINT claims of benefit to medicating to a Systolic BP of 120 mmHg, but that will be for another day. Today the focus is on BP averaging, how it was implemented in the SPRINT study, and why it makes sense even if you aren’t sold on the SPRINT findings.

 

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Top 4 Reasons PLUS Cuffs are an Innovation to the Blood Pressure Industry

 

opd plus cuffs

With the launch of SunTech’s innovative PLUS Cuff sizes, here are some of the reasons you should consider changing your blood pressure cuffs. The PLUS Cuffs were designed to specifically target the need to fit a greater range of patients – including bariatric patients, improve measurement reliability, and cut hospital costs and inventory.

 

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New Measures for Blood Pressure and Cardiovascular Health

 

Simulation of Blood Vessels in a Vein

Gone are the days where your cardiovascular health could be summed up in two numbers. Systolic and diastolic blood pressure, measured at the brachial artery, were the key tools for staving off heart attack, stroke and other cardiovascular disease (CVD). Have a BP of under 140/90? Great! You are going to live a long and healthy life. Over 140/90? Time to watch your salt and medicate away. While lowering BP in hypertensive patients has been proven to be an effective intervention, it may not be so simple any more. Research, such as the SPRINT study, are finding benefits for managing BP in pre-hypertensive patients. With that, a new series of indices and measurements are offering more tools for doctors to measure and treat hypertension.

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May 17th is World Hypertension Day - Be Sure to Know Your Numbers

 

Woman with Heart - World Hypertension Day

On recognizing the fact that fifty percent of the world hypertensive population did not realize they had the condition, the World Hypertension League (WHL) dedicated May 17th to the promotion of hypertension awareness. Since that day in 2005, World Hypertension Day has been celebrated by offering free blood pressure readings through the volunteered efforts of numerous affiliated organizations across the globe.

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Can Music Improve Data from Stress BP Tests?

 

Man undergoing a Stress Blood Pressure Test

Anyone who has had a stress test knows that stress tests are not easy and can even be painful! The commonly-used Bruce protocol for treadmill exercise tests includes 7 stages of 3 minutes each. The first stage starts at a 10% grade at a speed of 1.7 miles per hour. Each stage increases by 2% and between 5-9 miles per hour. Even though a stress test can last for over 20 minutes, most people don't last longer than seven minutes on the treadmill. However, it is important to keep going as long as possible to collect lots of data and be sure to reach the target heart rate. Each additional minute of a stress test could yield important information about the heart's condition.

 

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How to Measure Blood Pressure [Infographic]

 

How to Measure BP Infographic Thumbnail

Whether you take blood pressure readings on a regular basis or you’re taking a BP measurement for the first time, it's always good to review the latest standards on how to measure blood pressure. You may think that you're using the correct method however, incorrect results caused by improper technique are more common than you might think. Follow the steps in the infographic below to ensure you get an accurate blood pressure reading every time. Use it as a quick review to sharpen your skills or check out our video for a step-by-step “how to” with more in-depth instruction.

 

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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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What is Hypertension?

 

3D Simulation of the Hardening of a Blood Vessel

As I mentioned in my previous post, Hypertension or high blood pressure means a systolic pressure of 140 or higher and a diastolic pressure of 90 or higher. If left untreated, the time from hypertension onset to death is approximately 20 years. Occurring silently, painlessly and without warning, many do not know they have the disease until they experience its inevitable organ-damaging effects. Once organ failure begins, hypertension is already in its final stages and the patient can expect only a few years to live unless aggressive disease management is undertaken.

 

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What is Blood Pressure?

 

Picture of a Patient having their blood pressure checked by a Doctor

Blood Pressure Basics

Taking a patient’s blood pressure has become a routine practice for medical staff. Unfortunately, training in this area is often met with a very high-level overview and is sometimes neglected in regards to the overall mechanics of manual or automated methods in accurate blood pressure measurement techniques.

 

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5 Factors That Can Affect Your Pet’s Blood Pressure Readings

Female Vet with Cat

A blood pressure check is one of the first procedures done when you go to the doctor. So it should be no surprise that your veterinarian will likely check your pet’s blood pressure, too!

It is becoming more and more common for vets to regularly check blood pressure at every checkup. However, many pet owners do not realize that their pet’s blood pressure is constantly changing in response to many factors. Being aware of these factors and ensuring that your pet is comfortable in its environment will help the vet to get the most accurate blood pressure reading. Here is a list of 5 factors that may cause significant changes in your pet’s blood pressure:

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Why Should I Use ABPM?

Friends walking in a park

 

Diagnosing and treating hypertension is serious business, and as research shows, ABPM is far superior to other testing available to clinicians. ABPM provides valuable diagnostic information that in-clinic and home blood pressure monitoring systems are incapable of measuring including:

  • BP variability and a more accurate estimation of true blood pressure
  • Overnight changes in blood pressure (dipper status)
  • Morning surges in blood pressure

 

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NIH Ends Sprint Study Early Stating Lower Blood Pressure Is Better

Heart Icon with an arrow leaning towards the high blood pressure side

How Low Should Blood Pressure Go?

When it comes to blood pressure guidelines, it’s a question cardiologists have puzzled over for years – just how low should blood pressure go? Well, according to articles released by nearly every major news outlet, including The New York Times, US News & World Report, FOX News and NBC News, federal health officials have declared they have “potentially lifesaving information” as a result of a recent major study – one that they are ending a year early because it has already conclusively answered this question.

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SunTech Vet20 “How To” Videos Have Arrived!

 

Dogs in a Box marked Fragile

Taking a blood pressure on a companion animal is very different than what you experience at the doctor’s office. You can’t tell a dog or cat to sit still and be quiet throughout the entire blood pressure measurement and actually expect it to happen. It’s more similar to trying to take an infant’s BP, except these wiggly patients have fur!

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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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Complete Product Registration & You Might Just Get A Raise!

Picture of a Finger pressing a Register Button

We all see the card that comes with our new gadget, encouraging us to register our product online, and give it a furtive glance. But many times, that gets quickly forgotten or put into the ever-mounting pile of “to dos” that you will get to in your “free time.” Rather than list all of the reasons that product registration is important, here is what I intended to be a clever way of reviewing the benefits of completing this process…

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Kiosk Users Get Advice from FDA on Accuracy of BP Measurement

Illustration of a Blood Pressure Monitoring Kiosk

Do you ever see a kiosk that measures blood pressure (BP) and take a seat to see how you fare? Well, make sure you are aware of the latest information regarding accuracy of kiosk BP measurements. On June 24, 2014, the US Food and Drug Administration (FDA) issued a consumer update for blood pressure monitoring kiosks. In this update, users are advised that blood pressure cuffs on public kiosks do not fit everyone and consequently, may not provide accurate BP readings for every user. Luke Herbertson PhD, Biomedical Engineer at the FDA stated, “[BP kiosks] are easily accessible and easy to use. But it’s misleading to think that the devices are appropriate for everybody. They are not one-size-fits-all.” Users with arm circumferences outside of the cuff range may receive inaccurate BP values.

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Central Blood Pressure Measurement: Clinical Relevancy

Illustration of the Human Heart with the European Society of Hypertension Logo

Central aortic blood pressure (BP) measurement was a hot topic at the European Society of Hypertension (ESH) and International Society of Hypertension (ISH) 2014 Joint Meeting a few weeks ago in Athens, Greece. Most notable amongst these was the debate as to whether central BP measurements are relevant for everyday clinical practice. It’s only logical to conclude that large clinical trials are necessary prior to arguing convincingly either way - we simply need more data. However, as someone who supports the development and utilization of technological advancements, I tend to believe that there is a place in clinical practice for these contemporary characterizations of cardiovascular health.

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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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