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Advice from the BP Measurement Experts

A Surprising Number of Clinicians Fail to Accurately Measure Blood Pressure

 

clinician frustrated about blood pressure results

A surprising number of clinicians fail to accurately measure  blood pressure according to a recent joint survey of more than 2,000 healthcare professionals conducted by the AMA and the American Heart Association. One of the most striking highlights were only 1 in 10 medical assistants were able to answer all 6 of the best-practice in blood pressure (BP) measurement questions.

 


According to American Medical Association (AMA) president Dr. Patrice, Harris, “Hypertension is a leading risk factor for heart attacks, strokes and preventable death in the U.S. Inaccurate blood pressure readings can lead to diagnosis errors, which means getting an accurate reading is vital to treating the condition.”

A recent study published in the journal Hypertension found an increase in high blood pressure (hypertension) cases during pregnancy. By reviewing CDC data on >151 million women between 1970 and 2010, the researchers found a 6% yearly increase in hypertension. The implications being complications for the mother, such as preeclampsia, or an increased risk of preterm birth.

Although the need for accurate BP measurement is clear, the joint survey showed the gap in BP knowledge that many healthcare professionals have. The most frequently missed best-practice question was about proper cuff-wrap-inflation, followed by proper brachial artery cuff position. Both factors are critical to getting an accurate BP reading. Even though the healthcare professionals surveyed were aware of the opportunities for error in BP measurement, BP refresher training is reported to be infrequently held.

The same AMA-AHA survey suggested that healthcare professionals believe up to 41% of BP measurements taken across all medical practices are less than 100% accurate. Although the overall error rate was acknowledged, most respondents felt that their practice was better than the norm.

To ensure an accurate reading, consider these 10 factors that can affect blood pressure readings and advice from our Clinical Manager:

  • If you have a wound, do not apply a BP cuff over, as this can cause further injury.
  • If you have had a single mastectomy, do not apply a BP cuff to the arm on that side. In the case of double mastectomy, use the side of the least dominate arm.
  • Too frequent BP measurements can cause injury due to blood flow interference.

Additional Resources:

To learn more about the basics of BP, see this TedEd on How blood pressure works by Wilfred Manzano.

Want to try your hand at taking a BP reading? Check out this BP simulation.

Sources:

https://www.ama-assn.org/press-center/press-releases/new-research-shows-need-re-training-blood-pressure-measurement

https://www.modernhealthcare.com/safety-quality/ama-aha-look-retrain-physicians-measure-blood-pressure

https://www.washingtonpost.com/health/a-growing-problem-pregnancy-vs-high-blood-pressure/2019/11/08/0ff37238-fb52-11e9-ac8c-8eced29ca6ef_story.html

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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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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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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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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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5 Tips for Preparing for a Cardiac Stress Test

For accuracy purposes, some diagnostic tests require a little preparation on your part. So, what do you need to do before you have a cardiac stress test? According to a recent publication by the Heart and Vascular Team at the Cleveland Clinic, the following tips are good to know before you step on the treadmill:

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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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Mobile Healthcare Apps: Good or Bad?

Picture of Mobile Phone with Internet and Networking Concept Art

Healthcare Mobile Apps – there are certainly no shortage of them, and they cover just about every area of health care you can think of, including mobile blood pressure measurement. According to a recent online article published by Medical News Today, more than 500 million smartphone users worldwide will be using a health app within the next year. And the FDA has certainly taken notice of this growing trend, recently clarifying that only a very specific group of health apps are actually validated in accordance with their guidelines and regulated under their governance.

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Do I REALLY Need Treatment for Hypertension?

Picture of a various pills forming the shape of a question mark.

Were You Properly Diagnosed?

A vast amount of physicians are diagnosing hypertension without properly assessing a patient’s blood pressure during the course of a 24-hour period using Ambulatory Blood Pressure Monitoring. Simply put, 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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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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Errors in Images Depicting BP Measurement - No Wonder You’re Doing It Wrong!

Errors in Images Depicting BP Measurement - No Wonder You’re Doing It Wrong!

Two years ago, we published a blog titled, “You’re Doing It Wrong: New Study on BP Measurement." This post came about after a group of researchers assessed BP measurement technique at a large academic health science center and their results indicated that most clinicians are - simply put - doing it wrong.

While recently attending the 2014 Annual Scientific Meeting of the American Society of Hypertension (ASH), we learned of a new study1 by Drs. Clarence and Carlene Grim. Their research assessed the accuracy of BP measurement technique in online articles that included videos or photographs of BP testing. Their study, “ Blood pressure measurement is almost never shown being done correctly in TV/print news reports, or online reports/sources regarding BP news stories, reports that the majority of online images and videos depicting BP measurement were depicting people that were doing what? You guessed it - doing it wrong.

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Relax...Tips for Accurate Cardiac Stress BP Measurement

Audio Series by SunTech MedicalWhen most people have their blood pressure (BP) taken, it’s typically done by a clinician in a physician’s office. A past blog post - 10 Factors That Can Affect Your BP Reading– discusses several factors which may influence your BP reading during these visits, which are usually conducted under routine or “normal” conditions. But what if you are having your BP taken under different circumstances such as during a cardiac stress test or ABPM study? Do these same factors still apply?


Well, yes and no. Accurate cuff size and placement are still critical; however, as a result of the motion and noise introduced during these tests, not all of the 10 factors still apply. For example, during a cardiac stress test, your body will be ‘stressed’ on purpose. It will be necessary for you to talk to your clinician about how you feel throughout the course of the assessment. Additionally, you will not have any support other than the bar of the treadmill or the Ergometer and there are not any significant ‘rest times’ between measurements. So, how do you collect an accurate BP in an environment such as this?

Follow these simple tips:

  • Relax the arm on which the BP cuff has been placed
  • Do not grip the bar of the treadmill or Ergometer
  • Stand up straight – no leaning on the rail
  • Follow instructions carefully for when cuff inflates

To request a free, digital copy with a complete list of tips, simply click the button below to get one today! (Available in English, French, Italian, German, Spanish, Czech, Polish, Dutch, Brazilian Portuguese, Turkish, Chinese, and Japanese)

 

 

 

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You Want to do What with That?

You Want to do What with That?Have you ever read the instructions for use for a product that you purchased? Let’s be honest, a majority of us simply do not take the time to read the instructions that come with a product; especially if it is something we believe we are familiar with already. I mean, who has the time, or patience, to sift through all of the warnings and the over simplified step-by-step description of how to use something in order to find that one little nugget of information that might actual improve your user experience? And besides, aren’t we supposed to be saving trees?


But wait. What if we told you that the instructions are there because not all products are created equal? Take the omnipresent blood pressure cuff for example. You’ve used one you’ve used them all, right? Wrong. Not every cuff is identical. There are many varieties, sizes, and shapes and each of those has specific, appropriate applications.

We appreciate the value of even five minutes gained in a day by tossing the instructions aside and charging forward. But in the case of blood pressure cuffs, the instructions for fitting are even more important, no matter how simple they may seem. Having the right sized cuff and placing that cuff properly on the patient’s arm are integral to the accuracy of any blood pressure measurement. And for automated blood pressure measurement devices, the cuff is the sensor which collects the necessary data to derive the blood pressure values. Applying an unsuitable cuff to your patient can generate erroneous results, and therefore affect a patient’s diagnosis and/or treatment.

Reading the instructions for use will help you learn to select the appropriate cuff size for your patient as well as how to apply it properly, thus ensuring the data you collect is accurate and useful. But, for all you visual learners, we have created five new videos to help with placement of some of the cuffs we offer at SunTech Medical: Orbit Cuffs for use with our Oscar 2 ABPM system, and for the Tango stress monitors Orbit-K Cuffs for everyday use, and Single Patient Use Kits as a Disposable Cuff option for the Stress Lab.

 

 

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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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3 Types of Stress Tests: Part 2 of 2 - The ECHO and Nuc

ECHO and Nuc Stress TestingIn my previous blog I talked about one of the three types of stress tests, how your doctor will calculate your maximum heart rate, and what types of parameters they may be looking for during a stress test. In the second portion of the blog I will go over the other two types of stress testing, what parameters are looked for during these tests and why one may be used over the other.

 

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3 Types of Stress Tests: Part 1 of 2 - The ETT

Exercise Stress Test Running ManHave you ever been to your doctor’s office and wondered why one type of test was ordered over another? And, if they are all important, what makes a doctor ask for that particular type of test? Well when it comes to stress testing there are many different types of tests but generally they all come down to 3 different types. If your doctor orders you to have a stress test this can mean that you are having a cardiac or exercise stress test (often called an ETT or an exercise treadmill test), an echocardiogram stress test (often called Stress ECHO), or a nuclear stress test (often called a Walking Nuc or Nuc Test).

We have found that the type of test ordered is determined by your heart’s health or by your physical condition. In our 2 part blog series we will try to answer these questions about why one test can be used over another, what your doctor may be looking for during this test, and what parameters they look at during the test.

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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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