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Advice from the BP Measurement Experts

Get Out of the Office for Better BP Measurement

Out of Office BPThough we state it often, we at SunTech Medical aren't the only ones touting the utility of monitoring BP outside of a clinical setting. A recent article published by a northeastern regional news website advocates for the use of home BP (HBPM) and ambulatory BP monitoring (ABPM) to diagnose and monitor hypertension. An estimated 50% of patients experience either white coat hypertension or masked hypertension. Therefore, as Dr. David Landers is quoted in the article, "'One blood pressure reading in the office is not useful. What you need is more data points.'"

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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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New 3rd Edition Standards for NIBP (Part 2)

OEM NIBP from SunTechIn my last blog post I provided 4 out of 8 new 3rd edition regulatory requirements that impact automated non-invasive blood pressure. These included out of range values, nominal blood pressure ranges, service modes and shock/vibration changes. Here are the final four regulatory requirements that must be addressed if you are designing a product with your own non-invasive blood pressure (NIBP) or with NIBP supplied by an OEM provider.

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New 3rd Edition Standards for NIBP (Part 1)

Medical Design RegulationIf you're a medical device developer or active in the design process, you've probably been involved with creating a list of "must have" and "nice to have" features and requirements for a new or updated medical device. Some come from market feedback, industry trends, competitor analysis, R&D and others come from medical equipment Regulatory standards. When it comes to safety and meeting regulatory standards, this is always in the mandatory column. With several deadlines looming on the horizon, meeting the latest 3rd edition standards as well as being RoHS compliant are on almost everyone's must have list when starting a new project. So whether you are developing your own NIBP or purchasing OEM NIBP modules, you now have new requirements that need to be a part of your design not only in hardware and software but also in the product's technical documentation.

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Top 5 Blog Posts of 2012

Holiday trees illustration

As we look forward to the coming new year, we wanted to take a moment to look back at the most popular posts from this year. We'd like to wish all of our friends and followers of Blog@SunTech a Happy Holidays and safe New Year. Unless claims that the end of the world is upon us are true, we'll see you next year!

  1. You're Doing It Wrong: New Study on BP Measurement
  2. Top 7 Reasons You Should Be Using Automated Blood Pressure for Cardiac Stress Testing
  3. Determining BP Device Accuracy: Who Has It Right
  4. 5 Myths About Vital Signs Automation and EHR's
  5. 3 Things to Consider When Measuring Your BP at a Kiosk
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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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American Society of Hypertension Urges CDC to Use ABPM

Oscar 2 ABPM Device

Last week, we blogged on the recent report from the Centers for Disease Control and Prevention (CDC) that noted some pretty serious concerns about our national state of health as it relates to hypertension and its potentially deadly effects.

This week, we want to draw your attention to a press release from the American Society of Hypertension urging the CDC to incorporate ambulatory blood pressure monitoring (ABPM) as a way to apply a more "sensitive and specific tool for assessing blood pressure in its national surveys."1

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UC Berkeley Gets Blood Pressure Right

Nurse Reading on BeachSince it’s the summer, we’re doing more reading than writing. We came across this article from the University of California Berkeley School of Public Health and loved how it highlighted a lot of the topics we have written about in the past. From multiple tests to measuring blood pressure in both arms to the appropriate use of gold standard BP testing, it’s good to see agreement between healthcare providers and industry. Now it’s just a matter of putting this into everyday practice so it makes a meaningful impact on people’s lives. Enjoy the summer!

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You’re Doing It Wrong: New Study on BP Measurement

Taking Innacurate BP A new study1 published in the Journal of Clinical Hypertension has reached the conclusion that when it comes to proper blood pressure (BP) measurement technique, most clinicians just aren’t very good at it. According to the authors, Minor et al, the purpose of the study was to “assess BP measurement accuracy and the level of adherence to recommended techniques throughout a large academic health science center.” As it turns out, the results were poor on both fronts and their statistical analysis indicates that technique does indeed impact accuracy.

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BP Differences Between Arms Could be an Early Indicator of Serious Health Risks Ahead

Circulatory SystemSunTech has blogged on the importance of BP measurement in both arms before (see: Has My Physician Measured My BP in Both Arms?) and research articles continue to be published on this issue. But now, two new studies have been published showing that the benefits of BP measurement in both right and left arms could be a life saving step in routine care.

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Top 7 Reasons You Should Be Using Automated Blood Pressure for Cardiac Stress Testing

Cardiac Stress Blood PressureAs any cardiologist will tell you, a cardiac stress test is a fundamental step to diagnosing a multitude of heart conditions and is a necessary tool for any cardiac care facility.  The average cardiac stress test lab contains ECG stress systems, Echocardiogram machines, treadmills, ergometers and …. manual blood pressure gauges?  With all of this automated equipment that allows us to remove variability and minimize inherent patient risk, why are we still trying to take blood pressures manually during a stress test?!

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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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3 Things to Consider When Measuring Your BP at a Kiosk

Valentine's Day Candy Box with StethoscopeThis Valentine's Day, when you are out making a mad dash to your local pharmacy for the perfect card, you may consider checking your blood pressure at the pharmacy's kiosk. We'd like to whisper sweet nothings in your ear about 3 things to consider while having your BP measurement taken at a kiosk.


While blood pressure checks have historically been standard at community health fairs and elder-care centers, the local branch of your bank is not necessarily where you expect a check up and reminder of tips on healthy living.  But with the trend in the US, the UK, and other countries of raising self-awareness for personal health, healthcare services and organizations are exploring new, proactive ways to bring simple services like education and monitoring to their communities. 

At a public shopping mall, Covenant Health has been running a multi-service kiosk, which uses automated BP monitors for self-measurement.  While this is not so different than the BP kiosks that have been in pharmacies, grocery stores, and other public places for many years, Wegmans, a grocery store chain in the east coast of the USA, understands that these health initiatives need to be supported by educational information and recommendations to see a clinician for credible, actionable diagnosis and treatment.  To aid in the education of this trend, the following are the top three factors to consider when you decide to have your blood pressure taken at a blood pressure kiosk:

  1. Remember that your blood pressure changes just like your heart rate.  Exert yourself by walking up the stairs or even just dealing with the stresses of the workplace, and your BP and heart rate may be higher than what you are used to seeing in a doctor’s office or at home.  Some level of this variability is normal.
  2. One measurement is just that… it’s one instance in time.  It’s one data point.  In fact, clinicians and experts in BP are increasingly placing more emphasis on the average of several measurements over a given period of time instead of focusing on just one measurement.  A single high measurement may be due to dealing with the stress of being in a public place like the mall or being sick.
  3. BP measurement is like any diagnostic test.  It’s not always 100% accurate. While there are standards that BP monitors, including kiosks, must meet in order to be sold on the market, automated BP devices are not fool-proof.  Some of the factors that affect BP measurements are covered in other blog posts:

Given these factors, it’s important to take the right perspective when you have your BP measured in a public place.  In fact, one group who studied the use of a public access kiosk found that over 70% of users had high blood pressure.  While this might be alarming, they came to the following balanced, sensible conclusions:

“These statistics clearly illustrate the heart-health challenges facing our city… However, they also show that the population of people using these downtown kiosks beat the national average in terms of blood pressure. The Wellness Stations are terrific tools in helping people gauge their own health.”

In the end, engaging people about their health in their daily lives is the goal, one for which kiosks may serve as a cost-effective solution.

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Determining BP Device Accuracy: Who Has It Right?

Bullseye Dart on a Manual StethoscopeAll caregivers need to trust the accuracy of automated blood pressure (BP) devices they use to make clinical decisions. But when considering one specific BP device versus another, how does one establish that trust? Well, an automated BP device that’s used to guide patient treatment is legally considered a medical device, and therefore must adhere to the regulatory guidelines for the markets in which it is sold.

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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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Has My Physician Measured My BP in Both Arms?

Doctor taking a BP measurementThat’s the question I pondered while reading an article published earlier this year in the American Journal of Hypertension. In the article “Blood Pressure Measurement Method and Inter-Arm Difference: A Meta-Analysis,"* the authors reviewed studies where BP was measured in both the left and right arm of subjects. The results showed that on average, Systolic pressures differ by 5.4 mmHg between arms while Diastolic pressures showed an average inter-arm difference of 3.6 mmHg.

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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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Hypertension Diagnosis: Be confident and save money with an ABPM Study

Be confident with an ABPM studyHypertension is a prevalent condition globally and is quickly becoming a focus in the U.K., with particular emphasis on how to best diagnose the condition. In August, a study comparing blood pressure (BP) measurement methods, which was funded by the U.K.’s National Institute for Health and Clinical Excellence (NICE), was published on the same day that NICE announced the release of its new guidelines for hypertension management in adults.

In the study, Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study, the research found that “ambulatory monitoring is cost effective compared with further monitoring in the clinic or home for confirming the diagnosis of hypertension” for all age and gender groups considered. Specifically, ABPM provided cost savings ranging from £56 in men aged 75 years to £323 in women aged 40 years (Equivalent to $89 and $511 respectively). Additionally, it was determined that ambulatory blood pressure monitoring (ABPM) “resulted in improved health outcomes for male and female age groups older than 50.”

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My blood pressure monitor isn’t working! It’s reading too high!

patienttechniqueIt’s one of the occasional issues we hear about BP monitors and automated BP technology, ours included.  And while it’s one of the reasons that we blog about the 10 Steps to Accurate Manual Blood Pressure Measurement and the 10 Factors That Can Affect Blood Pressure Readings, sometimes it takes more guidance to diagnose if a monitor is mis-reading.  Comparing BP measurements manually taken by an observer to those from a monitor is a common way of examining the accuracy of a monitor.  Clinical standards1 that determine a monitor's accuracy provide detailed methods for making these comparisons.  Unfortunately, there are so many things done to control the environment and patient in these standards tests that it is not realistically possible to replicate in clinical practice.  However, here are a few of the more important issues that Richard Prowse, our OEM sales manager for Europe, Middle East, and Africa, shares with his customers when they are investigating a monitor that might be reading high.

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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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