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Advice from the BP Measurement Experts

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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Top 5 Factors To Consider When Deciding Whether To Use an OEM Technology Supplier

problem solutionThe SunTech blog was established as a discussion place about blood pressure (BP) measurement because that's what we do. Naturally, we have tried to share our understanding of the clinical application experiences with using automated BP measurement in practicing medicine. However, we also partner with other manufacturers to integrate OEM NIBP technology in their medical devices. Some of these are patient monitors that you see in all parts of the hospital. But some of the more specialized devices are used to save lives in an ambulance or Lifeflight, on commercial airline flights, and even in the battlefield. Regardless of the application, these companies all considered whether they should buy, build, or partner in order to achieve their goals. Here are the top five factors companies should consider when deciding whether to use an OEM technology supplier:

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Korotkoff Sounds vs. Oscillometric BP Measurement

sphygmomanometerOne thing we like to do at the SunTech blog is share debates and comparisons of automated vs. manual auscultatory blood pressure measurements. The latest comes from an article published in the Journal of the American Society of Hypertension earlier this year. This evaluation compared one particular automated oscillometric device with the results from the auscultatory method of listening for Korotkoff sounds during cuff deflation. The authors’ aim was to help readers better understand the fundamental differences between these two methods and illustrate how that might assist clinicians in effectively controlling and managing hypertensive patients.


Understanding that there is a dramatic difference between these two methods is, in fact, an important consideration of which clinicians should be aware. The auscultatory method has been the standard method of determining BP for over 100 years and relies on the observer to detect the audible sounds (Korotkoff sounds) that occur during constricted blood flow. The oscillometric method, employed by most clinical-grade automated BP devices, analyzes pulse waves collected from the cuff during constricted blood flow. In this case, the cuff is the sensor. The auscultatory and oscillometric methods are two very different approaches to determining the same vital sign.

Each method also presents its own unique set of challenges. The manual auscultatory method is prone to poor technique, observer digit bias and poor hearing (often unbeknownst to the observer). The oscillometric method can be prone to errors when there is too much patient arm movement.  In addition, each medical device manufacturer uses their own proprietary algorithm for acquiring blood pressure measurements so BP readings may vary significantly between devices which makes it important to shop around for a clinical grade device that is validated to industry standards such as the AAMI SP10 protocol.

Being aware of these differences and limitations can certainly be of help to clinicians when making hypertension treatment decisions. For further information on some of the challenges and best practices when taking an auscultatory blood pressure measurement, be sure to check out our e-book “10 Steps to Accurate Blood Pressure Measurement”. We also invite you to share your comments and experiences when comparing automated and manual BP measurements.

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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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What is a "Long" Blood Pressure Cuff?

Long size BP cuffAs a manufacturer of blood pressure (BP) cuffs, we are often asked: “What is the difference between an Adult BP cuff (or “standard” cuff) and an Adult Long BP cuff?”

Simply put, a “long” cuff has the same range indicators and bladder size as a “standard” cuff, but the actual length is longer than that of a “standard” cuff.  Therefore, a “long” cuff is able to fit on a larger patient population than a “standard”  cuff.

You are probably asking yourself, “If the range and the bladder size is the same on both a “standard cuff” and a “long cuff”, do they both give accurate readings?”


To answer this question, you need to understand the “80/40” rule.  The “80/40” rule states that in order to obtain an accurate blood pressure measurement, the cuff bladder length should be approximately 80% of the circumference of the upper arm and the cuff bladder width should be optimally 40% of the circumference of the upper arm.  The basic reasoning behind this rule is that the cuff bladder must be able to occlude the brachial artery (obstruct the flow of blood through the artery) when the bladder is inflated.  If the brachial artery is not completely occluded before you start to deflate the bladder, then you will hear the Korotkoff sounds earlier which will result in false high readings.  On the other hand, if the bladder size is too big for the arm, then it will take longer to hear the Korotkoff sounds which will result in false low readings.

So if a “long cuff’ is used on a patient with an arm circumference that fits in the intended range of the cuff, then an accurate blood pressure measurement can be expected.  However, if a “long cuff” is used on a patient with an arm circumference outside the intended range of the cuff, even if the cuff fits the arm of the patient, you risk obtaining inaccurate blood pressure measurements.

While we have kept customer demand in mind by making the long sized cuff available, we recommend always using best practices for obtaining an accurate blood pressure reading.  You can read “10 Steps to Accurate Manual BP Measurement” for a detailed guide for obtaining a high quality reading.  In addition, we highly recommend the following video tutorial for proper cuff sizing.

 

 

If you have experiences using "long" versions of blood pressure cuffs, we invite you to share your thoughts with us.

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Video: Consumer Reports Tests Home BP monitors

Home BP Consumer ReportThis news video reports on a clinical evaluation of select Home BP monitors recently completed by Consumer Reports. We were not surprised to see, among their findings, that the wrist monitors evaluated were not as accurate as upper arm monitors. We were encouraged that the video seems to indicate the evaluation was administered by two observers taking auscultatory readings with a stethoscope and mercury column where those results would serve as the basis to compare the automated monitors' results. This is truly the best method for performing clinical evaluations of automated, non-invasive BP monitoring technologies.

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Man Protests Outside Drug Store Over Faulty BP Monitor

Man ProtestingWe recently came across an article reporting on a man in Grand Forks, North Dakota, who is so upset about the erroneously high readings from his new BP monitor that he spent three days protesting outside the store he purchased it from*.

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The Psychology vs the Science of Blood Pressure

guessHave you ever been to a "Guess your age" booth at an amusement park?  If you are able to fool the person guessing the age of passers-by within a couple of years you win a stuffed animal or toy. Well believe it or not, clinicians occasionally do this to their patients.  Not for age, but for blood pressure.  Glenn Nyback, an EMT teacher, recounts a personal experience from one of his classes:

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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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Does Your New Physician Make Your Blood Pressure Rise

High Blood Pressure MeasurementA recent article in the Journal of Clinical Hypertension does a colorful yet effective job of describing the transient effects of White Coat Hypertension (WCH) when meeting  a new physician.  Studies show that patients who are not hypertensive but show high BP readings when visiting a new doctor for their first time can continue to present with these elevated BP readings for three to six visits.  Although treatment for hypertension based on these measurements is not recommended, the gold standard diagnostic test for WCH, a 24-hour study with an ambulatory blood pressure (ABP) monitor, can more effectively determine whether treatment is, in fact, needed.

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SunTech Partner's Remote Patient Monitor Featured in the Economist

RDT logoWe love to highlight our partners’ achievements.  While some of these have been highly technical BP measurement endeavours in the pursuit of expanding scientific understanding such as experiments on the International Space Station or Mount Everest, the Economist trumpets one which may help anyone who travels by plane. Congratulations to our colleagues at RDT!

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Masked Hypertension: What You Don't Know Could Kill You!

Masked hypertensionWhite-coat hypertension is a familiar term to most clinicians.  Patients with white-coat typically have elevated blood pressure measurements in the clinician’s office, but display normal BP measurements in their everyday environment.  The prevalence of white-coat hypertension varies from 15% to 20% of patients.  Conversely, there is another group of individuals whose hypertension often goes unnoticed by traditional methods of BP measurement.  These patients have normal in-office BP but elevated out-of-office BP.  This phenomenon is referred to as “masked hypertension” and is defined as having in-office BP < 140/90 mm Hg but daytime ambulatory or home BP ≥ 135/85 mmHg.

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Instrument Calibration Adds Error Potential in Manual BP Measurement

Blood pressure instrumentsIn previous posts, we have reviewed the 10 Steps to Accurate Manual Blood Pressure Measurement and 10 Factors That Can Affect Blood Pressure Readings.  As important as these details are, accurate measurement also requires two things:

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ASH 2010: A Focus on Improving Blood Pressure Measurement Technique

ASH logoAt the recent 25th annual scientific meeting for the American Society of Hypertension, there was a new program track targeted specifically to clinicians in primary care. The aim was to present the latest hypertension strategies and guidelines in a format that would be appropriate for the primary care physician but also for physician's assistants, nurse practitioners as well as seasoned hypertension specialists. While the session covered various current issues related to hypertension, one clear area of attention was a re-focus on blood pressure measurement methods.

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Preeclampsia: Pregnancy and Hypertension

PreeclampsiaAn important health issue that expectant mothers may encounter during pregnancy is Preeclampsia, a condition in which the expectant mother is diagnosed with hypertension and has protein present in the urine.  Preeclampsia is the most common medical disorder of pregnancy and affects 10%-12% of all expectant mothers (Pickering et al, 2005).  Since blood pressure plays an important role in the health of mom and baby, accurate blood pressure measurement is extremely critical, because one would never want to be misdiagnosed with hypertension and be prescribed medications/medical interventions that could potentially injure both mom and baby.

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10 Factors That Can Affect Blood Pressure Readings

Proper blood pressure cuff sizingHave you ever visited the doctor's office and discovered your blood pressure was higher than you expected? Most people do not realize their blood pressure is constantly changing minute by minute in response to mood, activity, body position, etc. In fact, simple changes can cause blood pressure to fluctuate between 5 and 40 mmHg. Here is a list of 10 factors that can temporarily cause significant deviations in your blood pressure measurements.

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Blood Pressure Monitoring at 30 Thousand Feet?

RDT Tempus IC in flightBlood pressure is everywhere nowadays. While we are used to seeing it measured in the hospital, clinic, and even at home, what about on an airplane? RDT makes this possible with their product and service called Tempus ICTM, which is used by non-medically trained staff to save lives in remote locations such as in-flight or at sea.

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Device enables world's first voluntary gorilla blood pressure reading

Gorilla blood pressure readingAs a leading manufacturer of automated blood pressure monitoring technology, we've seen some pretty interesting technological advances in our 25 plus years, but the work that Biomedical Engineering students from Emory University did for their senior project has to be one of the most impressive accomplishments we've seen in a while.

Zoo Atlanta recently became the first zoological institution in the world to obtain voluntary blood pressure readings from a gorilla. This groundbreaking stride was made possible by the Gorilla Tough Cuff, a blood pressure reading system devised through partnership with the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University.

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9 Common Signs and Symptoms of High Blood Pressure

Symptoms of Hypertension

Since Blog @ SunTech launched in July 2009, there has been a great amount of knowledge shared about blood pressure and blood pressure technologies.

We have covered the importance of accurate blood pressure, ambulatory blood pressure, and even discussed selecting the correct size blood pressure cuff. All the topics we've covered are important, but in many cases, people with high blood pressure are unaware that they have an issue they need to accurately manage.

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Save time and money with a regulatory approval pathway for medical devices

OEM BP chipAs a medical device manufacturer, we at SunTech Medical have a full appreciation for how laborious the regulatory approval process can be when bringing a product to market. Understanding the rules and requirements can help a medical device manufacturer avoid time-to-market delays and inflated project costs. It is with this unique perspective that we frequently assist our OEM partners with overcoming regulatory hurdles related to automated blood pressure to help them get to market on time while keeping costs to a minimum.

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