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Advice from the BP Measurement Experts

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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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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Cardiologists, Choose Your Weapons Wisely!

heart wrenchWhen all else fails, keep it simple. Isn’t this what we have been told since childhood? It seems that some cardiologists have gone back to this basic philosophy when it comes to diagnosing heart disease. Dr Martha Gulati, a cardiologist at the Ohio State Wexner Medical Center where she specializes in women’s heart disease, says that it is “simple stuff” like an exercise stress test that can “catch blockages and predict hypertension” that other more high-tech tests sometimes miss. She says that using an exercise stress test in a recent case allowed her to “find significant disease” that other tests like an MRI completely missed.

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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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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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In-Office Ambulatory Blood Pressure Monitoring: Could it replace traditional office BP assessment?

traditional doctors officeThat’s just the question Dr. Mark C. van der Wel and colleagues sought the answer to in an article published in the Annals of Family Medicine. As we at SunTech have mentioned in previous posts, two of the most prevalent problems with traditional in-office blood pressure assessment is improper observer technique and the white-coat effect.  As a way to overcome this, the authors developed a method of taking a series of in-office automated oscillometric blood pressure readings for 30 minutes by utilizing an ambulatory blood pressure monitor (ABPM) and compared those results with mean daytime ABPM results.

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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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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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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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The Different Types of Blood Pressure Cuffs on the Market

Specialty CuffMost people think of a blood pressure (BP) cuff as simply, “just a cuff.” However, there are actually a number of BP cuffs that have been developed to meet the varying needs of patients and medical facilities. In an effort to shed more light on the different cuffs available for use, here is some detailed information on each type, how they are used and the typical environment in which each are used.

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Automated BP vs Manual BP Measurement: Which is Better? (Part 1 of 2)

Automated or manual BP debateWhat’s a clinician to do? Debates about clinical trials, patient populations, and statistical analyses can seem hollow and distant when looking at an anxious patient in an exam room. At that moment, all that matters is what’s best for your patient. Yet clinically relevant data, and more importantly, rigorous discussion of that data, is the means to the end. Professional clinicians quite often need the former in order to effectively deliver the latter. To wit, two similar journal articles were recently published that arrived at two very different conclusions. Let’s take a look:

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Top 5 reasons your automated BP monitor gave an error code

The real problem is not whether machines think but whether men do.”  ~B.F. Skinner, Contingencies of Reinforcement, 1969

Sometimes, the more technology aims to help us, the more burden we take on to ensure it works. These days, automated blood pressure monitors are rapidly displacing mercury and aneroid sphygmomanometers in physician’s offices. As we move farther away from the 100 year old standard of listening for Korotkoff sounds to obtain a BP measurement, and towards the simple press of a button, there are a new set of usage factors that clinicians must remember when encountering problems.

Below is a list of the Top 5 reasons a clinician would encounter an error code when attempting to take an automated BP.

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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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Blood Pressure in your Medical Practice

SurveyThanks to the increasing concern regarding cardiovascular disease, blood pressure (BP) is one of the more well-known vital signs. Just about everyone has had their BP measured in a clinic. In the last few years, many track their own BP with the widespread availability and affordability of home monitors. Although experts in cardiology regard ambulatory blood pressure monitoring (ABPM) as the gold standard, it is not as frequently used in regular medical practice as in-office or home BP.
Each method has its benefits and disadvantages.

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