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Improving Blood Pressure Accuracy and Improving Care

Practitioner Newsletter - Issue 4, 2011

The following are excerpts from a quiz based on blood pressure measurement guidelines published by the American Heart Association Council for High Blood Pressure Research. This is not an exhaustive test of blood pressure measurement competency, rather, these questions are intended to help stimulate your thinking about blood pressure measurement and its improvement. Take the quiz below to see how you do (answers shown on the bottom of this page).

How many blood pressure (BP) readings are recommended each time you measure blood pressure?
A. One
B. At least two
C. As many as there is time for
D. The same number as taken at the last patient visit
Which of the following patient postures can cause an error of a higher blood pressure reading?
A. Patient seated on exam table
B. Arm at heart level
C. Forearm supported with palm up
D. Patient’s back against chair with feet flat on floor
According to evidence-based guidelines, what is the recommended cuff deflation rate for patients who are not bradycardic?
A. 2−3 mmHg per second
B. 4 mmHg per second
C. Accuracy is unaffected by cuff deflation rate
What is the recommended frequency for retraining health care professionals on blood pressure measurement technique?
A. Every two years
B. Once per year
C. Every six months
D. Up to the discretion of individual clinics

Accurate blood pressure measurement is an exacting process that requires careful attention and periodic retraining. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) and the American Heart Association (AHA) recommend that those responsible for measuring blood pressure should be trained and regularly retrained, and that all types of equipment should be regularly inspected and validated.

Answers for quiz: 1. B; 2. A; 3. A; 4. C

Sources: National High Blood Pressure Education Program (NHBPEP)/ NHLBI and AHA working meeting on blood pressure measurement. Bethesda: National Institutes of Health; 2002. Available at: www.nhlbi.nih.gov/health/prof/heart/hbp/bpmeasu.pdf Blood Pressure Measurement Toolkit |Wisconsin Heart Disease and Stroke Prevention Program Blood Pressure Measurement Toolkit: Improving Accuracy, Enhancing Care

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Improve Blood Pressure Measurement Accuracy

10 Steps to Improve Blood Pressure Measurement Accuracy:

Have patient rest five minutes before measuring blood pressure.
Patient should be seated in chair with back supported, feet flat on floor, arm supported on firm surface, with midpoint of upper arm at heart level.
Select appropriately sized blood pressure cuff by measuring patient’s upper arm circumference at the midpoint.
Position cuff on arm by centering bladder over brachial artery; lower edge of cuff must be approximately 1 inch above bend in elbow.
Deflate 2 mmHg per second. Read pressure to nearest 2 mmHg. Round upwards.
Listen for all five phases of Korotkoff sounds including auscultatory gap (if present).
After last sound is heard, listen for at least another 10 mmHg. If the last sound you hear is very early, listen for an additional 40 mmHg.
Allow one minute before rechecking pressure in the same arm.
Take blood pressure readings in both arms at first examination.
Guard against terminal digit bias or adjusting readings based on previous knowledge of the patient.

Get a copy of the complete Blood Pressure Management Toolkit.