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Is Your Technique Up to the Task? Minimize Blood Pressure Reading Inaccuracy with Proper Technique

Clinician places a blood pressure cuff on a patient’s bare arm.

Blood pressure measurement technique errors — even something as simple as placing the cuff over clothing during measurement — can lead to noticeable inaccuracies in the blood pressure reading itself.

It’s that time of year again in Central New York. The home to Hillrom Front Line Care is in the midst of unpredictable Spring weather, where daily temperature swings mean your patients are wearing anything from a thick down parka to a light windbreaker at their next appointment. Whatever the garment of choice, it’s important to remember how clothing over the arm and other factors can affect your ability to obtain an accurate blood pressure reading.

While several factors can cause measurement errors, procedure-related errors — either from the blood pressure measurement device, or the person using the device — are often the most concerning.

The most common procedural errors in clinical practice include: 1, 2

  • Failure to allow for a rest period
  • Talking with your patient during or immediately before taking a recording
  • Improper patient positioning
  • Incorrect cuff sizing
  • Incorrect cuff inflation and deflation
  • Failure to detect Korotkoff sounds
  • And transcription errors

Those procedural errors may sound familiar and can be relatively simple to correct if you keep technique in mind. Some errors, however, may be more subtle. For example, the measurement phenomenon known as “terminal digit preference” results in many blood pressure readings ending in either a 0 or a 5, thus leading to an inaccurate measurement.3, 4 This practice of rounding up or down occurs in more than 50% of manual blood pressure readings, reducing the precision of the reading and the accuracy of a hypertension diagnosis.5

The overall impact of these technique errors in a single office visit can lead to noticeable inaccuracies in the blood pressure reading itself. Capturing a blood pressure reading with the usual outpatient blood pressure measurement technique is higher than blood pressure readings obtained using the recommended guideline technique. The potential consequence? Many patients diagnosed with hypertension might be normotensive, while others with true hypertension may be left undiagnosed.3

Understanding the Impact of Blood Pressure Measurement Errors on Blood Pressure Readings1

Factor  Change in mmHg (SBP/DBP)
Talking or active listening
10/10
Cuff over clothing
5-50/-
Cuff too small
10/2-8
Smoking within 30 minutes of measurement
6-20/-
Paralyzed arm
2-5/-
Back unsupported
6-10/-
Arm unspported while sitting
1-7/5-11
Arm unsupported while standing
6-8/-

 

It may seem simple, but remembering proper blood pressure measurement techniques is crucial for a more accurate reading — so make sure to have your patients remove that winter coat next time.

By Christopher Long, Patient Monitoring Manager at Hillrom

Chris is a Global Marketing professional at Hillrom focusing on Patient Monitoring. A rookie blogger, Chris is looking to share his many years of experience in the medical industry to further Hillrom’s mission of Advancing Connected CareTM through solutions that help caregivers enable earlier diagnosis and treatment. Check in with Chris and his fellow Hillrom bloggers as we look to keep you #Connected!

References
  1. Handler J. The importance of accurate blood pressure measurement. The Permanente Journal 2009; 13 (3): 51-54.
  2. Muntner P, Shimbo D, Carey RM, et al. Measurement of blood pressure in humans. A scientific statement from the American Heart Association. Hypertension 2019; 73: e35-e66. DOI: 10.1161/HYP.0000000000000087
  3. Trilling JS, Froom J. The urgent need to improve hypertension care. Arch Fam Med 2000; 9: 794-801.
  4. Staessen JA, Li Y, Hara A, et al. Blood pressure measurement Anno 2016. Am J Hypertens 2017; 30(5): 453-463. DOI: 10.1093/ajh/hpw148
  5. Myers MG. The great myth of office blood pressure measurement. J Hypertens 2012; 30(10): 1894-1898.