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Are Your Manual Vital Measurement Techniques Doing More Harm Than Good?

Blood pressure cuff being placed on arm of patient by nurse

Fewer in-person visits means making them count — automated vitals equipment will help diagnose faster and more accurately than improper manual blood pressure measurement techniques.

On a typical day in your practice, each patient gets their vitals checked including blood pressure. While the patient sits down, you’re gathering all the tools for manual measurement including a stethoscope, sphygmomanometer, blood pressure cuff, pulse oximeter, etc.

Since you haven’t seen the patient in a while, you’re conversing with them while applying the cuff over the patient’s shirt and looking at the aneroid gauge. You take one reading and move on to the remaining vitals. During this process, you’re writing down the information in a chart or typing into an EMR. A lot of patients are coming through your practice and this process needs to happen as quickly as possible, especially if you’re understaffed.

This is how it’s always been done, but what if your manual vital sign measurement technique is doing more harm than good?

What it Means for Your Patient

By not using proper technique with the manual blood pressure setup of a sphygmomanometer and reading the gauge, you may be putting your patient at risk with incorrect measurements. A misdiagnosis of hypertension can have physical, psychological and economic impacts on your patient.1 With a hypertension diagnosis, your patient will see an increase in insurance costs leading to higher life insurance premiums.2,3,4

These costs can really add up. Compared to those without hypertension, people with hypertension face nearly $2,000 higher annual health care expenses.5 They also earn approximately two and a half times the inpatient cost, nearly twice the outpatient cost and nearly three times the prescription medication expenditures.5 These are serious expenses that could significantly impact someone’s life. Additionally, 20-97% of patients taking antihypertensive medications experience side effects.6 One analysis found that there was an increased risk of hypotension, syncope, and acute kidney injury.7

With these potential high costs and side effects for your patients, the quality and accuracy of your technique matters.

What it Means for Your Practice

While trying to save time and resources, manual measurement may be easier but improper technique could be costing you more than you think. Something as simple as putting the blood pressure cuff over clothing or not letting your patient rest can add up to an incorrect reading. The ACC (American College of Cardiology) and AHA (American Heart Association) have outlined 7 steps with 19 specific instructions to help you ensure accurate blood pressure readings.8,9

Hypertension costs the US an estimated $131 billion and is a primary or contributing factor in nearly 500,000 deaths each year.10 Nearly half of adults 20 years of age and older in the US (46%) have hypertension or are taking medication for hypertension.11

There are many best practices when taking blood pressure with manual devices such as an aneroid gauge. Is your practice using all of them? There are myriad factors that can cause blood pressure measurement errors on manual screenings:12

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 unsupported while sitting 1-7/5-11
Arm unsupported while standing 6-8/--

Another measurement phenomenon is terminal digit preference, resulting in readings ending in 0 or 5 leading to an inaccurate blood pressure measurement. 13, 14 This occurs in >50% of manual blood pressure readings, reduces the precision of the reading as well as the accuracy of a hypertension diagnosis.15

If taken using the steps necessary to ensure an accurate blood pressure reading, obtaining these readings would require an estimated 14 minutes of office time.16, 17 It’s important to have the right techniques in place to make accurate and timely decisions for your patients. Click here for some best practices on how to better identify hypertension.

How You Measure Matters

The healthcare industry has been pushed into the digital age for security, simplicity and innovation. Make it work for you, not against you with tools for better outcomes for your patients and your practice.

A study comparing three different measurement techniques found that a hypertension diagnosis could not be established with 80% certainty using a single clinic systolic blood pressure reading between 120-157mmHg.18 Even with the right tools, with improper technique you may be putting your patients at risk of misdiagnosis.

Get your practice ahead of the curve – two of the Healthy People 2030 objectives focus on blood pressure including reducing the proportion of adults with high blood pressure and increasing control of high blood pressure in adults.19 These objectives can be made possible with accurate blood pressure measurement through proper technique.

Automated office blood pressure measurement is the AMA preferred in-office approach for measuring blood pressure to increase accuracy, mitigate white coat effect, saving staff time, and more.20 Click here to walk through a manual vs. automated patient journey to see the impact your technique may have on your patients and your practice.

The Spot Vital Signs® 4400 Device helps you capture, access and document patient vital signs so you can focus on what matters most — your patients. Learn more at hillrom.com/spot4400.

References
  1. Viera AJ, Lingley K, Esserman D. Effects of labeling patients as prehypertensive. J Am Board Fam Med 2010; 23: 571-583.
  2. Ivanovic B, Cumming ME, Pinkham CA. Relationships between treated hypertension and subsequent mortality in an insured population. J Insurance Medicine 2004; 36: 16-26.
  3. Myers MG, Stergiou GS. White coat phenomenon. Removing the stigma of hypertension. Hypertens 2016; 67: 1111-1113. DOI: 10.1161/HYPERTENSIONAHA.116.07322.
  4. iAA Financial Group. Field Underwriting Guide for Representatives. Available at: https://iaa.secureweb.inalco.com/cw/-/media/documents-repository/individual-insurance-savings-and-retirement/individual-insurance/2019/06/dev004399.pdf Last accessed: September 20, 2020.
  5. Kirkland EB, Heincelman M, Bishu KG, et al. Trends in healthcare expenditures among US adults with hypertension: national estimates, 2003-2014. J Am Heart Assoc 2018; 7: e008731. DOI: 10.1161/JAHA.118.008731.
  6. Tedla YG, Bautista LE. Drug side effect symptoms and adherence to antihypertensive medication. Am J Hypertension 2016; 29 (6): 772-779. DOI: 10.1093/ajh/hpv185.
  7. Sheppard JP, Stevens S, Stevens R, et al. Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension. JAMA Intern Med 2018; 178 (12): 1626-1634. DOI: 10.1001/jamainternmed.2018.4684.
  8. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 71: e127-248. DOI: 10.1016/j.jacc.2017.11.006
  9. 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
  10. CDC. Facts about hypertension. Available at: https://www.cdc.gov/bloodpressure/facts.htm. Last accessed: March 1, 2022.
  11. Virana SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics—2020 update. Circulation 2020; 141: e139–e596. DOI: 10.1161/CIR.0000000000000757.
  12. Handler J. The importance of accurate blood pressure measurement. The Permanente Journal 2009; 13 (3): 51-54.
  13. Trilling JS, Froom J. The urgent need to improve hypertension care. Arch Fam Med 2000; 9: 794-801.
  14. 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.
  15. Myers MG. The great myth of office blood pressure measurement. J Hypertens 2012; 30(10): 1894-1898.
  16. Handler J, Zhao U, Egan BM. Impact of the number of blood pressure measurements on blood pressure classification in US adults: NHANES 1999-2008. J Clin Hypertens 2012; 14 (11): 751-759.
  17. Yarrows SA. How to measure blood pressure in primary care offices to assure accuracy while maintaining efficiency. J Clin Hypertens 2017; 19: 1386-1387. DOI: 10.1111/jch.13101.
  18. Powers BJ, Olsen MK, Smith VA, et al. Measuring blood pressure for decision making and quality reporting: where and how many measures? Ann Intern Med 2011; 154 (12): 781-788.
  19. Gaziano T. Accurate hypertension diagnosis is key in efficient control. Lancet (online); 2011. DOI: 10.1016/S0140-6736(11)61299-3.
  20. Rakotz, M. A MAP for Improving Blood Pressure Control. Available at: https://www.heart.org/-/media/files/affiliates/mwa/mo-hypertension-summit/a-map-for-improving-blood-pressure-control.pdf?la=en. Last accessed: 10.25.2020.