Seven Ways to Easily Improve Blood Pressure Measurement Accuracy

By Dr. Tom Schwieterman, chief medical officer and vice president of clinical affairs, Midmark Corp. September 10, 2018

As caregivers continue to work to standardize care, one area in particular is getting a lot of attention: blood pressure (BP) measurement. It’s estimated that around 9.8 percent of the population is affected by overestimation of high blood pressure errors.[1]

So, why is this concerning?

• Underestimating true blood pressure by 5 mm Hg would mislabel more than 20 million Americans with prehypertension when true hypertension is present.
• Overestimating true blood pressure by 5 mm Hg would lead to inappropriate treatment with antihypertension medications in almost 30 million Americans.

How can we fix this? The American Heart Association (AHA) and the American Medical Association (AMA) have published guidelines for in-clinic BP measurement. Unfortunately, many healthcare providers are not aware of current standards for proper BP measurement.

Below are seven recommendations from AHA and AMA.

1. Support the back and feet. Patients should be seated with feet flat on the floor with back firmly supported., back straight and legs uncrossed. If the back and feet are not properly supported, the diastolic pressure could be higher.
   
2. Support arm at heart level. Place and stabilize patient arms at heart height. If the arm is below the heart, the reading will be too high. if it is above the heart, it will be too low.
   
3. Keep legs uncrossed. Instruct patients to sit with legs uncrossed before doing the reading. Not only will it help ensure patients are relaxed, it will also result in a more accurate reading.
   
4. Put cuff on bare arm. Avoid placing the blood pressure cuff overtop clothing. Roll the sleeve above the elbow so it does not create a tourniquet and affect the reading.
   
5. Use correct cuff size. The cuff should encircle at least 80 percent of patients’ arm circumference and be placed 2 to 3 cm above the (antecubital fossa) elbow pit.
   
6. Don’t have a conversation. Talking during the reading can actually raise BP. Encourage patients to remain quiet and relaxed during the test.
   
7. Empty bladder first. Ask patients if they need to use the restroom before taking the reading. A full bladder can cause the reading to be too high.

One more recommendation, which is actually not from the AHA or AMA: It is important to keep abreast of the newest equipment and technology. A growing number of new technologies and equipment being introduced to the industry have been designed to ensure clinical standards for BP capture can be easily followed.

One example of new equipment that is helping standardize proper patient positioning for more accurate BP measurement is Midmark’s new generation of Barrier-Free Examination Chairs. They offer:

• Low chair height that allows majority of patients, even females with height in the third percentile, to place feet flat on the floor.
• Powered movement of the chair back section to ensure patient back support.
• Patient Support Rails Plus that support arm at heart height.
• Automated BP measurement through connection with a diagnostic device, with data sent directly to electronic medical records (EMR) systems to help reduce transcription errors.

Following these recommendations correctly, will help clinical care teams capture a more accurate BP reading to fully understand a patient’s clinical landscape. The end result? Better quality care.