Blood Pressure Assessment: JACC Expert Panel Report
- Muntner P, Einhorn PT, Cushman WC, et al.
- Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research: JACC Scientific Expert Panel. J Am Coll Cardiol 2019;73:317-335.
The following are key points to remember from this JACC Scientific Expert Panel review of blood pressure assessment in adults in clinical practice and clinic-based research:
- Hypertension (HTN) affects over 100 million adults in the United States and over a billion worldwide. Ample evidence exists demonstrating that lowering blood pressure (BP) is associated with lower risk for cardiovascular disease (CVD). Accurate assessment of BP is critical to appropriate management and screening for HTN. This statement aimed to discuss the integration of measurement methods into clinical practice with accuracy and how the use of high-quality BP measures translates into improved patient care.
- Variation in BP measurement can differ substantially between research (using standardized protocols) and clinical measures. BP measurement quality in clinical practice remains poor due to lack of standardization, lack of training of personnel, and/or validation of measurement devices. Other factors that lower quality include the use of improper cuff size and conditions (e.g., loud environment, no rest before measuring, and talking with the patient during measurements).
- Measurement of BP in the clinic should include avoiding stimulants, exercise, and smoking before measurement. The patient should be sitting quietly for at least 5 minutes before reading with the arm supported with feet flat on the floor. The proper cuff size should be used, and multiple measurements taken 1-2 minutes apart with ≥2 readings on ≥2 occasions. The patient should be provided with BP readings both verbally and in writing. Full details are presented in the statement. When BP is measured in the clinic, the following should be documented in the electronic medical record: date/time, location, pain level, position, site of cuff placement, and cuff size. BP should be measured in both arms and the arm with the higher reading used in subsequent measures. Training of staff who perform BP measures should be conducted using a standard, detailed protocol with re-training every 6 months.
- Out-of-clinic BP measures include ambulatory BP monitoring and home monitoring. Ambulatory BP monitoring can also detect white coat HTN and masked HTN and is associated with CV outcomes. Such monitoring can also detect abnormal nocturnal BP readings. However, some patients cannot tolerate the testing, and equipment is not widely available. Home BP monitoring also has a strong association with CV outcomes and can detect both white coat HTN and masked HTN. Limitations include patient misreporting of readings, the need for patient training, and lack of validation in many home devices.
- Novel methods of measuring BP are currently under development. As with traditional measures, thorough validation of these measures is required. Use of the electronic medical record to document both clinic and outpatient measures provides an opportunity to assess BP control and facilitate adequate management of HTN.
Keywords: Blood Pressure, Blood Pressure Determination, Blood Pressure Monitoring, Ambulatory, Electronic Health Records, Hypertension, Patient Care, Primary Prevention
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