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Multiple readings may be necessary for accurate BP measurement
Appel L. Ann Intern Med. 2011;154:838-839.
Powers B. Ann Intern Med. 2011;154:781-788.
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The averaging of several BP measurements could have a substantial effect on reducing the variability in measurements witnessed among hypertensive patients, with the greatest benefit observed with five to six measurements, according to a new study.
In the study, 444 veterans (mean age, 64 years; 92% men) with hypertension from the Durham Veterans Affairs Medical Center, Durham, N.C., were followed for 18 months. Investigators obtained BP through three methods — clinic BP measurements obtained during outpatient visits; standardized research BP measurements every 6 months; and home BP measurements with a monitor transmitting measurements electronically. Controlled systolic BP was defined as a mean measurement of less than 140 mm Hg for clinic or research measurement and less than 135 mm Hg for home measurement.
During follow-up, a substantial variability in BP measurements was found among patients. Specifically, 28% of patients were designated as in control by clinic measurement, 47% by home measurement and 68% by research measurement. Variability was particularly apparent during the short-term for all methods, culminating with a mean within-patient coefficient of variation of 10%.
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Overall, a single clinic systolic BP measurement from 120 mm Hg to 157 mm Hg was unable to classify patients as having BP in or out of control with 80% certainty. However, variability could be substantially reduced by averaging several measurements, the researchers said, with the most benefit detected at five to six measurements.
“Current treatment of patients with hypertension relies heavily on clinic measurement of BP, and the quality of this care is evaluated solely in this setting,” the researchers wrote. “For patients who visit their physician to receive personalized health recommendations, high-quality care should reflect good clinical decision-making based on adequate information. In hypertension, simple changes in the setting and number of BP measurements used for decision-making could greatly enhance the personalization of care.”
In an accompanying editorial, Lawrence J. Appel, MD, Edgar R. Miller III, MD, PhD, and Jeanne Charleston, BSN, RN,with Johns Hopkins University, wrote that previously, the importance of accurate and precise BP measurement had been largely ignored and that this study highlights the benefits of recording and averaging high-quality BP measurements across several visits.
“Given persistent problems in obtaining such measurements, a regulatory approach should be considered in which the Joint Commission, the National Committee for Quality Assurance and other organizations set standards and monitor compliance,” they said. “It is time to get serious about BP measurement.”
Disclosures: Drs. Appel, Miller and Charleston report no relevant financial disclosures.
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