April 27, 2019Open Access
Optimizing observer performance of clinic blood pressure measurement
Key Result
Standardized blood pressure measurement using validated automated devices and proper observer training is recommended to minimize measurement errors and optimize hypertension management.
Structured PICO
How can observer performance in clinic blood pressure measurement be optimized?
P
Population
Individuals requiring clinic blood pressure measurement, with special attention to low-to-middle-income settings
I
Intervention
Standardized techniques and validated semi-automated/automated upper arm cuff devices for BP measurement
C
Comparator
Auscultation or non-standardized measurement
O
Outcome
Accurate blood pressure measurement and correct hypertension status classification
Accurate clinic blood pressure measurement requires standardized patient preparation, validated automated upper arm cuff devices, and ongoing observer training to prevent misclassification of hypertension.
Limitations
- Challenges in low-to-middle-income settings include resource limitations, heavy workloads, time constraints, and lack of electrical power.
Abstract
: High blood pressure (BP) is a highly prevalent modifiable cause of cardiovascular disease, stroke, and death. Accurate BP measurement is critical, given that a 5-mmHg measurement error may lead to incorrect hypertension status classification in 84 million individuals worldwide. This position statement summarizes procedures for optimizing observer performance in clinic BP measurement, with special attention given to low-to-middle-income settings, where resource limitations, heavy workloads, time constraints, and lack of electrical power make measurement more challenging. Many measurement errors can be minimized by appropriate patient preparation and standardized techniques. Validated semi-automated/automated upper arm cuff devices should be used instead of auscultation to simplify measurement and prevent observer error. Task sharing, creating a dedicated measurement workstation, and using semi-automated or solar-charged devices may help. Ensuring observer training, and periodic re-training, is critical. Low-cost, easily accessible certification programs should be considered to facilitate best BP measurement practice.