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Principles And Techniques Of Blood Pressure Measurement Pdf

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This study aimed to quantify blood pressure BP measurement accuracy and variability with different techniques. Ten observers without receiving medical training were asked to determine BPs using a traditional manual auscultatory method and b visual auscultation method by visualizing the Korotkoff sound waveform, which was repeated three times on different days. The measurement error was calculated against the reference answers, and the measurement variability was calculated from the SD of the three repeats. Statistical analysis showed that, in comparison with the auscultatory method, visual method significantly reduced overall variability from 2. It also showed that BP measurement errors were significant for both techniques all , except DBP from the traditional method.

General principles of blood pressure measurement

Exploratory Study. METHODS: A questionnaire with 5 questions about practices and behaviors regarding blood pressure measurement and the diagnosis of hypertension was sent to 25, physicians in all Brazilian regions through a mailing list.

The responses were compared with the recommendations of a specific consensus and descriptive analysis. The following items were reported: use of an aneroid device by For hypertension diagnosis, The results suggest that, to include the great majority of the medical professionals, disclosure of consensus statements and techniques for blood pressure measurement should go beyond the boundaries of medical events and specialized journals.

Blood pressure measurement with the indirect method with the auscultatory technique is the most frequently used procedure in clinical practice for the diagnosis of arterial hypertension and assessment of the efficacy of treatment. The international recommendations presented in the VI Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1 by the World Health Organization and the International Society of Hypertension 2 point to principles that constitute the bases for correct measurement of blood pressure.

Likewise, the III Brazilian Consensus on Hypertension 3 recommends the routine for standardization of blood pressure measurement. Preoccupation with standardization of blood pressure measurement is not a new fact. Since , the American Heart Association 4 has discussed the procedure and published recommendations in the years , , , , and 5 , the last with adjustments in 2.

At each recommendation, new aspects related to the technician, equipment, patient, environment, and technique have been discussed aiming at eliminating the possibility of errors, which compromise the reliability of blood pressure measurement, and, consequently, the diagnosis of hypertension. Of the errors regarding the equipment, lack of sphygmomanometer calibration stands out 6,7.

In regard to procedures, the frequency of blood pressure measurement during medical visits is low. Another important aspect is the number of blood pressure measurements required for the diagnosis of hypertension, which was consensually recommended as at least 2 readings on 2 or more occasions.

Even if asymptomatic, as in most hypertensive patients, hypertension accounts for an important reduction in life expectancy and quality of life, which are reasons sufficient to make blood pressure measurement, indeed, a routine medical procedure. Despite the existing recommendations and the personal and social relevance of the problem, it is yet unknown how blood pressure is measured and the degree of medical adherence to the current consensus and guidelines in Brazil.

Considering all these highlighted issues, the objectives of this study were to determine how the basic technical procedures of blood pressure measurement and the operational criteria for the diagnosis of hypertension are used in daily medical practice.

In , 25, questionnaires were sent to Brazilian physicians - general practitioners, cardiologists, and nephrologists - through a mailing list with responses being voluntary, covering the entire clinical registry of a large, national pharmaceutical manufacturer.

The questionnaire comprised 5 simple questions, which required 3 minutes, at most, to answer, and encompassed practices and behaviors regarding blood pressure measurement and the diagnosis of hypertension as follows: 1 type of device used for blood pressure measurement; 2 frequency of calibration of the device used; 3 number of blood pressure measurements for the diagnosis of hypertension; 4 number of occasions on which blood pressure measurement was used for the diagnosis; 5 diagnosis of hypertension following the recommendations of the current consensus 1,2.

The analysis was descriptive. We received 3, The aneroid sphygmomanometer was the most frequently used device When 2 types of sphygmomanometer were considered, Calibration of the device in a period shorter than 1 year was reported by The majority of the physicians In regard to classifying the patients as hypertensive, for more than half of the respondents II ; on the other hand, only Contrary to data in the national literature , the most important finding in this study was the high frequency of blood pressure measurement reported at most medical visits The remaining issues approached are the first national results that emphasize the correct attitude in accordance with the consensus, when most professionals This recommendation is required because of the characteristic blood pressure fluctuations Reeves 12 , when considering this aspect, reported that blood pressure varies both from minute to minute with a standard deviation of approximately 4 mmHg for the systolic reading and mmHg for the diastolic reading, and throughout the day and on different days, with a variation of mmHg for systolic blood pressure and mmHg for diastolic blood pressure.

On the III Brazilian Consensus on Hypertension 3 , it was agreed that, at each medical visit, blood pressure should be measured at least twice at 1-tominute intervals; if the diastolic pressure values differed by 5 mmHg or more, new measurements should be taken until the difference was lower than that value. According to the patient's clinical condition, the measurements should be repeated at least at 2 or more medical visits; on the first evaluation, blood pressure should be taken on both upper limbs with the patient seated or lying down, or both.

Currently, the choice of the proper device for blood pressure measurement is widely discussed. When the aneroid device is chosen, the difficulty in calibrating the manometer should be highlighted.

The recommended calibration periodicity is at least once every 6 months, and the aneroid device should be counter-checked with an adequately calibrated mercury column device. For aneroid manometers, the alignment of the needle with the zero point does not mean that the device is calibrated; on the other hand, in the mercury column device, if the meniscus is in that position, the calibration is adequate.

The wide use of aneroid sphygmomanometers may perhaps be justified by their convenient size and weight, which facilitate their transportation. Negative aspects of the use of mercury column devices have been discussed. O'Brien 13,14 foretells that sphygmomanometry will undergo changes in this millennium due to mercury toxicity to the environment, and that, once its use is abolished, less resistance to the introduction of kilopascal as a unit for blood pressure measurement will occur.

Holland and Sweden do not allow the use of mercury devices in hospitals, preferring the aneroid or automated devices. The latter represent an alternative, as long as accurate and abiding by the operational rules recommended by the British Hypertension Society and the Association for the Advancement of Medical Instrumentation However, a recent survey evaluating devices used in ambulatory blood pressure monitoring in 3 epidemiological studies showed that 14 values of systolic blood pressure, among which 4 in the range from to mmHg, were persistently omitted by the devices It is worth noting that a number of automated devices were designed for blood pressure measurement by the patient at home and the routine use in hospitals or in clinical practice is the one to be assessed.

In addition, most devices use the oscillometric method for blood pressure measurement, which is not appropriate in conditions of complex arrhythmias. Undoubtedly, in the near future, automated devices will tend to replace the indirect method based on the auscultatory technique, reducing the possibility of errors inherent to the device and the observer. As a diagnostic parameter, most respondents adopt age and not the cut points of blood pressure values recommended by consensus statements.

This preference leads to an underestimation of the diagnosis false negative in the population assisted, consequently delaying the treatment and its benefits, such as a reduction in cardiovascular morbidity and mortality. This study does not include all clinical specialties, but those whose professionals account for blood pressure measuring in daily medical practice. This does not invalidate the results, but the external validity is impaired by the limitation of the origin of the participants from a single registry.

However, even with a response rate of Despite the facilities provided for questionnaire return, the anonymity of the responses, and just one professional category physicians being targeted, the expected cooperation did not occur. Even when the interviewees are gathered at a professional event, the high frequency of lack of response and concentration of the responses by professionals living in the region or in the place housing the inquiry have been recently observed in Brazil, when assessing some type of knowledge related to medical practice The response rate to questionnaires sent by mail is usually low and varies with the focus and the disease being investigated.

The negative behavior of the Brazilian professional is probably due to not recognizing the value of their responses for understanding the national reality in regard to such an important problem as hypertension. Anonymity theoretically would avoid the nonresponse bias due to not knowing the techniques and the consensus statements considered in this study.

To suppose the existence of bias resulting from the origin of the responses of the professionals, who would consider themselves better informed, is not in accordance with the important observation that was the discordance in regard to the correct information concerning the number of blood pressure measurements and the occasions required for that measurement, and the incorrect information concerning the criterion for the diagnosis of hypertension and the periodicity of device calibration.

To suppose that the southern and southeastern professionals were the major respondents theoretically because they were the most updated professionals does not seem to be true. In a national experience with the previously reported investigation conducted in the northeastern region, the professionals of that area were those who adhered most to the inquiry Therefore, it is not known whether the results would be similar, had the sample been probabilistic and originated from a large registry of professionals, such as that of the Brazilian Medical Association, even though that should be the best sampling alternative.

However, this report is particularly relevant mainly due to the lack of national data that may serve as a start or alert, or both, for similar investigations in the country, and due to the fact that the responses, as suggested by the authors, may undergo validation tests.

The investigation revealed that aspects inherent in the blood pressure measurement procedure and diagnostic criteria of hypertension need to be reinforced in the medical population of the country, through means of information other than congresses and specialized events. Medical journals are limited to the medical population. The continuous education of health professionals remains a possibility for informing and updating, but other forms of wider information disclosure more appropriate to the profile of the Brazilian physicians should be encouraged.

Arch Intern Med ; World Health Organization. J Hypertens ; Rev Bras Clin Terap ; Standartization of blood pressure readings. Am Heart J ; Human blood pressure determination by sphygmomanometry. Circulation ; Mion D, Pierin A. How accurate are sphygmomanometers? J Hum Hypertens ; Sphygmomanometers in hospital and family practice: problems and recommendations. Br Med J ; Rev Assoc Med Bras ; Rev Assoc Med Brasil ; Cabral AH.

Reeves RA. Does this patient have hypertension? How to measure blood pressure. JAMA ; O'Brien E. Will mercury manometers soon be obsolete?

J Human Hypertens ; 9: Replacing the mercury sphygmomanometer: requires clinicians to demand better automated devices. The British Hypertension Society Protocol for the evaluation of blood pressure measuring devices.

J Hypertens ; 1 suppl 2 S Hypertension ; Arq Bras Cardiol ; A survey of clinician attitudes and management practices in hypertension. Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices, and the role of guidelines and evidence based medicine. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. Methods In , 25, questionnaires were sent to Brazilian physicians - general practitioners, cardiologists, and nephrologists - through a mailing list with responses being voluntary, covering the entire clinical registry of a large, national pharmaceutical manufacturer.

Results We received 3,

Blood pressure measurement

Arterial blood pressure is most commonly measured via a sphygmomanometer , which historically used the height of a column of mercury to reflect the circulating pressure. For each heartbeat, blood pressure varies between systolic and diastolic pressures. Systolic pressure is peak pressure in the arteries, which occurs near the end of the cardiac cycle when the ventricles are contracting. Diastolic pressure is minimum pressure in the arteries, which occurs near the beginning of the cardiac cycle when the ventricles are filled with blood. Systolic and diastolic arterial blood pressures are not static but undergo natural variations [2] from one heartbeat to another and throughout the day in a circadian rhythm. They also change in response to stress , nutritional factors, drugs , disease, exercise, and momentarily from standing up. Sometimes the variations are large.


Basic techniques of blood pressure measurement. Location of measurement. The standard location for blood pressure measurement is the brachial artery. The auscultatory method. The oscillometric technique. Ultrasound techniques. The finger cuff method of Penaz.


Chapter 2. Measurement and clinical evaluation of blood pressure

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Principles and techniques of blood pressure measurement.

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Hales first measured blood pressure in by inserting tubes directly into the arteries of animals.

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Aquiles L. 08.06.2021 at 19:32

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