Categories of BP Among Adults

  • Normal: SBP <120 mm Hg and DBP <80 mm Hg
  • Elevated: SBP 120-129 mm Hg and DBP <80 mm Hg
  • Hypertension Stage 1: SBP 130-139 mm Hg or DBP 80-89 mm Hg
  • Hypertension Stage 2: SBP ≥140 mm Hg or DBP ≥90 mm Hg

Guidelines for Conducting Ambulatory BP Monitoring (ABPM)

  • Training
    • Provide knowledge about BP measurements that can be obtained through ABPM
    • Provide training in the specialized equipment, techniques, and devices needed to conduct ABPM
    • Provide training in preparing patients for ABPM
    • Train clinicians to prepare/initialize devices for recording
    • Train clinicians to fit the device, cuff, and tubing on the patient
    • Train clinicians in ABPM software and downloading data
  • Devices, cuffs, and equipment
    • Use validated upper-arm cuff oscillometric devices
    • Use a cuff that is the appropriate size for the patient’s nondominantarm
    • Use new or recharged batteries
  • Patient preparation and instruction
    • Provide instruction on what ABPM involves and how to cope with the procedure
    • Inform patients that ABPM may disrupt sleep
    • Inform patients to avoid showering and swimming, and tell them not to remove the ABPM device, cuff, and tubing
    • Tell patients to follow their usual daily activities, but to keep their body still during each BP measurement
    • Provide a brief summary of ABPM procedures on a reference card
    • Teach the patient how to refit the cuff if it migrates from its ideal position
    • Show the patient how to place the device on the bed or beneath a pillow during sleep
    • Show the patient how to turn off the device in case of malfunction
    • Provide instructions for filling out a diary documenting sleep and awakening times, times of antihypertensive medication intake, occurrence of symptoms, and meals
  • Frequency and number of readings
    • Every 15-30 minutes during the 24 hour period (48-96 total readings)
  • Duration of monitoring
    • Ideal period is 24 hours
  • Analyzing readings
    • Commonly-recommended criteria are ≥20 readings during the day and ≥7 readings during the night, but an ABPM recording with fewer may still be valid
    • For each period (day, night, and 24 hours), calculate the average of all readings

Guidelines for Home BP Monitoring (HBPM)

  • Patient training provided by clinicians
    • Provide information on hypertension diagnosis and treatment
    • Provide information on proper device selection
    • Teach patients how to measure their own BP
    • Instruct patients to bring the HBPM device and BP readings to healthcare visits
    • Teach patients that individual BP readings may vary greatly during the monitoring period
  • Preferred devices and cuffs
    • A validated upper-arm cuff oscillometric device
    • A device that can automatically store all readings
    • A device that can print results or electronically send BP values to clinicians
    • A cuff that is appropriately sized for the patient’s arm circumference
  • Best practices
    • Preparation
      • Have an empty bladder
      • Rest in seated position for ≥5 minutes
      • Do not talk or text
    • Position
      • Sit with back supported
      • Keep both feet flat on the floor
      • Do not cross legs
      • Place BP cuff on bare arm
      • Place BP cuff directly above the antecubital fossa
      • Place the center of the bladder of the cuff over the arterial pulsation of the bare upper arm
      • Pull cuff taut around the bare upper arm, with comparable tightness at the top and bottom edges
      • Support the cuffed art on a flat surface
  • Number of readings
    • Take 2 readings at least 1 minute apart in the morning before taking antihypertensive medications and 2 readings at least 1 minute apart in the evening before bed
  • Duration of monitoring
    • Preferred monitoring period is ≥7 days with a minimum of 3 days
    • Monitoring conducted over consecutive days is ideal
  • Analyzing readings
    • The average of all readings should be calculated for each monitoring period

Summary of Scientific Statement on the Measurement of BP in Humans

  • BP components
    • Several BP components, including SBP, DBP, pulse pressure, and mean arterial pressure, are associated with cardiovascular disease (CVD) risk
    • Most guidelines use SBP and DBP to define hypertension
  • BP measurement in the office
    • While the auscultatory BP method has been the traditional approach, it is being increasingly replaced by the oscillometric method
    • Aneroid sphygmomanometers require frequent calibration (every 2-4 weeks for handheld devices and every 3-6 months for wall-mounted devices)
    • Automated office blood pressure (AOBP) devices should be considered for measuring office BP
    • Office BP should be measured ≥2 times per visit
    • Even when AOBP is being used, clinician training is integral for accurate BP measurement
  • 24-h ABPM
    • ABPM is the preferred approach for assessing out-of-office BP
    • The main indications for ABPM are to detect white-coat hypertension and masked hypertension
    • ABPM is the preferred approach to assess nocturnal hypertension, which is common among black patients
  • HBPM
    • HPBM can be used to assess out-of-office BP when ABPM is not available or accepted by the patient. It can be used to detect white coat hypertension and masked hypertension
    • Many HBPM devices have not been validated; clinicians should only recommend devices that have been validated
    • By itself, HBPM has a limited effect on BP control, but it is effective in reducing BP when used in conjunction with supportive interventions
    • Encourage patients to use HBPM devices that automatically store readings or transmit them to their clinician
  • Special BP measurement techniques
    • While devices that measure BP at the wrist have been validated, they face many challenges in obtaining an accurate reading
    • A preliminary analysis of wireless BP monitors showed poor accuracy

This article originally appeared on The Cardiology Advisor