Not all blood pressure measurements are created equal, based on a recent paper that reviewed the pros and cons of different ways we screen patients for hypertension. The paper was published in the Journal of the American College of Cardiology and stresses the need for accurate blood pressure readings to identify and treat patients with high blood pressure.
Hypertension, often referred to as high blood pressure, is a chronic condition that affects one in three American adults and more than one billion people worldwide. Hypertension occurs when the force of blood pushing against the walls of your blood vessels is consistently high, increasing risk for heart disease, heart attack and stroke.
Since hypertension is both common and dangerous, it’s standard practice to measure blood pressure at most office visits. However, we can’t rely on standard screenings to identify all patients with high blood pressure, as experts point out in their recent paper.
The paper was written by a panel of experts who came together for two days to discuss blood pressure assessments currently used in clinical practice and research studies. Below are the key messages that authors wanted to share with patients and providers alike based on their conversations.
To start, there are three types of blood pressure measurements commonly used today, each of which have their own strengths and weaknesses.
The first is in-office measurements, which are what we usually think of when we have our blood pressure checked in a medical setting. The assessment takes only a few minutes and higher blood pressure readings (above the normal level of 120/80 mmHg) have clearly been linked to increased cardiovascular risk.
While this type of screening is simple and widely used, it’s not always precise and can overlook or misdiagnose certain types of patients. For example, providers don’t always perform readings in the same way (ideally while a patient is seated, resting quietly with their back supported and feet flat on the floor) and can use different devices, which can impact blood pressure readings. Also, some patients may have high blood pressure in the office but normal blood pressure outside the office (a phenomenon called "white coat hypertension") or vice versa.
For this reason, providers may recommend either home blood pressure monitoring or ambulatory monitoring in certain patients. Home blood pressure monitoring usually involves the use of an automated blood pressure machine, which can be used to measure patients’ blood pressure at rest in the morning and at night. Ambulatory monitoring is similar, except blood pressure is usually obtained round the clock for up to three days to track changes over time.
The benefit of home and ambulatory monitoring is that it provides a better picture of what blood pressure levels are like at home, as opposed to in the office, and at different times in the day. However, they could be more prone to device and user-error than those performed in the office.
Regardless of which assessment is used, according to authors, the key goal is to get an accurate measure of patients’ blood pressure. That helps ensure that all patients with any form of high blood pressure is both diagnosed and treated, while minimizing the number of patients that could be wrongly diagnosed.
Authors also add that accurate readings are especially important for research studies, as measurements should be standardized across both patients and studies.