by Tonya L. Breaux-Shropshire, PhD, DNP, FNP, MPH-
Have you ever wondered if the way your blood pressure is measured could affect your diagnosis and treatment for hypertension? In this podcast episode, we will explore the differences between automated, attended, and ambulatory blood pressure measurements and how these differences may impact the treatment of hypertension.
You probably know by known that High blood pressure, or hypertension, is a common condition that can lead to serious health problems if left untreated.
In order to accurately diagnose and treat hypertension, it’s important to have accurate blood pressure readings. But what you might not know is there are several ways to measure blood pressure besides the usual office measurement and home measurement.
So, let’s unpack the definitions of these blood pressure methods.
Automated attended blood pressure monitoring refers to the measurement of blood pressure using automated devices, with a healthcare professional present. Automated devices are typically machines that measure blood pressure using an oscillometric method, which involves inflating a cuff around the arm and measuring the oscillations in the arterial walls as the cuff deflates.
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The healthcare professional is present to assist with the measurement, typically by placing the cuff on the patient’s arm and starting the automated device. Automated attended blood pressure monitoring is typically done in a healthcare setting, such as a doctor’s office, and can provide a quick and convenient way to measure blood pressure.
It is important to note that automated attended blood pressure measurements may not always be as accurate as other methods, such as automated unattended, ambulatory, or home blood pressure monitoring.
Ambulatory blood pressure monitoring, also known as ambulatory blood pressure measurement, is a method of measuring blood pressure at regular intervals throughout the day while the person is going about their normal activities. This method involves using a portable device, such as a blood pressure monitor worn on the wrist or upper arm, to take multiple blood pressure readings at set intervals over a period of time, typically 24 hours.
Ambulatory blood pressure monitoring can provide a more comprehensive view of a person’s blood pressure patterns over time, as it takes into account variations in blood pressure that may occur due to factors such as physical activity, stress, and changes in posture. Ambulatory blood pressure monitoring is often used to diagnose and manage hypertension, as it can provide more accurate and reliable blood pressure readings compared to a single measurement taken in a healthcare setting. It can also be used to monitor the effectiveness of blood pressure medications and to identify potential issues with treatment. However, not many providers offer this type of monitoring.
Home blood pressure monitoring is a method of measuring blood pressure at home, rather than in a healthcare setting. This can be done using a blood pressure monitor, which is a device that measures blood pressure using an oscillometric method.
To use a blood pressure monitor at home, a person typically wraps a cuff around their upper arm and activates the device, which inflates the cuff and measures the oscillations in the arterial walls as the cuff deflates. The device then displays the systolic (the higher number) and diastolic (the lower number) blood pressure readings.
Home blood pressure monitoring can be useful for people who have been advised by their healthcare provider to monitor their blood pressure at home, either as part of their treatment plan for hypertension or to check for potential issues with their blood pressure medication.
It can also be useful for people who want to track their blood pressure over time to identify potential changes or trends. It is important to use a reliable and accurate blood pressure monitor and to follow proper techniques when taking blood pressure readings at home to ensure the accuracy of the measurements.
Automated unattended blood pressure monitoring, also known as automated office blood pressure measurement, is a method of measuring blood pressure using automated devices without the presence of a healthcare professional.
This typically involves using a blood pressure monitor that is set up in the exam room and the health staff apply the cuff and press the button on the bp monitor that initiates several readings that are averaged to one reading. So, multiple measurements at regular intervals, in one setting. The health staff is not in the room during the readings.Research has shown that automated unattended blood pressure monitoring can provide the most accurate office blood pressure reading.
Evaluating the Accuracy of Automated Blood Pressure Measurements in Hypertensive Patients
A study published in THE blood Pressure journal in 2018 entitled A multicenter study on unattended automated office blood pressure measurement in treated hypertensive patients,
In this study, the researchers aimed to investigate the differences between automated, attended (meaning with a healthcare professional present), and ambulatory (meaning taken outside of a healthcare setting) blood pressure measurements in patients with stable hypertension. The study included 172 patients from four university hospitals in the Czech Republic, who had their blood pressure measured using automated devices, attended measurements taken by a healthcare professional, and ambulatory measurements taken outside of a healthcare setting.
By understanding these differences, healthcare professionals can better determine the correct threshold for diagnosis and treatment goals for each individual patient.
The results showed that unattended automated measurements were on average lower than attended measurements, no matter if it was a manual reading or a reading taken with the automatic blood pressure monitor. The researchers concluded that these differences should be taken into consideration when diagnosing and treating hypertension, as the threshold for diagnosis and treatment goals may differ depending on the measurement method used.
Recommendations for the Diagnosis, Evaluation, and Management of High Blood Pressure
The 2017 hypertension guidelines, were developed by the American Heart Association (AHA), the American College of Cardiology (ACC) using large randomized clinical trials that used the unattended office blood pressure method.
The guidelines provide recommendations for the diagnosis, evaluation, and management of high blood pressure (also known as hypertension) in adults.
According to the guidelines, high blood pressure is defined as a systolic blood pressure (the top number in a blood pressure reading) of 130 mmHg or higher or a diastolic blood pressure (the bottom number) of 80 mmHg or higher.
The guidelines recommend treating blood pressure to a target of less than 130/80 mmHg in people with high blood pressure, including those with diabetes or chronic kidney disease. For people at high-risk of cardiovascular disease, the guidelines recommend treating to a target of less than 120/80 mmHg.
The guidelines recommend lifestyle changes, such as maintaining a healthy diet, engaging in regular physical activity, and avoiding tobacco use, as the first line of treatment for high blood pressure. If lifestyle changes alone are not sufficient to control blood pressure, the guidelines recommend the use of medications, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, and thiazide diuretics.
The guidelines also recommend regular monitoring of blood pressure to ensure that treatment goals are being met and to adjust treatment as needed. In addition, the guidelines recommend screening for high blood pressure in all adults, with more frequent monitoring for those at high risk of cardiovascular disease.
Overall, the 2017 hypertension guidelines provide important recommendations for the diagnosis, evaluation, and management of high blood pressure in adults. They emphasize the importance of lifestyle changes and the use of medications, as well as regular monitoring and screening, in the prevention and treatment of high blood pressure.
Take Action
Here are 3 things everyone ought to know and consider about hypertension:
1). Discuss with your healthcare provider which method of blood pressure measurement is best for you. It may be helpful to ask about the pros and cons of each method and how it may affect your diagnosis and treatment plan.
2). Consider getting a home blood pressure monitor to take your blood pressure at regularly throughout the week. This can provide a more comprehensive view of your blood pressure and may be more accurate than a single measurement taken in a healthcare setting.
3). Make lifestyle changes to help lower your blood pressure, such as eating a healthy diet, exercising regularly, and reducing stress. These changes can help improve your overall health and may also help lower your blood pressure.
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