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Measuring Blood Pressure for Decision Making and Quality Reporting FREE

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The full report is titled “Measuring Blood Pressure for Decision Making and Quality Reporting: Where and How Many Measures?” It is in the 21 June 2011 issue of Annals of Internal Medicine (volume 154, pages 781-788). The authors are B.J. Powers, M.K. Olsen, V.A. Smith, R.F. Woolson, H.B. Bosworth, and E.Z. Oddone.

Ann Intern Med. 2011;154(12):I-23. doi:10.7326/0003-4819-154-12-201106210-00001
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What is the problem and what is known about it so far?

In patients with hypertension (high blood pressure [BP]), a BP reading taken at an outpatient visit is usually used to decide if the dose of hypertension medication needs to be increased. However, there is concern that BP readings may be higher when visiting a health care provider because patients are anxious, also known as “white-coat” hypertension. There is no agreement about the best place to measure BP in patients receiving treatment for hypertension, how often to measure it, or how many high readings should occur before hypertension medication is increased.

Why did the researchers do this particular study?

To compare BP readings in patients when they took their own BP at home, when it was taken in a regular outpatient health care setting, and when it was taken by a trained research team member. The researchers had hoped to figure out how many times a patient's BP needed to be taken to be certain that a high reading was really accurate and where BP varied least.

Who was studied?

Persons who had high BP for an average of 10 years and whose BP was not considered to be controlled.

How was the study done?

Patients measured their BP at home by using equipment designed for home use. Their BP was also taken at clinic visits by using typical BP cuffs and in special research settings by using a noninvasive, automated monitoring device. Researchers compared these 3 ways of monitoring BP. They focused on systolic BP, the first and higher number reported in a BP reading. For example, if a patient's blood pressure result is 120 over 80, the systolic BP is 120.

What did the researchers find?

Systolic BP readings varied in an individual patient no matter where readings were taken. Blood pressure needed to be taken as many as 5 or 6 times to give the best estimate of a patient's true BP.

What were the limitations of the study?

Because this study was done in a Veterans Affairs medical center, most of the participants were men. In addition, only persons with BP that providers considered to not be in control were included in the study.

What are the implications of the study?

This study suggests that a decision to increase BP therapy should not be made based on a single BP reading but rather on repeated measurements. Home monitoring provides a convenient way for patients to obtain several BP measurements.





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