Hypertension is a very common medical condition, affecting millions of adults worldwide. Consequently, blood pressure measurement is a universally performed clinical procedure. However, studies have shown that errors in measurement may occur as often as 63% of the time. This study sought to determine whether improper blood pressure measurement techniques occur in our clinic, and to assess our medical staff’s knowledge of the procedure.
A single-blinded observational study was conducted at an academic tertiary referral center’s cardiology clinic. Criteria for proficiency in blood pressure measurement were assessed with a 15-point checklist based on American Heart Association guidelines. All observers received hands-on training in BP measurement prior to evaluating medical staff. After the observational period, medical staff were asked to complete a multiple-choice questionnaire regarding BP measurement technique.
In total, 72 different BP measurements were observed, and 25 members of the medical staff completed the post-observation questionnaire. A mean of 69% (10.35 of 15, SD of 13%) of AHA guidelines were followed when obtaining BP measurements. In no encounter were all 15 measured guidelines completed. The most commonly overlooked criteria included inquiry about recent exercise or tobacco/alcohol consumption (completed in 5.6% [4 of 72] of encounters), instruction not to speak (27.8% [20 of 72]), and absence of communication during testing (51.4% [37 of 52]). While cuff size was selected appropriately 87.5% (63 of 72) of the time, in ~24% (17 of 72) of encounters, the cuff was not properly placed on the patient’s arm. The post-observational questionnaire demonstrated less significant deviation from guideline recommended techniques compared to the observed clinical practice. For example, greater than 92% (23 of 25) of medical staff answered that they should ask patients about recent exercise, tobacco, or alcohol use. The most commonly incorrect answers regarded cuff selection, communication with patient, and patient positioning.
The data demonstrates that nearly a third of AHA guidelines for proper BP measurement are not followed. Differences between our observational and questionnaire results suggest that guidelines are either largely ignored, or more easily remembered when given in multiple-choice format. As most of these improper techniques lead to falsely elevated BP recordings, further research is needed to evaluate for possible overdiagnosis of hypertension and unnecessarily aggressive treatment.