Improving the Measurement of Blood Pressure: Is It Time for Regulated Standards?
Authors: Lawrence J. Appel, Edgar R. Miller, Jeanne Charleston
Journal: Annals of Internal Medicine (2011)

Editorials21 June 2011Improving the Measurement of Blood Pressure: Is It Time for Regulated Standards?Lawrence J. Appel, MD, MPH, Edgar R. Miller III, MD, PhD, and Jeanne Charleston, BSN, RNLawrence J. Appel, MD, MPHFrom Johns Hopkins University, Baltimore, MD 21205., Edgar R. Miller III, MD, PhDFrom Johns Hopkins University, Baltimore, MD 21205., and Jeanne Charleston, BSN, RNFrom Johns Hopkins University, Baltimore, MD 21205.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-12-201106210-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Blood pressure (BP) measurement is one of the most common procedures that clinicians perform. Ideally, a trained health care professional using a validated, calibrated device with an appropriately sized cuff should measure BP in a patient who has rested in a seated position for at least 5 minutes with his or her feet on the floor and back supported (1). The clinician then diagnoses hypertension or assesses BP control after considering the most recent BP in the context of measurements from previous visits. Yet, deviations from these standards are extraordinarily common (2).In practice, BP measurement is remarkably casual. As ...References1. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111:697-716. [PMID: 15699287] MedlineGoogle Scholar2. Jones DW, Appel LJ, Sheps SG, Roccella EJ, Lenfant C. Measuring blood pressure accurately: new and persistent challenges [Editorial]. JAMA. 2003;289:1027-30. [PMID: 12597757] CrossrefMedlineGoogle Scholar3. McKay DW, Campbell NR, Parab LS, Chockalingam A, Fodor JG. Clinical assessment of blood pressure. J Hum Hypertens. 1990;4:639-45. [PMID: 2096205] MedlineGoogle Scholar4. Graves JW, Bailey KR, Grossardt BR, Gullerud RE, Meverden RA, Grill DE, et al. The impact of observer and patient factors on the occurrence of digit preference for zero in blood pressure measurement in a hypertension specialty clinic: evidence for the need of continued observation. Am J Hypertens. 2006;19:567-72. [PMID: 16733227] CrossrefMedlineGoogle Scholar5. Bailey RH, Bauer JH. A review of common errors in the indirect measurement of blood pressure. Sphygmomanometry. Arch Intern Med. 1993;153:2741-8. [PMID: 8257249] CrossrefMedlineGoogle Scholar6. Rose G. Standardisation of observers in blood-pressure measurement. Lancet. 1965;1:673-4. [PMID: 14258545] CrossrefMedlineGoogle Scholar7. Canner PL, Borhani NO, Oberman A, Cutler J, Prineas RJ, Langford H, et al. The Hypertension Prevention Trial: assessment of the quality of blood pressure measurements. Am J Epidemiol. 1991;134:379-92. [PMID: 1877599] CrossrefMedlineGoogle Scholar8. Rosner B, Polk BF. Predictive values of routine blood pressure measurements in screening for hypertension. Am J Epidemiol. 1983;117:429-42. [PMID: 6837557] CrossrefMedlineGoogle Scholar9. Vollmer WM, Appel LJ, Svetkey LP, Moore TJ, Vogt TM, Conlin PR, et al; DASH Collaborative Research Group. Comparing office-based and ambulatory blood pressure monitoring in clinical trials. J Hum Hypertens. 2005;19:77-82. [PMID: 15361888] CrossrefMedlineGoogle Scholar10. Powers BJ, Olsen MK, Smith VA, Woolson RF, Bosworth HB, Oddone EZ. Measuring blood pressure for decision making and quality reporting: where and how many measures? Ann Intern Med. 2011;154:781-8. LinkGoogle Scholar11. Patel B, Turban S, Anderson C, Charleston J, Miller ER, Appel LJ. A comparison of web sites used to manage and present home blood pressure readings [Editorial]. J Clin Hypertens (Greenwich). 2010;12:389-95. [PMID: 20591083] CrossrefMedlineGoogle Scholar12. Kim JW, Bosworth HB, Voils CI, Olsen M, Dudley T, Gribbin M, et al. How well do clinic-based blood pressure measurements agree with the mercury standard? J Gen Intern Med. 2005;20:647-9. [PMID: 16050862] CrossrefMedlineGoogle Scholar13. Graves JW, Sheps SG. When a "quality measure" may not be what it seems: the national committee for quality assurance report and hypertension control. J Clin Hypertens (Greenwich). 2004;6:706-7. [PMID: 15599119] CrossrefMedlineGoogle Scholar14. Standardization of methods of measuring the arterial blood pressure: a joint report of the committees appointed by the cardiac society of Great Britain and Ireland and the American Heart Association. Br Heart J. 1939;1:261-7. [PMID: 18609823] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Johns Hopkins University, Baltimore, MD 21205.Acknowledgment: The authors thank Drs. William Cushman and Jackson Wright Jr. for their insightful reviews of this editorial.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1042.Corresponding Author: Lawrence J. Appel, MD, MPH, Johns Hopkins University, 2024 East Monument Street, Suite 2-618, Baltimore, MD 21205-2223; e-mail, [email protected]edu.Current Author Addresses: Drs. Appel and Miller: Welch Center for Prevention, Epidemiology and Clinical Research, Division of General Internal Medicine, Department of Epidemiology, Johns Hopkins University, 2024 East Monument Street, Suite 2-618, Baltimore, MD 21205-2223.Ms. Charleston: Department of Epidemiology, Johns Hopkins University, 2024 East Monument Street, Suite 2-618, Baltimore, MD 21205-2223. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeasuring Blood Pressure for Decision Making and Quality Reporting: Where and How Many Measures? Benjamin J. Powers , Maren K. Olsen , Valerie A. Smith , Robert F. Woolson , Hayden B. Bosworth , and Eugene Z. Oddone Metrics Cited ByOptimización del desempeño del observador al medir la presión arterial en el consultorio: declaración de posición de la Comisión Lancet de HipertensiónOptimizing observer performance of clinic blood pressure measurementClinician accountability in a primary care clinic time-interval blood pressure measurements study: Practice implicationsBlood Pressure Assessment in Adults in Clinical Practice and Clinic-Based ResearchA bundled quality improvement program to standardize clinical blood pressure measurement in primary careBarriers to Accurate Blood Pressure Measurement in the Medical OfficeEffects of room environment and nursing experience on clinical blood pressure measurementBlood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patientsDo the Benefits of Participation in a Hypertension Self-Management Trial Persist After Patients Resume Usual Care?Length of Time Required to Achieve a Stable Baseline Blood Pressure in the Diagnosis of Orthostatic HypotensionBlutdruck in Deutschland 2008–2011Analysis of Early Hypertension and Clinical Outcome With Bevacizumab: Results From Seven Phase III StudiesBlood Pressure Measurement: Clinic, Home, Ambulatory, and BeyondIs It Time for a Blood Pressure Measurement "Bundle"?Es necesario regular ya las distintas modalidades de medida de la presión arterial. ¿Cómo, dónde, cuántas y en qué intervalos? 21 June 2011Volume 154, Issue 12Page: 838-839KeywordsAntihypertensive drug therapyBlood pressureClinical epidemiologyHealth care quality assessmentHeartHypertensionOutpatient clinicsOutpatientsResearch and reporting methodsTreatment guidelines ePublished: 21 June 2011 Issue Published: 21 June 2011 CopyrightCopyright © 2011 by American College of Physicians. 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