Blood pressure: What to do when patients aren’t measuring up

Sara Berg
Senior Staff Writer
AMA Wire
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The new hypertension guideline published by an American Heart Association-American College of Cardiology task force calls for the use of self-measured blood pressure (SMBP) monitoring for diagnosis, treatment and management. But what if patients encounter trouble when measuring their own BP or fail to do it when they should? Here are some ways physicians and their health care teams can overcome common challenges to help engage patients and improve the quality of BP measurements. 


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Ensure patients are trained

If a patient does not receive proper education on SMBP technique and use, they may find it difficult to take their daily measurements correctly. Physicians and their teams should show patients how to operate their device, explain preparation, share proper positioning and technique, and inform them on when to take BP measurements.

Monitoring BP at home does not have to be complicated or inconvenient. To help, provide written information or videos for patients on how to properly perform SMBP monitoring. This can include links to online materials in patient portals or other websites, such as the tools and resources available through Target: BP™ or LowerYourHBP.org.

Patients should also receive additional support when participating in a SMBP program, such as a one-time training session. During this session, the physician or a specific team member can watch the patient obtain their BP measurement. This helps ensure the patient understands how to perform their measurements correctly.

    Test monitor for accuracy

    Each patient should be using a validated, automated upper arm home BP monitor. Patients should bring their monitors to your practice for testing to ensure they are properly fitted and working properly. Their home monitoring device should be tested before use as part of the SMBP program before beginning and again annually, or any time BP readings are questionable. To determine accuracy, follow this SMBP device test.

    A member of your team should take five measurements—two with the office machine and three with the patient’s device. After averaging the patient device readings and the office measurements separately, if the difference is greater than 10 mm Hg, the device will need to be replaced before proceeding.

    Resolve positioning errors

    In a training session, have the patient show you how they are taking their BP measurement. Watch their positioning and correct any errors. Here are six tips to share with your patient for an accurate BP reading.

    • Place cuff over bare arm.
    • Keep legs uncrossed.
    • Ensure the cuff fits properly.
    • Position arm so it is supported and the cuff is at heart level.
    • Sit in a chair with back supported and feet flat on the floor or on a footstool.

    For further reference, share this infographic with your patients to help them get in an appropriate position before taking their BP measurement.

    Emphasize two measurements twice daily

    Are your patients performing BP measurements twice a day? If not, this could interfere with the accuracy of their data. The hypertension guideline recommends patients take at least two readings one-minute apart each morning before medication and each evening before dinner. Weekly readings taken two weeks after a treatment change and a week before a clinic visit are also recommended.

    With the SMBP device in a quiet space where they can sit comfortably without any distraction, instruct the patient to rest for five minutes while in position before starting. After resting, they should take two or three measurements, one minute apart, and should remain relaxed and seated without moving during each reading. After completion, the patient can record their measurements.

    Patients can maintain accuracy in measurement with this seven day recording log from Target: BP. This data collection log also serves as backup to their device’s memory on the BP monitor and helps them remember to take measurements each day.

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    Sep 19, 2018
    Medication-assisted treatment and inpatient care are among approaches that work, but many states still only offer minimal care for a massive problem.