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Some health professionals use old guidelines to screen and diagnose high blood pressure

 


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A study found that the majority of healthcare professionals did not screen and diagnose hypertension according to current evidence-based practice, and another study found that the use of automated office blood pressure (AOBP) monitors was new in 2020. Cases of hypertension, according to a new study presented at the Virtual American Heart Association’s Hypertension 2020 Science Session, October 10-13.

Blood Pressure Checks and Diagnosis of Hypertension: Provider Knowledge, Beliefs, Practices (#P163)

The 2017 American Heart Association / American College of Cardiology Guidelines for Adult Hypertension Prevention, Detection, Evaluation, and Management Guidelines Recommend Out-of-Office Use Blood pressure measurements such as ambulatory blood pressure monitoring (ABPM) before making a new diagnosis of .. Outpatient monitoring involves patients with cuffs that automatically check blood pressure every 30 minutes during the day and every 60 minutes at night. However, the researchers in this study note that this approach is not common in routine work.

Researchers have developed a survey for health professionals to assess their knowledge, beliefs, and practices regarding current hypertension diagnostic tests. In total, 282 experts from 10 primary care medical centers responded. The survey results show the following:

  • 79% of experts believe that blood pressure measured manually with a stethoscope is a very or very accurate way to assess blood pressure.
  • Over 96% of health care providers reported that they always or almost always rely on clinic blood pressure measurements in making new diagnoses of high blood pressure.
  • However, 60% of doctors want to use ABPM when possible.

“I was surprised to find the most reliable method of measuring blood pressure, manually measured using a cuff and a stethoscope,” was most often used in making a new diagnosis of hypertension. Physician in Manente Washington, Principal Investigator at Kaiser Per Manente Washington Health Institute, Associate Clinical Professor at Washington University School of Medicine. “Furthermore, most doctors and specialists thought that the high blood pressure threshold for 24-hour portable or home blood pressure monitoring was >140/90 mm Hg and did not reflect the updated new ACC/AHA. Was [issued in 2017] Or previous high blood pressure guidelines. “

According to the American College of Cardiology/American Society of Cardiology guidelines for the prevention, detection, evaluation, and management of adult high blood pressure, hypertension should be defined as 130/80 mm Hg. At the time the researchers started this study, before the updated ACC/AHA guidelines were released in 2017,? He pointed out that 140/90 mm Hg is a good standard. The limitations of this survey include: But researchers point out that having survey respondents from multiple centers helps strengthen the sample.

Impact of Automated Office Blood Pressure and Attendance and Rest Time for Diagnosing Hypertension (#MP35)

In the second study, Green and colleagues investigated how to use an automated office blood pressure (AOBP) monitor. Using an automatic monitor, 3-5 blood pressure measurements were taken and averaged to influence the results, and AOBP was found to have led to a reduction in hypertension.

“Blood pressure changes throughout the day for everyone. We investigate whether attendance in a room is important and use automatic readings to determine the effect of changing rest time on blood pressure.” We focused on doing this,” says Green. “We also evaluated the performance of the AOBP monitor in making a new diagnosis of hypertension, compared to 24-hour ambulatory blood pressure, which is considered the gold standard for determining if a patient is hypertensive. I will.”

The study included 130 adults with high blood pressure (defined as >140/90 mm Hg in this study) who had not previously been diagnosed or treated for hypertension. All participants completed a 24-hour ambulatory blood pressure monitoring (APBM) shortly before the study started, with over 60% testing positive for hypertension based on the ABPM index.

Participants were randomized into one of two groups. The first group to receive the AOBP with the attendant and the second unattended, and the group to receive the first unattended AOBP with the attendant second. The AOBP measurement was performed again after a 5 minute break and after 15 minutes.

The results show that the presence of attendants in the cabin did not affect the AOBP reading. Without resting prior to AOBP, blood pressure measurements were significantly higher than the average 24-hour ambulatory blood pressure during the day. in addition:

  • AOBP correctly identified with a 67% probability with or without hypertension.
  • 21% of high blood pressure diagnoses were overlooked. And
  • 12% of participants were overdiagnosed.

“These findings show that AOBP measurements may not be the best way to rule out or rule out a new diagnosis of hypertension. Expect to lower blood pressure after resting for more than 15 minutes I was surprised that it didn’t fall.” “If you have questions about whether your blood pressure is high or normal, increasing your blood pressure readings, either by a home test or a 24-hour handheld monitoring test, may lead to better decisions.”

In this study, blood elevation Was defined as Reading == 140/90 mm Hg. According to the 2017 American Heart Association/American Society of Cardiology guidelines for the prevention, detection, assessment, and management of adult high blood pressure, hypertension should be defined as >= 130/80 mm Hg. Limitations of this study include small sample size.


Shorter rest periods have the same result when measuring blood pressure


For more information:
Paul K. Whelton et al. 2017 ACC / AHA / AAPA / ABC / ACPM / AGS / APhA / ASH / ASPC / NMA / PCNA Guidelines: Prevention, Detection, Evaluation and Management of Adult Hypertension: American College of Cardiology / American Heart Association on Reporting Clinical Practice Guidelines Special committee, High blood pressure (2017). DOI: 10.1161 / HYP.0000000000000065

Quote: Some healthcare professionals use old guidelines to screen and diagnose high blood pressure (September 10, 2020). September 10, 2020, https: //medicalxpress.com/news/2020-09-health-professionals-outdated-guidelines-screen.html

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