How better blood pressure measurement can improve lives and bottom lines

Blood pressure (BP) measurement is a seemingly simple tool that helps providers manage patients’ health. Even small adjustments to current clinical BP practices, both in measurement and management, can make a big impact. During a Nov. 3 webinar, Dr. Tom Schwieterman, chief medical officer and vice president of clinical affairs at Midmark Corporation, and Dr. Harvey Hahn, director of the cardiovascular fellowship training program and codirector of KPN CV quality at Kettering Health, shared research and insights about the clinical and financial impact of BP measurement techniques, and what can be done to improve accuracy.

1 Blood pressure is the single most important vital sign

The most important vital sign to get right is blood pressure. BP has a deep relationship to cardiovascular issues like heart attacks, strokes, and lower and peripheral vascular disease. But it also impacts other organ systems, like the kidneys. Robust evidence links high BP (hypertension) to higher risk of chronic conditions in multiple and diverse body systems. Effectively treating hypertension is proven to reduce overall morbidity and mortality, and lower cost of care.

2 With revised hypertension diagnosis rates, treatment is even more important

Hypertension is the top treated diagnosis in both inpatient and outpatient settings. The average hypertensive patient costs health systems up to $2,500 USD more in annual care. Protocols for diagnosing hypertension changed in 2017, with diagnosis at 130/80, instead of 140/90. At 130/80, researchers saw a 26 percent reduction in long-term health issues. The diagnosis change meant more than 30 million U.S. adults are now included in the hypertensive category. Measuring and treating BP correctly will help improve care and lower costs for this large patient population, yet only 47 percent of those with hypertension currently have it under control.

3 Blood pressure matters for atrial fibrillation

Atrial fibrillation (a-fib) can have serious long-term and short-term impacts on patient health, and it’s increasing. A-fib is predicted to affect up to 12 million people in the U.S. by 2050. Hypertension is present in 60 to 80 percent of those with a-fib and controlling hypertension can reduce a-fib’s incidence by 50 percent. Managing the fast heart rate caused by a-fib often involves using BP medications. If a physician doesn’t know the patient’s normal BP, these medications can make the patient dizzy, tired, or hypotensive. This can occur with the management of other conditions, not only a-fib.

4 A standardized BP protocol improves accuracy

There is a standardized protocol for BP measurement to improve accuracy and decrease variability. The automated in-office BP cuff system is the most accurate method for measuring BP among diverse care teams. Other best practices for accurate BP readings are asking patients to abstain from nicotine and caffeine use for several hours prior to the reading, have an empty bladder and sit with legs uncrossed, feet flat on the floor, and back supported; allowing the patient to rest for at least five minutes before the reading; and keeping the arm supported with cuff at heart height. Ideally the provider should not be in the room during the reading, and the patient should not be talking or on the phone. Three automated readings are the goal, with the results averaged.

5 There’s an art to training staff

Staff must be trained on the appropriate BP measurement protocols. Provide staff with data about the importance of standardization and the factors affecting a patient’s BP. Staff are more likely to follow proper BP protocols if they have access to the appropriate equipment for automated measurements and seating to support the patient’s back and arm and allow their feet to rest flat on the floor.