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Office Blood Pressure Readings Result in Incorrect Diagnoses & Treatment Changes 81% of the Time

Posted: Friday, October 22, 2010

Blood pressure readings taken in clinical settings may lead to inaccurate diagnoses as much as 81% of the time, according to research presented at the American Academy of Family Physicians (AAFP) 2010 Scientific Assembly.

Steve Burgess, MD, Texas Tech University Health Sciences Center, Amarillo, Texas, headed the study that investigated the impact of closely following the standard guidelines for blood pressure diagnosis and treatment (American Heart Association [AHA] and The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [JNC-7]).

Dr. Burgess and his research team initiated the testing project after learning of a study in which 172 physicians and nurses were evaluated for blood pressure technique and all failed to follow the AHA guidelines for measuring blood pressure in a clinical setting.

"The JNC-7 lists improper blood pressure measurement as one of the leading causes of resistant hypertension," explained Dr. Burgess, "which led us to question how much blood pressure changes when pressures are retaken according to the published guidelines, [and] we saw dramatically different results when we followed the guidelines. These changes can make a significant difference in how doctors manage their patients."

The current study was conducted at the Texas Tech University Health Sciences Center. Subjects had to have a systolic blood pressure reading over 120 mm Hg and/or a diastolic reading over 80 mm Hg and be over 18 years of age. Individuals experiencing "significant, acute pain" and those in emotional or respiratory distress were excluded from the study. In all, 56 subjects were included in the initial subject group.

Blood pressures were retaken following published AHA and JNC-7 guidelines, including ensuring that the cuff fit properly, there was no restrictive clothing, the patient sat for 5 minutes in a chair with back support, the patient had their feet firmly planted on the floor and legs uncrossed, the middle of the cuff was located at mid-sternum for the patient, the patient had had no caffeine and had not smoked or exercised for 30 minutes, and 2 separate readings were taken and then averaged, with a third reading taken if the first 2 differed by over 5 mm Hg.

Dr. Burgess noted that the only AHA/JNC-7 recommendation to which the group did not adhere involved his team's decision to use "validated, calibrated machines" to take the blood pressure rather than using auscultatory technique. He pointed out, however, that this removed the variable from the study of different individuals possibly taking blood pressures slightly differently.

"Over half [56.4%] of the patients changed JNC-7 classifications upon having their blood pressure taken according to these guidelines," pointed out Dr. Burgess. In fact, average systolic pressures fell 15.7 mm Hg (P <.0001) and average diastolic pressures fell 8.2 mm Hg (P <.0001) when the AHA and JNC-7 recommendations were followed, he added. Initial blood pressure averaged 146.4/87.6 mm Hg, then fell to 130.7/79.4 mm Hg under "proper measurement techniques" (P <.0001).

These differences led to some fairly dramatic changes in diagnosis. Initially, only 21.4% of the subjects were classified as "at goal blood pressure," but nearly half classified as "not at goal" changed classification to "at goal" when proper blood pressure techniques were used, the researchers reported. Additionally, patients who had no pre-existing hypertension diagnosis but received a diagnosis based on their measurements that day had their classifications changed when appropriate blood pressure techniques were used.

"Eighty-one percent of these patients changed JNC categories," reported Dr. Burgess, "either from stage 2 hypertension to stage 1 hypertension, from stage 1 hypertension to prehypertension or from prehypertension to normal. We did not have anyone go up in classification."

Based on this study, the researchers not only concluded that critical decisions about blood pressure management may be based on inaccurate readings in the majority of cases in clinics, but they also determined that following AHA and JNC-7 recommendations closely "results in significantly lower blood pressure measurements," said Dr. Burgess.

Source:, Presentation title: Blood Pressure Rising: Is There a Difference between Current Clinical and Recommended Measurement Techniques? Abstract RS015

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