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Invited Commentary
June 2018

Treating Blood Pressure Correctly by Measuring It Correctly

Author Affiliations
  • 1Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
JAMA Intern Med. 2018;178(6):860-861. doi:10.1001/jamainternmed.2018.0311

High blood pressure is one of the most common conditions seen in office practice. Depending on the definition (140/80 mm Hg or 130/80 mm Hg), at least 72.2 to 103.3 million US adults have hypertension.1 Measurement of high blood pressure is among the very first clinical skills taught to medical students and other health professional students. Measurement is available in pharmacies, grocery stores, gyms, airports, and hair salons. New devices are being developed and widely marketed to encourage more frequent measurement, especially outside of the medical office.

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2 Comments for this article
Blood Pressure Precision
Paul Nelson, M.D., Med-Ped | Community Practice, Primary Physician retired
Now approaching an age of 75 years, 2 years of retirement and endowed with good health, I still need an occasional healthcare encounter. In the last two years with 3-4 visits a year for baseline services, I have not had an accurate blood pressure taken on any occasion. In addition to the above, I still believe that a blood pressure should be taken in the right arm, unless there is dextrocardia (which is probably a 1 per 1000 primary care physician life-time encounter). Always taking the blood pressure in the same arms adds another element of precision. />

Admittedly, the conditions for taking a blood pressure accurately are not usually considered during the architectural design of a primary care physician's exam room. Also, it make me a bit nervous when there isn't a sink in the room for hand washing.

Finally, the measurement technique along with standards for immediate physician notification should be reviewed twice a year for all vital signs. A rotating schedule of staff education for vital signs in combination with certain "medical triage" processes are a must.

Much Needed Reminder on Proper Blood Pressure Measurement Techniques
Mary Anderson, MD, MPH, FACPM | Preventive Medicine & Public Health Physician - no current affiliation
I concur with the stated need to develop "a clear strategy for best practice office measurement" because I have yet to encounter a practice in which the personnel entrusted with measuring vital signs have been trained to follow the guidelines to optimize blood pressure measurement.

During the intake procedure for an office visit, I am invariably presented with the dilemma of how much to teach the medical assistant about the correct way to measure blood pressure as I assume the role of a patient. Usually, the measurement is attempted in haste without any allowance for the five-minute period of
rest. Any suggestion that there should be time allowed for the patient to equilibrate is either met with a glazed expression or an "I-don't-have-time-to-bother" attitude. Poor arm positioning, attempts to leave clothing under the cuff, taking the temperature while questioning the patient about medications at the same time the automated sphygmomanometer is cycling through its measurement have all occurred during the same encounter.

Promoting the use of the guidelines is an important preventive medicine initiative both for those who have hypertension and those who do not. I believe--as does the author of the commentary--that identifying patients "who do not need medications [for hypertension] is well worth it."