When treating any disease, it is essential that the clinician and the patient are aligned and equally convinced on the need for change. Clinicians need to be assured they are treating the right test results, and patients need to be convinced that the result being treated was achieved with precision.
With the recent Systolic Blood Pressure Intervention Trial (SPRINT) study report and the subsequent American Heart Association (AHA) and American College of Cardiology (ACC) Guidelines, the diagnosis and treatment of blood pressure has been brought into the modern paradigm. Finally, blood pressure diagnosis is receiving the attention to detail it deserves.
Be properly prepared: Within the new guidelines, it is recommended that patients are properly prepped for a test, even before they arrive. Patients should avoid caffeine for at least an hour prior to their appointment and should have recently emptied their bladder. Just prior to blood pressure measurement, the patient needs to be resting quietly for an absolute minimum of 5 minutes. During the testing, it is important the feet are flat on the floor, the back is supported, and the arm where the blood pressure is being taken is supported at heart height. There should be no talking during testing.
First result is not enough: When determining blood pressure, a single reading is not enough. Rather, at least three readings should be taken about one minute apart and averaged. This protocol is in stark contrast to the common-day practice of slapping a blood pressure cuff on a sleeved arm right after arriving in the room and taking one reading while talking, with the patient seated with legs crossed, back not supported and arm held by the clinician or otherwise not supported.
Worth the effort: Effective treatment of blood pressure can have dramatic effects on outcomes. When lowering pressures to levels closer to normal, ideally to 120/80 if possible, individuals can expect a 28 percent lower incidence of cardiovascular complications later in life. The AHA/ACC guidelines are designed to achieve this, with the understanding that medication is only a part of the answer. Specifically called out in the recommendations is the need to engage with patients to buy-in completely to treatment that includes being actively engaged with changes in diet and lifestyle. Because lifestyle change is so difficult for patients to do, it is important they experience a level of precision with blood pressure measurement so there is no sense of doubt in the diagnosis. They need to be at least as convinced as their clinician.
The right tools: Clinicians are beginning to pay attention to a higher level of blood pressure testing preparations, the details of proper patient positioning, and the completeness of the measurements taken when diagnosing hypertension. This type of comprehensive protocol and having the proper equipment to support it, not only will help establish a true foundational baseline for blood pressure treatment, it also will have the necessary level of engaged impact for both clinicians and patients. By investing in equipment designed to provide proper patient positioning and automatic blood pressure measurement, I think you’ll find not only satisfied clinicians and patients more receptive to owning their personal test results, but also improved outcomes. You’ll also help get the correct message to both clinicians and patients that ‘blood pressure is really important’.
