michigan hypertension core curriculum - State of Michigan

the BP understands current national guidelines for identifying, referring, and managing high BP. In all
settings the individual whose pressure is being recorded should be seated with the back supported,
legs uncrossed, feet flat on the floor, and the arm supported at heart level. The setting should be as
private and as quiet as possible.
In the clinical setting, a conscious decision must be made to establish an appropriate screening
area. This is especially important as some individuals demonstrate “white coat hypertension” with the
elevation of BP triggered by anxiety or nervousness usually in response to being in the healthcare
setting. To evaluate the presence of white-coat hypertension, patients are encouraged to measure their
BP at home. Home readings are useful for engaging patients in their own BP treatment program and
also provide additional information for healthcare providers to better manage the therapy.
Patients who purchase a home BP unit need guidance so that they purchase an accurate upper
arm machine, rather than finger or wrist device, and that the correct cuff size is obtained. Patients
should be instructed to choose a monitor that has been tested and validated by either the Association
for the Advancement of Medical Instrumentation, the British Hypertension Society, or the International
Protocol for the Validation of Automated Blood Pressure Measuring Devices. A list of validated monitors
is available on the British Hypertension Society website (www.bhsoc.org/blood_pressure_list.stm) or
the Dabl Educational Trust website (www.dableducational.org/sphygmomanometers/devices_2_sbpm.
html#ArmTable). (Dabl is a leading provider of healthcare management systems and research tools
for the prevention and management of cardiovascular conditions including high BP). If the device is to
be used for children or pregnant women, then patients need to know to select a monitor that has been
validated for those conditions. Once the monitor is obtained, healthcare providers should assess the
patient’s accuracy in following measurement guidelines, and should compare home monitor readings
with measurements taken in the provider’s office. Providers should then give the patient directions as to
the frequency and timing of the home measurements, as well as instructions as to what data should be
reported to the provider.
Essential Points
1. Diagnosis and treatment decisions for high BP require accurate BP measurement – which
should be done by the professional health care provider.
2. Many providers do not follow established protocols for BP measurement resulting in inaccurate
diagnoses and treatment plans.
3. All measurement devices must be calibrated and/or validated for accuracy on a regular
NKFM & MDCH 13