Policy Statement of the World Hypertension League on Noninvasive Blood Pressure Measurement Devices and Blood Pressure Measurement in the Clinical or Community Setting

Abstract

Increased blood pressure (BP) is the leading risk factor for death and disability globally, 1 with more than 40% of the adult population older than 25 years having hypertension.2 Although much of hypertension is preventable, especially by reducing the amount of salt added to foods, hypertension treatment can also prevent the adverse consequences of stroke, heart attack, and heart and kidney failure.2 Unfortunately, about half of patients with hypertension remain undiagnosed. Hence, the World Hypertension League has made the increase in regular BP assessments and encouragement of widespread BP screening programs linked to diagnosis and clinical management of hypertension to be among the highest of priorities.Whether in low-, middle-, or high-resource settings, recommendations for BP assessment are consistent and include a standardized approach to pre-measurement preparation, patient positioning, appropriate cuff selection and placement, measurement technique, and use of accurate BP-measuring devices.4-9 For BP-measuring devices, there is typically a choice between manual devices using the auscultatory technique and either semi-automated (manual inflation) or fully automated (automated inflation) devices using oscillometry.

Diagnosing Hypertension in Primary Care Clinics According to Current Guidelines

“…6 -10 Are primary care clinics adequately prepared to implement these recommendations for accurate OBPM and out-of-office BP monitoring for the 70 million patients with hypertension in the United States? 11 Effective implementation of these interventions requires the use of OBPM and HBPM devices validated for accuracy by international protocols, 12 training and subsequent monitoring of both clinic staff and patients in correct OBPM and HBPM protocols, 13,14 convenient access to 24-hour ABPM services, 15,16 and, optimally, use of an electronic health record (EHR) or electronic registry that can identify and track hypertension patients and their HBPM values. 17 Utah formed the Utah Million Hearts Coalition (UMHC) as part of the national Million Hearts initiative to prevent 1 million heart attacks and strokes by 2017.…”

Assessment of an educational intervention to improve nurses’ knowledge of blood pressure measurement

“…[6] Previous research has shown a lack of knowledge in undergraduate nursing students, [9,15] reinforcing the need for regular training and updates. Therefore, it is necessary to alert managers and nursing schools to the need to seek educational programs for professionals in order to provide safer patient care.…”

“…[2] In the United States, [3] Canada [4] and Europe, [5] the guidelines recommended the use of an automated oscillometric BP measurement device because it is easy to use, it is accurate and it reduces observer errors. [6] In contrast, in Brazil, the auscultatory method is widely used by nurses and other healthcare practitioners to assess BP. [7] This method is specifically indicated for cases of severe arrhythmias because the oscillometric device may not capture abnormal heartbeats.…”

Controlling Hypertension to Prevent Target Organ Damage: Perspectives from the World Hypertension League President

“…The inclusion of WHL among the professional NGOs at WHO is particularly helpful in stabilizing and facilitating ongoing projects, which include hypertension detection and surveillance, the production of hypertension awareness materials for the public including World Hypertension Day, the development of combined sessions and symposia at international conferences, and involvement in WHO campaigns to prevent hypertension including a focus on salt reduction in global diets. [21][22][23][24][25][26][27] A major objective of the WHL is professional education for the health care workforce team, including physicians, nurses, pharmacists, physician assistants and community health care workers with access to the current evidence and resources for population hypertension detection, prevention and control. In summary, evidence from multiple sources identifies the impact of blood pressure on a substantial body of information that helps assess the absolute and relative risk reduction decline attributed to blood pressure reduction.…”