Clinicians Take 5: Emphasizing Accountably in Blood Pressure Measurement

Purpose: Over the years there has been numerous support to guideline based approaches to treatment and management of individuals who carry a diagnosis of hypertension. There is minimal information however, supporting the uncertainty of whether blood pressure measurements (BPMs) are accurately obtained through evidence-based best practices. The United States Preventive Services Task Force (USPSTF) recommends that all individuals age 18 years and older receive screening for high blood pressure (BP) or hypertension. This recommendation includes allowing a 5 minute rest interval before any BPM is collected; however, it is well known that such recommendations are not used in everyday practice in contrast to research studies and controlled trials. The goal of this study was to evaluate BPM readings of individuals in a primary care clinic when applying the USPSTF recommendations versus BPM collection as usual.

Methods: A repeated-measures design was used to examine individual BPMs at the intervals of baseline, after a 5-minute rest period post-baseline, and after a 10-minute rest period post-baseline. BPMs were collected during a single patient encounter. The sample included 100 participants (48% European American; 51% African American; 1% Asian; 68% Female) between the ages of 18 and 88 years old (M_age = 53.23, SD = 14.95) who visited a university based primary care clinic in the Southeast United States region between May 2016 and August 2016. Two participants were excluded from the analysis due to insufficient participants in those categories, the only Asian participant and the only underweight participant. Thus, the final sample included 98 participants.

Results: For systolic blood pressure (SBP) measurements between intervals, results indicated that there were no significant differences across sex, F(1, 96) = 0.50, p = .48, , race, F(1, 96) = 3.42, p = .07, or BMI categories, F(2, 95) = 1.30, p = .28. However, there were significant differences between age groups, F(2, 95) = 4.21, p = .02. 18-45 year olds had significantly lower SBP than both 46-64 year olds and 65+ year olds (both ps < .05). For diastolic blood pressure (DBP) measurement intervals, results indicated that there were no significant differences across sex, F(1, 96) = 0.14, p = .71, race, F(1, 96) = 2.54, p = .11, or age groups, F(2, 95) = 2.72, p = .07.

Conclusion: When applying USPSTF recommendations SBP measurements were significantly impacted while there was little to no effect on DBP measurements. These findings support the USPSTF recommendation that there should be at least a 5-minute rest period before BPMs are taken in an office based setting. Due to busy schedules and longstanding routines or practices, clinicians might not stop to evaluate processes such as blood pressure collection for accuracy or latest supported evidence. It is important that healthcare clinicians are aware of these findings in order to prevent misdiagnosis of hypertension, which can lead to a myriad of problems for the individual who is receiving care. The USPSTF recommendation is based on evidence and clinicians must ensure that evidence based best practices are being implemented in practice.