Quality of blood pressure measurement in the management of hypertension - A pilot study

In clinical practice, diagnosis and follow-up of hypertension is based on b lood pressure (BP) as measured by auscultatory method. BP is usually measur ed using a stethoscope to auscultate the Korotkoff sounds and mercury or an aneroid sphygmomanometer. However due to the lack of regulatory rules, the devices are rarely checked making the quality of the measures doubtful. Objective: to compare BP measured following the WHO recommendations, using 2 different devices: the mercury or aneroid sphygmomanometer used by the ph ysician and a SECURUS manometer that has been calibrated just before the im plementation of the study. Method: The study was performed with 1694 French general practitioners. Eve ry physician included 2 ambulatory patients: a newly diagnosed non-treated hypertensive patient and a treated hypertensive patient. The physician was asked to include the first patient of each category attending his office. B P was measured sequentially with the 2 devices in a random order. Collected data were socio-demographic parameters, cardiovascular risk facto rs, hypertension related diseases, drug treatment for hypertension and BP l evels. Results: Mean BPs differ by less than 1 mmHg between the 2 devices. However 10% of the treated hypertensive patients are not classified as having norm alised BP values (BP< 140/90 mmHg) or high BP values, in the same way by th e 2 devices. Mean absolute difference between the 2 devices is >5 mmHg in 2 2% and 13% of the physicians for SBP and DBP respectively. Conclusion: this pilot study emphasises the need of BP measurements of good quality in clinical practice, because of the possible impact on the care o f the patients and the related costs. Regulatory rules on the control of th e devices might improve the quality of BP measurements.