When Wisconsin family medicine physician Kim Hardy, MD, saw this blood pressure chart the AMA posted on Twitter, she knew it was something that could help her practice obtain more accurate blood pressure measurements. She shared her success story, which inspired other physicians to weigh in on how they ensure accurate blood pressure measurement in their practices.
Using the chart helped Dr. Hardy immediately improve a patient’s blood pressure measurement, preventing her from having to readjust the patient’s medication. Here's what other physicians had to say:
CHAIMTN: A diary of multiple recordings, AM & PM, for month prior to visit may be best measure for adjusting Rx.
lissr: Surprised size of cuff not mentioned...very big deal in some circles—different widths can make very disparate readings!
lonestar32: Another common contributor to elevated readings: The patient is running late, rushes from parking lot, checks in and BP is read immediately before returning to baseline. This happened to me, with a hillside parking compounding the problem. With very well-controlled mild essential hypertension, I was getting systolic readings of 135-140. When I made a point of coming 10 minutes early and sitting in the waiting room before checking in, I got the below -110 readings I was getting at home, avoided the risk of "dealing with" the elevated reading inappropriately.
james blaine: I have practiced medicine for 40 years, half of that in emergency trauma and the last half in family practice. Diagnosing and treating hypertension has always seemed mystical to me. As an emergency physician, almost all of my patients had elevated blood pressures. As a family physician, the regulation seemed unscientific at best.
A few years ago, I read an article in the Hypertension Journal that made a great deal of sense: home blood pressure monitoring (HBPM). The patient is instructed in the proper method of taking his/her BP and asked to take the measurement twice in the morning (a few minutes apart) and twice in the evening for a week. The patient then returns the list, and we average it.
A significant percentage of the patients are normotensive at home and turn out to have office hypertension; the others are treated with diet, salt restriction and aerobic exercise, and then, if needed, medication. Their treatment efficacy is also monitored by HBPM. We have preprinted HBPM monitor sheets for the patients, and loan them an automatic BP machine if they do not have one. If they are diagnosed as hypertensive, they are requested to purchase their own.
Since initiating this protocol, hypertension diagnosis and treatment is no longer mystical to me, and my patients seem to assume better ownership of their BP management.
Read more comments at AMA Wire®.
Several physicians touched on what is known as “white coat” hypertension, pointing to home blood pressure monitoring as a way to ensure more accurate readings. Physician practices in Illinois and Maryland are addressing this issue and others as part of the AMA’s Improving Health Outcomes initiative, which seeks to apply principles of safe design in the ambulatory setting to improve outcomes around high blood pressure.
Practices participating in the program are investigating resources in their communities that could help patients get home blood pressure devices or direct patients to local programs that could take blood pressure measurements and provide feedback to physicians.
Other participating practices are employing automated blood pressure devices, which help gain accurate measurements outside of the medical office setting.
Join the discussion: Share what methods you’ve found successful in improving outcomes around hypertension in your practice in a comment below on AMA Wire,and on Facebook.
