When measuring blood pressure, the patient’s arm should be supported at about the level of the heart. Tunvarat Purukshachat/Moment RF/Getty Images Hide caption
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Tunvarat Purukshachat/Moment RF/Getty Images
Think back to the last time you took your blood pressure.
How did you sit? Where on earth were the cuffs? And what exactly was your arm doing?
Going to the doctor’s office is such a familiar ritual that most of us give little thought to the details, but in reality, even a small mistake can result in inaccurate readings.
Research shows that this can happen for all sorts of reasons. The cuff size may be incorrect. The patient’s legs are crossed or dangling from the examination table. The simple stress of being in the clinic, so-called “white coat hypertension,” can cause your numbers to skyrocket.
Now we’ll add some relatively common mistakes to the list. It’s about holding your arms in the wrong position.
A study by researchers at Johns Hopkins University found that simply deviating from arm position guidelines can overestimate a patient’s blood pressure.
Dr. Tammy Brady, professor of pediatrics at Johns Hopkins University School of Medicine and lead author of the study published in JAMA, said the inflated readings were not significant enough to lead to a misdiagnosis of hypertension or a decision to start medication. states that there is a possibility. Monday is internal medicine.
“People take blood pressure tests for granted,” Brady says. “But many decisions are made based on instrument measurements.”
In this study, more than 130 adults had their blood pressure measured in three different scenarios, all using an automated device.
The first was sticking to the guidelines. In this case, the arm was placed on a desk and the cuff was located on the arm approximately at heart level.
But the other two deviated from protocol by placing their arms on the patient’s lap or dangling them by the patient’s side, in ways Brady often sees in clinical practice. Blood pressure was significantly overestimated in both positions.
If a patient’s arm is resting on their lap, the upper and lower readings, known as systolic and diastolic blood pressure, which are the units of blood pressure measurement, can erroneously rise by about 4 millimeters of mercury (mmHg).
This phenomenon was even more pronounced when the arm was placed at the side. At that location, systolic increased by 6.5 mmHg and fundal increased by 4.4 mmHg.
While this may not sound like a huge variation, it is concerning that preventable oversights like this could lead to misleading data points used to assess cardiovascular disease risk. .
For example, a patient with a systolic blood pressure of 128 mmHg is in the high range between 120 and 129, but a misplaced arm could incorrectly classify him into the definitive hypertensive range starting at 130.
“This is very basic, but I hope it’s a reminder to everyone that this is really important.” Brady of the team says. “Some people may be prescribed medications that they don’t need at all.”
Blood pressure measurement guidelines outline a series of steps to obtain the most accurate readings. It must be done quietly, the patient must wait 5 minutes before the measurement, go to the toilet beforehand and keep the feet flat on the floor. Among other requirements, you must sit on the floor and support your back.
“We’ve known for a long time what to do, but it’s been difficult to do all of this in a real-world setting,” said Dr. Stephen Juracek, director of the Hypertension Center at Beth Israel Deaconess Medical Center in Boston. says.
It’s no surprise that some of these details fall by the wayside in the daily rush of seeing patients, but research also suggests that new doctors aren’t adequately trained. Masu. Another major obstacle is the layout of the exam room itself, which often makes it difficult to measure blood pressure properly. (Even Brady says he has to rearrange the furniture before seeing patients.)
Juracek said this latest study makes it abundantly clear that proper arm position is “essential.”
In his experience, dangling arms are usually not an isolated problem. These errors can compound to compound the inaccuracy.
“I’ve seen people lose as much as 20 mmHg net,” he says. “We’re talking about the decision to start or not to start treatment, so I think when you start adding up all of these characteristics, you really start to see an effect” that has a significant impact on the patient. ”
