Measuring a patient’s blood pressure is a common procedure in healthcare settings. An accurate measurement is critical to ensuring correct diagnosis and treatment, particularly for conditions such as hypertension. However, there are various factors that can potentially lead to inaccuracy in blood pressure measurements.

One study identified 29 sources of inaccuracy in the measurement of adults’ resting blood pressure in clinical settings. This 2016 study was conducted by Noa Kallioinen, from the School of Psychology in the University of Queensland, together with four other researchers.

The authors had categorised each of these sources into four different categories: patient-related, device-related, procedure-related and observer-related. Device-related factors that were found included device model inaccuracy as well as the integrity and calibration of the device.

Clinical evaluation of device for more accurate measurements

Over the years, oscillometric blood pressure measurement devices have increasingly replaced the use of sphygmomanometers. The advantages of such devices include their eco-friendliness, ease of use as well as elimination of potential sources of bias.

These devices are also beneficial in challenging situations such as when handling newborns and young infants, as well as in intensive care settings. However, the clinical evaluation of automated devices is still important to ensure measurement accuracy.

Studies on clinical evaluation that were published in 2002 demonstrated that the accuracy of the measurements taken using wrist type devices was significantly lower than in upper arm monitoring devices.

Greater caution needed to avoid improper measurements

According to Janusz Kaczorowski, a medical sociologist and lead author of a recently published study, about 20% of patients receiving treatment for hypertension do not actually have a problem and do not need medication. This error was mainly due to the fact that their blood pressure was improperly measured.

Kaczorowski also said that manual measurement is acceptable if it is properly done, but that is often not the case. Although automatic devices are more expensive, greater precision is offered because they involve the taking of several measurements.

Automated devices can reduce white coat hypertension

Research has also shown that the utilisation of automatic devices can reduce the “white coat” effect, a phenomenon in which a patient shows a higher level of blood pressure than normal due to the stress of being in a clinical setting.

The significance of this phenomenon has been revealed through findings of a study published earlier this year which showed the association between the white coat hypertension with long-term risk of cardiovascular disease and total mortality in patients without antihypertensive treatment.

Although other factors such as patient, procedure and observer remain potential sources of inaccuracy, clinicians should not underestimate the advantages of adopting more advanced automated devices to improve the accuracy of blood pressure measurement.

However, the utilisation of advanced monitoring devices alone is insufficient to ensuring the quality of blood pressure monitoring. Adequate training, proper execution as well as frequent maintenance of the device are also important aspects that should always be kept in mind. MIMS

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