Evidence-Based, Streamlined Approach to Measure Blood Pressure in Primary Care Settings

Abstract

The current guideline-recommended clinic blood pressure (BP) measurement procedure takes nearly 10 minutes to complete and may not be feasible to implement in busy clinical practice settings. Additionally, evidence supporting the steps in the current guideline-recommended procedure is of uneven quality. A streamlined, evidence-based approach to clinic BP measurement that still produces accurate and precise BP measurements may facilitate improved hypertension diagnosis and management. We summarized the latest evidence from studies that have quantified the impact of streamlining certain steps in the BP measurement procedure on BP measurement accuracy and precision. We translated this evidence into a practical, streamlined protocol for office BP measurement in usual primary care and potentially other settings. Studies have demonstrated it is possible to reduce the rest period before measurements from 5 to 0 minutes, and the interval between measurements from 60 to 30 seconds, without compromising accuracy. Additionally, analyses of studies with replicate BP measurements performed according to clinical practice guideline recommendations showed that repeating the initial screening measurement only when the first one is ≥130/80 mm Hg optimized accuracy and efficiency. Meanwhile, using the proper cuff size, arm support, and patient positioning are critical for BP measurement accuracy and recommendations for these steps remain unchanged from current guidelines. Broad implementation of a streamlined approach would result in more efficient BP measurement without compromising accuracy or precision, thereby increasing capacity to screen, diagnose, and manage hypertension.