Professional Documents
Culture Documents
BP Measurement Techniques
Method
Brief Description
In-office
Ambulatory BP
monitoring
Self-measurement
Office BP Measurement
Use auscultatory method with a properly calibrated and validated
instrument.
Patient should be seated quietly for 5 minutes in a chair
(not on an exam table), feet on the floor, and arm supported at heart
level.
Appropriate-sized cuff should be used to ensure accuracy.
At least two measurements should be made.
Clinicians should provide to patients, verbally and in writing,
specific BP numbers and BP goals.
JNC 7 2003
Use a standard bladder . but have a larger and a smaller bladder available for fat and
thin arms, respectively.
Have the cuff at the heart level, whatever the position of the patient.
Use phase I and V .
Measure blood pressure in both arms at first visit to detect possible differences
..
Measure blood pressure 1 and 5 min after assumption of the standing position in elderly
subjects, diabetic patients,..
Measure heart rate by pulse palpation (30 s) after the second measurement in the sitting
position.
Heart
Stroke
TIA
Vascular dementia
CAD
LV hypertrophy
LV syst. dysfunction
Vascular system
Kidneys
Hypertensive
nephropathy
Hypertensive retinopathy
Aortic aneurysm
PVD
Overt atherosclerotic
Damage indicators
HEART
BRAIN
KIDNEYS
RETINA
PERIPHERAL
VASCULAR SYSTEM
Grade 2
Grade 3
Mild
hypertension
Moderate
hypertension
Severe
hypertension
SBP 140159
or DBP 9099
SBP 160179
or DBP 100109
SBP 180
or DBP 110
Low risk
Med risk
High risk
II 12 risk factors
Med risk
Med risk
High risk
High risk
IV ACC
Normal
High normal Grade 1
SBP 120-129 130-139
140-159
or DBP 80-84 85-89
90-99
Aver. Risk
Aver.risk
Low added
risk
Low added
risk
Mod. added
risk
ACC
Grade 3
> 180
> 110
Low added
risk
Grade 2
160-179
100-109
Very high
added risk
Very high
added risk
Very high
added risk
>180/110
160/179
100-109
140/159
90-99
*
180/110
140/159
90-99
Treat
Treat
130/139
85-89
<130/85
<140/90
Reassess
yearly
Reassess
in 5 years
* Unless malignant phase of hypertensive emergency confirm over 1-2 weeks then treat.
If can cardiovascular complications, target organ damage, or diabetes is present, confirm over 3-4 weeks then threat, if
absent remeasure weekly threat if blood pressure persists at these levels over 4-12 weeks.
If cardiovascular complications, target organ damage, or diabetes is present, confirm over 12 weeks then threat, if absent
remeasure monthly and threat if these levels are maintained and estimated 10 year cardiovascular disease risk is 20%.
Assessed with risk chart for cardiovascular disease.
Lifestyle
Modification
Without Compelling
Indication
With Compelling
Indication
Encourage
Prehypertension
120-139/80-89 mm Hg
Yes
Stage 1 hypertension
140-159/90-99 mm Hg
Yes
Thiazide-type diuretics
for most; may consider
ACE-I, ARB, BB, CCB, or
combination
Stage 2 hypertension
160/100 mm Hg
Yes
No drug indicated
AUSTRALIA 2003
furosemide, bumetanide
amiloride, spironolactone
hydrochlorothiazide, bendrofluazide
chlorthalodone, indapamide
Doxazosin, Prazosin
Atenolol, Metoprolol, Bioprolol, Carvedilol
Labetalol
Captopril, Enalapril, Perindopril etc
Losartan, Valsartan, Candesartan etc
Nifedipin, Amlodipin
Diltiazem, Verapamil
monoxidine, nilmenidine
hidralazine, minoxidil
Uncomplicatied
hypertension
American Kidney
Assiciation (2001)
+ DM or
Renal disease
+ RF with
proteinuria*
<130/80
<125/75
British Hypertension
Society (1999)
< 140/85
< 140/80
<125/75
Canadian Hypertension
Society (1999)
< 140/90
< 130/80
<125/75
European Hypertension
Society (2003)
< 140/90
< 130/80
<125/75
JNC-VII (2003)
< 140/90
< 130/80
<125/75
< 140/90
< 130/80
<125/75
WHO-ISH (1999)
< 140/90
< 130/80
<125/75
Health recommendation
Diet
Exercise
Body weight
Alcohol comsumption
Smoking cessation