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Measurement of Blood Pressure: Issues and Challenges

Measurement of Blood Pressure: Issues and Challenges. Sadhana Bhagwat, NPO WCO India 13 December 2018. Silent killer. Most hypertensive people have no symptoms Under-diagnosis Under-treatment. Hypertension Prevalence, Awareness, Treatment. 78m. 12m. 230m. 300m.

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Measurement of Blood Pressure: Issues and Challenges

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  1. Measurement of Blood Pressure: Issues and Challenges Sadhana Bhagwat, NPO WCO India 13 December 2018

  2. Silent killer Most hypertensive people have no symptoms Under-diagnosis Under-treatment

  3. Hypertension Prevalence, Awareness, Treatment 78m 12m 230m 300m China: Age 35-75. Liu J, Lancet. 2017 Dec 9;390(10112):2549-2558

  4. Most with Hypertension in India Are Not Aware and Hence Not treated 218M Barely 1 in 10 of the 218 million adults with hypertensionin India have itunder control 74M 60M 24M <11% Roy A et al. BMJ Open. 2017;7:e015639. Data for Delhi National Capital Region weighted and applied nationally.

  5. WHO Guidance on Hypertension FDC, Blood Pressure Device, Self care Best buys, Global action plan CVD, risk factors Technical package Risk stratification -STEP survey -WHS plus -Screen

  6. Diagnosis • Confirmation of hypertension: • after two visits ideally 1 to 4 weeks apart • Systolic blood pressure on both days is ≥140 mmHg and/or Diastolic blood pressure on both days is ≥90 mmHg • Patients with SBP ≥160 mmHg or DBP ≥100 mmHg may be indicated for immediate treatment based on one assessment

  7. Essential technology (device and lab) Challenges at PHC at low resource settings -Affordable technology blood pressure measuring devices for low resource settings, WHO 2005

  8. Diagnosis and treatment of hypertension Diagnosis confirmation Detection Prolonged Treatment

  9. Challenges in Diagnosis • Three sources of error in the measurement of blood pressure (AHA) • Observer bias • Faulty equipment • Failure to standardize the technique of measurement Diagnosis confirmation

  10. Three sources of error in the measurement of blood pressure (AHA) • Observer bias • Faulty equipment • Failure to standardize the technique of measurement

  11. Common errors…. • Raise the pressure to 30mm above pulse palpation • Lower at 2mm/sec (faster rate: lower SBP and higher DBP) • Terminal digit preference: rounding off to the zero: over estimation *Office blood pressure measurement practices among community health providers (medical and paramedical) in northern district of India; BishavMohan a,*, Naved Aslam a, Upma Ralhan b, SaritSharma et al, India Heart Journal 6 6 ( 2 0 1 4 ) 4 0 1 -4 0 7

  12. Three sources of error in the measurement of blood pressure (AHA) • Observer bias • Faulty equipment • Failure to standardize the technique of measurement

  13. Common errors….* • The best equipment???? • Calibration interval

  14. Three sources of error in the measurement of blood pressure (AHA) • Observer bias • Faulty equipment • Failure to standardize the technique of measurement

  15. Common errors…. • Supporting the arm: lower SBP/DBP by 11 and 12mm as compared to unsupported arm • Right cuff sizes: if small (obese people) SBP can rise by 8mm • Resting the patient: food, cold weather, stress, activity, coffee, tobacco • Auscultation: 1st appearance of sound: systolic • Complete disappearance of sound: diastolic

  16. Common errors…. • Minimum two readings • Sitting is better than supine: 3mm SBP raised and 3mm DBP lowered in supine • Centre of the bladder: Heart level: Increases if above, decreases if below that

  17. WHO Guidance

  18. Objectives of the workshop • Present the available guidelines and preliminary progress on guidance updating • Solicit practical country-level inputs from representatives on the most suitable devices for different levels of health care • Purchasing and maintaining blood pressure devices at different levels of health care provision

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