Blood Pressure Measurement: Calling For A Turn Of The Century
Education and Advocacy No medical procedure is more common than blood pressure measurement, and yet there is a disturbing lack of interest in Canada about its effectiveness as a diagnostic tool.
The sphygmomanometer — a recognizable device with an inflatable cuff and a mercury or aneroid manometer that is used, along with a stethoscope, to measure blood pressure — was popularized around the year 1900 and remains in common use today. That’s a startlingly long lifetime for any technology; we consider flip phones from 2005 to be bona fide antiques.
In fact, healthcare professionals have known for many years that better and more accurate methods for blood pressure measurement exist. Getting Canada’s healthcare professionals to use them needs to be a top priority for universities, professional associations and governments.
Diagnosis is tricky
Seven and a half million Canadians — that’s one in five — are living with high blood pressure, or hypertension. The only way to diagnose hypertension is through accurate blood pressure measurement, since high blood pressure has no signs or symptoms at the outset. The antiquated use of sphygmomanometers in clinics means that tens of thousands of Canadians are misdiagnosed with hypertension every year.
This misdiagnosis results from the ‘white coat effect,’ and applies to as many as 25 percent of people who are diagnosed with hypertension. Their blood pressure measures high in clinics but is normal when measured in non-clinical settings, either by ambulatory 24-hour measurement or by themselves at home.
“Missed” diagnosis is just as big a problem: 25 percent of people living with hypertension have ‘masked’ hypertension, making their high blood pressure undetectable with in-office blood pressure measurement. “People with masked hypertension are at a similar risk for cardiovascular disease as people who have uncontrolled hypertension.
With accurate diagnosis, these complications can often be avoided,” explains Angelique Berg, CEO of Hypertension Canada.
“The antiquated use of sphygmomanometers in clinics means that tens of thousands of Canadians are misdiagnosed with hypertension every year.”
Misdiagnosis reverberates throughout the healthcare system: scarce pharmacare dollars end up spent on medicating people needlessly and these needless medications can have a negative impact on people’s well-being.
Meanwhile, hypertension silently puts the undiagnosed at risk of cardiovascular events such as strokes, heart attacks and heart failure.
Methods need updating
Hypertension Canada has updated its CHEP Guidelines for the treatment and control of hypertension in order to promote the use of current in-office (automated) and out-of-office (ambulatory or home-based) technologies that will help to end the scourge of hypertension misdiagnosis.
What’s needed now is a coordinated effort to turn common practice around by bringing blood pressure measurement into this century and in line with the latest research and technologies.
Medical, nursing and pharmacy schools should integrate Canadian best practice guidelines to their curricula. Professional associations can help by dispelling the common myths and misunderstandings that accompany all new technologies. Governments need to support the implementation of best practices with appropriate incentives for healthcare professionals.
The result of these coordinated actions will be a more cost-effective and focused response to hypertension, which is currently the leading cause of death and disability around the world.