Asai Y, Kawamoto R, Nago N, Kajii E
Department of Community and Family Medicine, Jichi Medical School.
Nihon Koshu Eisei Zasshi. 2000 Apr;47(4):326-36.
To examine the usual methods of blood pressure (BP) measurement by primary care physicians and to compare them with the standard methods.
Cross-sectional survey by self-administered questionnaire.
Primary care physicians who graduated from Jichi Medical School and were working at clinics. Each standard method for 20 items was defined as the one that was most frequently recommended by 6 guidelines (USA 3, UK 1, Canada 1, Japan 1) and a recent comprehensive review about BP measurement.
Of 333 physicians, 190 (58%) responded (median age 33, range 26 to 45 years). Standard methods and percentages of physicians who follow them are: [BP measurement, 17 items] supported arm 96%; measurement to 2 mmHg 91%; sitting position 86%; mercury sphygmomanometer 83%; waiting > or = 1 minute between readings 58%; palpation to assess systolic BP before auscultation 57%; check accuracy of home BP monitor 56%; Korotkoff Phase V for diastolic BP 51%; bilateral measurements on initial visit 44%; small cuff available 41%; > or = 2 readings in patients with atrial fibrillation 38%; > or = 2 readings on one visit 20%; cuff deflation rate of 2 mmHg/pulse 14%; large cuff available 13%; check accuracy of monitor used for home visit 8%; waiting time > or = 5 minute 3%; readings from the arm with the higher BP 1%. [Knowledge about BP monitor, 2 items] appropriate size bladder: length 11%; width 11%. [Check of sphygmomanometer for leakage, inflate to 200 mmHg then close valve for 1 minute] leakage < 2 mmHg 6%; median 10 (range 0-200) mmHg. Average percentage of all 20 items was 39%. Number of methods physicians follow as standard: median 8 (range 4 to 15) and this number did not correlate with any background characteristics of the physicians. Furthermore, we also obtained information on methods not compared with the standard. Fifty-four percentage of physicians used more standard methods in deciding the start or change of treatment than in measuring BP of patients with good control. About 80% of physicians use home BP readings in diagnosis or treatment of hypertension, but about half of physicians with ambulatory BP monitors use their measured readings.
Primary care physicians used various techniques for routine BP measurement and no physician completely followed the standard. Such measurements may affect the diagnosis and treatment of hypertension, but measuring all BPs solely by the standard is not practical. We need to have a practical and efficient method of BP measurement for routine practice in the primary care setting.
研究基层医疗医生测量血压的常用方法，并与标准方法进行比较。
通过自填问卷进行横断面调查。
毕业于自治医科大学并在诊所工作的基层医疗医生。20项标准方法中的每一项均定义为被6部指南（美国3部、英国1部、加拿大1部、日本1部）及近期一篇关于血压测量的综合综述最常推荐的方法。
333名医生中，190名（58%）作出回应（年龄中位数33岁，范围26至45岁）。标准方法及遵循这些方法的医生比例如下：[血压测量，17项]支撑手臂96%；精确到2 mmHg 91%；坐姿86%；水银血压计83%；两次读数间隔等待≥1分钟58%；听诊前触诊评估收缩压57%；检查家用血压监测仪准确性56%；舒张压采用柯氏音第V期51%；初诊时双侧测量44%；备有小号袖带41%；房颤患者测量≥2次读数38%；一次就诊测量≥2次读数20%；袖带放气速度2 mmHg/脉搏14%；备有大号袖带13%；检查用于家访的监测仪准确性8%；等待时间≥5分钟3%；取血压较高一侧手臂的读数1%。[关于血压监测仪的知识，2项]合适的气囊尺寸：长度11%；宽度11%。[检查血压计有无漏气，充气至200 mmHg然后关闭阀门1分钟]漏气<2 mmHg 6%；中位数10（范围0至200）mmHg。所有20项的平均比例为39%。医生遵循为标准方法的数量：中位数8（范围4至15），且该数量与医生的任何背景特征均无关联。此外，我们还获取了未与标准进行比较的方法的信息。54%的医生在决定开始治疗或更改治疗方案时比在测量血压控制良好的患者血压时使用了更多标准方法。约80%的医生在高血压的诊断或治疗中使用家庭血压读数，但约一半使用动态血压监测仪的医生使用其测量读数。
基层医疗医生在常规血压测量中使用了多种技术，没有医生完全遵循标准。此类测量可能会影响高血压的诊断和治疗，但仅依据标准测量所有血压并不实际。我们需要一种实用且高效的血压测量方法用于基层医疗环境中的常规实践。
