Gulati Martha, Peterson Lori-Ann, Mihailidou Anastasia
University of Arizona, Phoenix, AZ, USA.
Royal North Shore Hospital, Sydney, Australia.
Am J Prev Cardiol. 2021 Oct 13;8:100280. doi: 10.1016/j.ajpc.2021.100280. eCollection 2021 Dec.
Accurate blood pressure (BP) measurement is essential for the diagnosis and management of hypertension. In clinical practice, BP is estimated using noninvasive methods with significant variability of application of guidelines in clinical practice, impacting the accuracy and certainty of BP measurements.
We sought to assess how BP is measured in clinical practice.
A survey was administered through professional societies that included predominantly cardiologists. Assessment of adherence to guideline recommendations for BP assessment was measured and compared to the level of confidence in clinic BP measurement.
There were 571 surveys completed. The majority of respondents were cardiologists (61.1%), with 47 preventive cardiologists. BP was routinely checked in both arms by 53% at the initial visit, 48% check BP once each visit, and 64% wait 5 min before initial BP assessment. Automated BP assessment is used by 58% respondents. The majority (83%) trust their BP readings, and those who trust their BP readings are more likely to perform the initial BP assessment themselves, compared to those who do not trust the clinic BP readings (30.2% vs. 13.6%, = 0.009). Accurate BP measurement is performed by 23% of cardiologists, and more likely performed accurately by a preventive cardiologist (38.3%) compared with other cardiologists (20.0%, = 0.007). Accurate BP measurement is more likely for those who perform the initial BP themselves rather than any other staff (36.8% vs. 17.9%; <0.001); and for those who repeat BP manually (80% vs. 54%; <0.001), compared to those who do not measure BP accurately. Despite the inaccuracy of BP measurement, there is a high level of confidence in the BP readings.
Accurate BP assessment continues to remain suboptimal in clinical practice. Reliability of BP assessment requires education, identifying barriers to implementation of recommendations and engagement of the entire team to improve BP assessment.
准确测量血压对于高血压的诊断和管理至关重要。在临床实践中，使用无创方法估计血压，临床实践中指南应用存在显著差异，影响血压测量的准确性和确定性。
我们试图评估临床实践中血压是如何测量的。
通过主要包括心脏病专家的专业协会进行一项调查。测量对血压评估指南建议的遵守情况，并与临床血压测量的信心水平进行比较。
共完成571份调查问卷。大多数受访者是心脏病专家（61.1%），其中有47名预防心脏病专家。53%的人在初次就诊时常规检查双臂血压，48%的人每次就诊检查一次血压，64%的人在初次血压评估前等待5分钟。58%的受访者使用自动血压评估。大多数（83%）人相信他们的血压读数，与不相信诊所血压读数的人相比，相信自己血压读数的人更有可能自己进行初次血压评估（30.2%对13.6%，P = 0.009）。23%的心脏病专家能准确测量血压，与其他心脏病专家（20.0%）相比，预防心脏病专家更有可能准确测量血压（38.3%，P = 0.007）。与由其他工作人员测量相比，自己进行初次血压测量的人更有可能准确测量血压（36.8%对17.9%；P<0.001）；与不能准确测量血压的人相比，手动重复测量血压的人更有可能准确测量血压（80%对54%；P<0.001）。尽管血压测量不准确，但对血压读数仍有很高的信心。
在临床实践中，准确的血压评估仍然不尽人意。血压评估的可靠性需要教育，识别建议实施的障碍，并让整个团队参与以改善血压评估。
