From the 2021 HVPAA National Conference
Andrew Baird (University of Pittsburgh Medical Center), Joshua Levenson
Background
Hypertension (HTN) affects nearly half the US population and is a leading risk factor for cardiovascular disease, however, studies show only 45% of patients are well controlled (1). The AHA and AMA partnered to launch “Target BP,” an initiative to improve blood pressure control and reduce the number of strokes and heart attacks by optimizing HTN control. A leading challenge to HTN control is lack of accuracy and precision in-office blood pressure recordings, with measurement errors accounting for 5-30mm Hg fluctuations (2). Through staff and patient training, confounders can be minimized to produce improve reliability. Additionally, automated office blood pressure (AOBP) machines have previously been validated to correlate well with 24-hours blood pressure monitors and to minimize variability in measurements (3). In an effort to improve HTN control rates in our cardiology clinics, the Target BP protocol was initiated using AOBP.
Methods
Staff from the HVI Shadyside cardiology clinic was lead through a concise educational curriculum surrounding the basics of Target BP curriculum, patient and provider factors that affect blood pressure recordings, and taught to use AOBP instruments. Protocol reminders were printed in each patient room. All patients were seated >5 minutes before vitals recorded, appropriate cuff size was assessed, and it was ensured patients were not talking, with supported back and legs, with an empty bladder, and with the cuff over their non-obstructed bare arm. If the recorded blood pressures were >140/90 using a standard manual cuff, then 3 consecutive blood pressure measurements using AOBP were then completed.
Results
In the first five months following initiation, there was a statistically significant increase in blood pressure control rates from 64.2 ± 3.0 to 71.8 ± 0.9 (p <0.01). There was a similar decline in the average systolic blood pressure from 131.1±1.1 to 130.0 ± 0.1 (p = 0.04). There were also declines in the rates of stage I HTN from 25.5 ± 2.7 to 20.6 ± 1.4 (p = <0.01) and stage II HTN from 7.1 ± 1.7 to 5.0 ± 0.6 (p = 0.02).
Conclusions
A standardized process of blood pressure monitoring and incorporation of AOBP machines can improve the accuracy of BP monitoring allowing for better HTN management and control.
Clinical Implications
Improved reliability in blood pressure monitoring can improve hypertension control rates and could be protective against dangerously over-treating elevated in-office readings. Limited staff interventions and the use of new measurement technology can significantly improve outcomes and patient care.
