Blood Pressure & Health

The following letter published in The Times in response to the news that there is to be a change in the way blood pressure readings are taken:

Sir, That 24-hour blood pressure monitoring will now be more widely available does not negate the need for an improvement in the currently suboptimal standard of “office” blood presure measurement. Too often, patients in primary care as well as in secondary care undergo the following routine, which is in contravention of the guidelines for correct measurement of blood pressure: the measurement of blood pressure takes place almost immediately after the patient enters the consulting room, in contravention of the recommendation that the patient should remain seated for at least three minutes beforehand. Furthermore, in contravention of the recommendation that at least two measurements should be taken, most patients have only one measurement.

Finally, given that incorrect measurements are registered by electronic blood pressure monitors when a patient has an irregular pulse, the least precaution that should be taken before deciding whether to measure the blood pressure using an electronic device or manually is to document the patient’s pulse and its regularity. Many times, when I have had my blood pressure measured, I have not had my pulse taken.

And another brief contribution

Sir, Nice seems to be recommending that a nurse just “download an average” from the device. There is far more information in a day’s worth of readings than this: attempts should be made to categorise regularly observed patterns and to correlate them with comings and goings in the patients’ daily lives to see if any common threads can be discovered.

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A new device promises to revolutionise measuring blood pressure

Source The Times | BBC Health News

For many years the accepted way of measuring blood pressure has been using a cuff around the upper arm. This could be soon surpassed with the invention of a “wrist watch” capable of more accurate blood pressure readings. The device, which has been designed by scientists at the University of Leicester and in Singapore, could revolutionise the way blood pressure has been measured for over 100 years.

The watch-type device works by calculating pressure in the largest artery in the body, the aorta. The readings from the Aorta is already known to give a different reading from pressure in the arm.

Because the aorta is closer to the brain and heart readings taken from it are a much more accurate and it is hoped that doctors will be able to recommend better, more appropriate treatment based on the risks from high blood pressure – which are stroke and heart attacks.

A sensor in the watch sits over the radial artery in the wrist and records the pulse wave, which is then fed into a computer to calculate the pressure close to the heart.

Bryan Williams, of the University of Leicester’s department of cardiovascular sciences said that he expected the technology to be in use soon in specialist centres before being available more generally in the NHS. “Within five years I think this is going to be used much more widely,” he said.

“The aorta is millimetres away from the heart and close to the brain and we have always known that pressure here is a bit lower than in the arm. Some patients have high pressure in the arm but their aortic pressure is completely normal. We believe that these patients don’t need to be treated. Unless we measure the pressure in the aorta we are not getting an appreciation of the risks or benefits of treatment.”

Professor Williams believes that it is important to ensure that the new device was as small as possible to encourage healthcare professionals and patients to use it. “We knew that whatever we came up with had to be quite small and preferably similar to what people were used to. It has been a fabulous scientific adventure to get to this point and it will change the way blood pressure has been monitored for more than a century.”

A study on the device is published in the Journal of the American College of Cardiology. Mr Lansley said that the technique, which he had seen in action, was “a great example of how research breakthroughs and innovation can make a real difference to patients’ lives”.

A senior cardiac nurse at the British Heart Foundation commented that although conventional measuring of blood pressure had its limitations it continues to provide valuable information.

“Previous research by these scientists has shown that measuring blood pressure close to the heart is a better indicator of the effectiveness of treatment for high blood pressure than the standard method,” she said. “However, further research is needed before we can be certain of its superiority in the doctor’s surgery.”

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