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.

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.”

A new gadget called iHealth was unveiled at this years Consumer Electronics Show (CES) that enables users to track, chart and share your blood pressure information on an iPad, iPhone or iPod touch.

The iHealth Blood Pressure Monitoring System is battery-powered docking station and blood pressure arm cuff for use with Apple devices and is being reported as a potentially exciting way to combine Apple’s iPhone, iPod touch, and iPad with home blood pressure monitoring devices.

The kit includes a glossy white plastic dock (battery powered) and an arm cuff that interface with your iOS device using a Dock Connector, relying upon a free iHealth application to inflate the cuff, take measurements and then display realtime results of your blood pressure readings.

Early reactions to the iHealth Blood Pressure Monitoring System

In all seriousness, this seems like a good product. I know people who monitor their BP regularly, and had ‘scares’ at doctors’ offices because they were nervous at those settings, when their measured BP at home hadn’t been above normal.

One concern: does the ‘app’  have adequate security? Does it ‘report back’ results or store them on the device insecurely?

Uh, I have a $40 blood pressure cuff that already keeps track of readings and does everything that is talked about here. Not clear what value the iPhone connection adds other than cool factor.

I will concede that my blood pressure monitor can’t make phone calls but then neither does the iPad!

This article (http://www.nytimes.com/2011/01/02/science/02see.html?ref=technology) explains how computers can monitor patients’ pulses with cameras. Is the iPhone’s camera good enough to detect the same subtle changes in facial coloration that these computers can? If so, why not make an app to monitor pulse and blood pressure with the inbuilt camera?

“Patients can also share their results with a physician, either via e-mail or by showing them the phone or iPad with the data on it during their next doctor visit.

For the socially minded the application can also deliver blood pressure readings to user accounts such as Twitter and Facebook as a way to generate positive reinforcement about good readings among a user’s social network profile.

Having your blood pressure monitor tested and calibrated is an important part of maintaining your blood pressure monitor.

The accuracy of your blood pressure monitor is of the utmost importance and faulty monitors may give incorrect blood pressure readings affecting results and diagnostics.

Having your blood pressure monitor tested and calibrated reduces maintenance costs and significantly improves efficiency, allowing your blood pressure monitor’s component parts to work longer at a minimal increase to costs.

Tips on choosing the right company to test and calibrate your blood pressure monitor:

Choose an independent medical equipment testing and calibration company, who will fix your blood pressure monitor rather than condemn it.

The accuracy of your blood pressure monitor is of the utmost importance and faulty blood pressure monitors may give incorrect readings affecting results and diagnostics. Having your blood pressure monitor tested and calibrated ensures complete accuracy, efficiency is improved and maintenance costs are reduced.

Choose an accredited company.

TAG Medical is an ISO 9001 accredited company, underlining the ability to deliver a quality assured service.

Blood Pressure Monitor “Return-To-Base” express service. TAG offers a popular “Return-To-Base” express service for testing and calibrating your monitor.

Service Details

Cost: £19 +vat.
Timescale: 3-5 working days from receipt of unit.
Instructions: Simply send your blood pressure monitor to:
TAG Medical Ltd
1 The Triangle
ng2 Business Park
Nottingham
NG2 1AE
Please also send the blood pressure cuff and a cheque for £19 + vat (£21.85 inc vat) made payable to TAG Medical Ltd who will test and calibrate the unit and send it back to you complete with test certificate and certification label.

Please remember to include your return address and contact details. If the unit requires a charger please send that too. We recommend you send the unit by recorded delivery.

If your blood pressure monitor is found to be operating outside the recommended tolerance levels or is faulty in any other way, TAG Medical will attempt to repair the unit at no extra charge. If it is beyond economic repair, TAG Medical will inform you immediately. TAG Medical is an independent company and does not in any way benefit from this process, ensuring an unbiased and objective service.

There are many blood pressure monitors on the market, but not all of them have been clinically validated for accuracy. The British Hypertension Society (BHS) maintains an up-to-date list of clinically validated blood pressure monitors, which we have reproduced on this page The majority of clinically validated monitors are upper arm monitors, where the cuff is put around the arm, above the elbow. However a number of wrist monitors are now clinically validated, but readings at home may be inaccurate if the wrist is not held at heart level. For this reason, the British Hypertension Society recommends the use of upper arm monitors in preference to wrist monitors.

All monitors that are clinically validated will give a reliable result, regardless of whether they cost £35 or £135. The differences in cost reflect the number of additional features a monitor has (for example the ability to store previous readings or speak out readings). But none of the extra features is necessary for an accurate reading, only that the monitor is clinically validated.

Where to buy a blood pressure monitor

Many shops and chemists stock blood pressure monitors but you will find these models cheaper online from medical equipment supply specialist such as Medisave

Cuff size:

If you have very large or very small arms you may need a smaller or larger sized cuff – ask your doctor or nurse for advice. If different sizes are available for any models they are listed as:  small , standard and large.

Resperate

This device is not clinically validated but reports from the USA show that when used in conjunction with existing treatments resperate does help to lower BP by encourging breathing control.

up-to-date list of clinically validated blood pressure monitors,

The British Hypertension Society (BHS) maintains an up-to-date list of clinically validated monitors, which we have reproduced below.

A and D Instruments monitors (Small, Standard and Large cuffs available to buy)

•    A and D Instruments UA-704
•    A and D Instruments UA-705
•    A and D Instruments UA-767
•    A and D Instruments UA-779
•    A and D Instruments UA-787
•    A and D Instruments UA-767 Plus
•    A and D Instruments UA-767 Plus Memory
•    A and D Instruments UA-774
•    A and D Instruments UA-767PC
•    A and D Instruments UA-767V
•    A and D Instruments UA-767P-BT

Microlife monitors (Standard  and Large cuffs available to buy)

•    Microlife 3AG1
•    Microlife – As easy as 123
•    Microlife BP 3BTO-A
•    Microlife BP A100
•    Microlife 3BTO-A (2) with two different sized cuffs provided that can also be used during pregnancy
• Microlife BP 3AC1-1
•    Microlife BP A100 Plus
•    Microlife BP 3AC1-1PC
•    Microlife WatchBP – details awaited

Omron monitors (Small, Standard and Large upper arm cuffs available to buy. Wrist monitor cuffs fit wrists 13.5-21.5cm)

•    Omron M1 Plus
•    Omron M2 Compact
•    Omron MX2 Basic
•    Omron MX3 Plus
•    Omron M4-I
•    Omron M6
•    Omron M6 Comfort
•    Omron M7
•    Omron M10-IT
•    Omron R6 (Wrist monitor)
•    Omron R7 (Wrist monitor)
•    Omron 705CP-II
•    Omron 637-IT (Wrist monitor)
•    Omron 705IT

more monitors…

The ongoing campaign to eliminate mercury from medical devices continues to expand and now the challenge has become global. A new campaign hopes to encourage greater use of digital thermometers to lower the toxic risks associated with mercury models.

A combination of automatic blood pressure monitors that have been validated by impartial third parties and a growing concern for the manual inaccuracies of listening for a pulse with a stethoscope when measuring blood pressure with mercury blood pressure monitors has promoted increased production of accurate, affordable, mercury-free medical devices especially monitors for home users.

The British Hypertension Society produces a list of validated machine suitable for both clinical and home use.  Soon all the monitors on this list will be automatic digital blood pressure monitors – available from medical supply specialist such as Medisave who already only offer digital and aneroid monitors on their web site.

Switch to Digital Thermometers for Clinical and Home Use

Mercury in other medical instruments.

A global partnership coordinated by the World Health Authority has announced that it plans to eradicate mercury from health care organisations with an initial target of replacing over seventy % of all mercury blood pressure monitors in the next decade.

In the US and Europe, regulations and efforts by concerned pressure groups have resulted many hospitals to stop using medical devices that contain mercury.

The WHO/Health Care Without Harm partnership focuses solely on thermometers and sphygmomanometers, which are widely used and have viable alternatives.

One of the most common  medical instruments that contains mercury is the thermometer.

Mercury thermometers are still widely used throughout the world.  1000′s of thermometers  break over the course of a year in hospitals, releasing mercury, a potent toxin that spreads quickly.

Digital thermometers are both accurate and easy to use so the resistance to changing from mercury thermometers should be small. New digital thermometers are however more expensive.

It is forecast that as the quantities produced increases, the costs will fall. and it is hoped that once hospitals calculate the cost of mercury thermometer breakage including the proper cleaning up after the breaks, the switch becomes a minor cost issue.

Encouraging people to invest in digital thermometers for home use is still a challenge in the developing world, but as with the old style blood pressure monitors mercury thermometers are being phased out so they are harder to find.

How to tell if a thermometer contains mercury

If a thermometer has a silver bulb, it contains mercury; if the bulb is any other color, it is mercury-free.

You can see a wide selection of clinically approved digital thermometers and medical thermometers here.

For a full explanation of the impact of mercury please see this article – http://www.environmentalhealthnews.org/ehs/news/push-to-replace-mercury-thermometers-is-going-global

UK health awareness organisations are urging more health professionals to support home blood pressure monitoring as an additional way of keeping an eye on patients’ blood pressure.

Home monitoring can be a great way to help people with high blood pressure feel more in control of their condition,

It enables them to keep track of their blood pressure between visits to their doctor or nurse and also helps them to see what effect lifestyle changes and taking their medication are having.

Self-checking is a great way to keep a track of your blood pressure between checks by a medical professional.

Using a monitor at home may also show whether your readings are higher in the doctor’s surgery than at home (known as hypertension – white coat effect).

Many people with high blood pressure find that home monitoring helps them to feel more in control of their condition. If you have high blood pressure, talk to your doctor before starting home monitoring so that they can be part of the process.

How you measure your blood pressure can affect the accuracy of results. To help, the you can read the following guidelines on measuring your blood pressure at home.

How to choose a blood pressure monitor

Many blood pressure monitors are available but make sure you choose one that is clinically validated. Such monitors have been shown in trials to give accurate results.

The British Hypertension Society publishes a list of clinically validated blood pressure monitors.

For continued updates from this blog get the blood pressure feed