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.