Blood Pressure Monitoring and Diagnosis

There are a number of ways in which blood pressure can be monitored for diagnosis:

  1. Clinic blood pressure
  2. Ambulatory blood pressure monitoring
  3. Home blood pressure monitoring

https://cks.nice.org.uk/topics/hypertension/diagnosis/diagnosis/

BP > 180/120 requires same-day specialist assessment for end target organ damage:

  • fundoscopy (retinal haemorrhage, papilloedema)
  • urinalysis (protein, blood, glucose)
  • red flag symptoms (chest pain, heart failure, etc)
1. Clinic Blood Pressure 140/90

Check radial or brachial pulse before measuring BP. If the pulse is irregular:

  • take manual BP
  • carry out an ECG, AliveCor, or Fibricheck
  • Measure blood pressure in a relaxed and comfortable setting
  • Use an appropriate cuff size
  • Consider checking BP in both arms. If there is more than 15mmHg difference, use the arm with the higher reading

Postural drop is if there is 20mmHg or greater difference between sitting/ lying and standing

2. Ambulatory Blood Pressure 135/85

Specialised equipment is usually required:

  • At least 2 BP measurements per hour during waking hours (08:00-22:00)
  • Average value of at least 14 measurements
3. Home Blood Pressure 135/85
  • Check twice daily, morning and evening
  • 2 BP readings, at least 1 min apart whilst seated
  • Duration of at least 4 days, ideally for 7 days

Calculate the average home BP readings after DISCARDING first day readings