This article was originally published in Spanish on Medscape.
BUENOS AIRES, Argentina — Simplified blood pressure measurement methods based on two or even a single measurement instead of the recommended three may be reasonably reliable and more effective in detecting hypertension in large populations, concludes a new study Posted in OLP Medicine.
“Concretely, the results open up the possibility of using a simplified method to save time in screening for hypertension in programs intended for thousands or millions of people. And they can also be used in very attended as an initial screening,” said first author Rodrigo. Carrillo-Larco, MD, from the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK, said Medscape Spanish Edition.
For screening, the standard way to accurately measure blood pressure measurement is to measure blood pressure three times at 3-minute intervals and use the average of the last two. High blood pressure is defined as systolic blood pressure ≥ 140 mm Hg or diastolic pressure ≥ 90 mm Hg, said Carrillo-Larco, who is also an associate researcher at the CRONICAS Center of Excellence in Chronic Diseases at the Peruvian University. Cayetano Heredia, in Lima.
“Given that this procedure requires a minimum of 6 minutes per participant, we are surprised that no global study exists that evaluates the simplification of the method, even though it may save time and therefore screen more people”, did he declare.
To explore this knowledge gap, the researchers analyzed World Health Organization (WHO) STEPS surveys at the population level. These surveys covered 145,174 individuals (mean age, 35 to 45 years) in 60 countries, including Ecuador and Uruguay. The data included each participant’s three blood pressure measurements, in addition to their anthropometric information and information on smoking status, fasting blood sugar and total cholesterol levels.
The researchers estimated the consistency between the possible diagnoses of the various simplified methods and those of the standard method. They calculated in each case how many cases could have been missed (i.e. the cases in which the patients had not been diagnosed with high blood pressure when it would have been detected with the reference method ) and how many patients might have been overdiagnosed.
Results can spark discussion
The results are encouraging, both globally and in the regions and countries studied. In all countries, compared to the standard approach, the simplified approach that missed the fewest cases (5.6%) used the second blood pressure reading if the first blood pressure reading was 130 -145/80-95 mm Hg. Next comes the approach that considers the second reading independently of the first (5.8%).
Conversely, using the second determination only if the first was ≥140/90 mm Hg missed 15% of patients with hypertension (i.e., it did not detect these patients as having hypertension). hypertension), but it is the method with the lowest rate of overdiagnosis: 3.03% worldwide. Using the second reading only if the first measurement was ≥ 140/90 mm Hg led to overdiagnosis, which nationally ranged from 1% to 11%. The authors consider that this simplified method offers the most “reasonable” proportion of underdiagnosis and overdiagnosis.
“The results indicate that simplified methods may be useful and provide an alternative to hypertension screening to reach more people. These results can initiate the discussion on simplified methods and, if necessary, motivate validations in each country to choose the best protocol. co-author Wilmer Guzman-Vilca, a medical student and member of CRONICAS and the Scientific Society of Medical Students of Cayetano Heredia, Lima, Peru, said Medscape Spanish Edition.
Using regression models and available survey data in 54 countries, the researchers noted that the cardiovascular risk after 10 years for hypertensive patients whose cases were missed with the simplified methods was slightly lower than that of their peers whose hypertension was detected, which serves as additional reassurance. “However, this observation deserves further exploration, including prospective studies,” Guzman-Vilca said.
According to the researchers, the use of simplified methods of blood pressure measurement with two determinations instead of three could allow the screening of 20 people per hour instead of 10 per hour, which could be useful in large campaigns and in clinics that lack sphygmomanometers or staff, especially in low- and middle-income countries.
“Spreading the reliability of a simplified method could help drive testing campaigns that would benefit hundreds or thousands of people,” Carrillo-Larco said. “Similarly, they could promote the performance of screenings in busy healthcare facilities, and the treating physician could thus decide on the next steps, such as a new measurement following clinical diagnostic guidelines or the use of other instruments, such as home measurement, as required in each case.” Carrillo-Larco emphasized that the study results are applicable for screening, not for initiating treatment or for monitoring patients with hypertension. “It is still premature for these indications.”
Two big problems
The new study also works as a safeguard for countries that, due to time or personnel constraints, currently conduct population screening campaigns using two or even one determination per person instead of the recommended three. It can also allow them to adjust their diagnosis, as in Argentina. When in 2017 the Argentine Society of Arterial Hypertension (SAHA) joined the International Society of Hypertension (ISH) Global May of Measurement (MMM) Campaign, its authorities felt that it was impractical for participants to answer a 28-question survey and have their blood pressure taken three times. The MMM campaign has benefited over one million people in hundreds of countries.
“We decided that the survey would consist of only nine questions and that blood pressure would be taken twice, averaging the results,” said Marcos Marín, MD, president of SAHA and former coordinator of the Know and SAHA’s Control Your Blood Pressure. Medscape Spanish edition.
“We asked the ISH if it would work, and they said yes. There are countries that only took one blood pressure measurement. It’s not ideal, but it was a campaign of awareness,” said Marín. SAHA’s Know and Control Your Blood Pressure campaign screened 98,000 people in 2019 alone. That total was “the third-largest country in the world by amount,” Marín said.
Besides the very low level of surveillance, the lack of awareness is one of the two big problems, Marín said. “Four out of 10 people with high blood pressure don’t know they have it.” In addition to increasing specific population screening campaigns, more doctors should take blood pressure appropriately at the consultation, he said.
Marín is co-author of the recent published Study of the Argentine Registry of Blood Pressure Measurement in Consultation (RAMPAC). In this study, the researchers analyzed all outpatient consultations conducted one day in September 2019 in nine health centers. It revealed that in only 14.1% of consultations, doctors performed this measurement. “There is a lot of work to do,” concluded Marín.
Carrillo-Larco, Marín and Guzman-Vilca disclosed no relevant financial relationships.
Follow Matías A. Loewy of Medscape Spanish Edition on Twitter @MLoewy.