Blood Pressure Methodologies: Which is most accurate?
Purpose: Obtaining a patient's blood pressure (BP) is one of the most common tests performed by physical therapists. It is standard practice to obtain client's blood pressure before, during and after treatment as a method of assessing the client's responce to treatment. Measurement accuracy is important, as inaccuracies can lead to unsafe treatments.1 Methods of measuring BP continue to evolve with some methods being fully automated. This may lead clients to question why a therapist is using a manual sphygmomanometer to obtain their BP when there are alternate methods. As health care professionals, it is important to know which method of measuring BP is most accurate, allowing informed decision making regarding client care and to be able to explain to a client why one method is prefered over another.Methods/Description: A systematic review of literature was conducted using the databases PubMed, Cochrane Library, and PEDro with the following phrases: non-invasive blood pressure, invasive vs noninvasive, radial artery, oscillometric blood pressure, auscultatory blood pressure, wrist cuff blood pressure and accuracy. Articles selected met the following criteria: 1) peer-reviewed, 2) published in the 21st century and 3) at least 30 human participants. Two different methods of non-invasive BP measurements were analyzed: auscultatory and oscillometric. Sub-categories were then established. Auscultatory measurements were split into mercury and aneroid sphygmomanometers, while oscillometric measurements were divided into upper arm and wrist cuffs. The auscultatory method is known as the standard method for BP measurement in medical practices, with the mercury sphygmomanometer considered to be the gold standard.3-5 For this review, a "very accurate" measurement was defined as having a range variability between the specified method and the gold standard of less than four, "fairly accurate" between four and eight, and "not accurate" as anything greater than eight.3,8-12Results/Outcomes: Auscultatory devices - Studies reported a range variability between aneroid and mercury sphygmomanometer measurements to be 3.2 mmHg for Systolic BP (SBP) and 2.9 mmHg for Diastolic BP (DBP)9. These values meet the "very accurate" category. Oscillometric device - Upper Arm: Studies report a range variability between the oscillometric upper arm cuff to the mercury sphygmomanometer of 5.0-6.14 mmHg in SBP and 4.0-6.65 mmHg in DBP. These values meet the "fairly accurate" catagory. Oscillometric device - Wrist cuffs: Studies report a range variability between the oscillometric upper arm cuff to the mercury sphygmomanometer of 8.1-8.7 mmH in SBP and 5.8-8.0 mmHg in DBP. These values meet the "not accurate" catagory for SBP and "fairly accurate" catagory for DBP.Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: This study found that, when compared to the gold standard of mercury sphygmomanometry, the aneroid sphygmomanometer is most accurate. Oscillometric devices on the upper arm were "fairly accurate" while on the wrist were "fairly accurate" to "not accurate."References: Handler J. The Importance of Accurate Blood Pressure Measurement. Perm J. 2009;13(3). Clark-kennedy A. Stephen Hales, DD, FRS. Br Med J [serial online]. December 24, 1977;2(6103):1656. Chio, S., Urbina, E. M., Lapointe, J., Tsai, J., & Berenson, G. S. 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