BLOODPRESSURE

of a small cuff that records BP every

Updated AHA guidelines on BP 15 to 30 minutes. Benefits of 24-hour
measurement reflect emerging science monitoring include identifying poten-
tial white-coat, masked, or nocturnal

W hen measuring blood pressure (BP), pharmacists and other health

care practitioners should select appropriate cuff sizes, allow
patients to relax for 3 to 5 minutes beforehand, and provide verbal
hypertension that would otherwise go
undetected during routine office mea-
surements. However, ABPM is uncom-
and written results afterward. Automated machines are also the devices mon in the United States because of lim-
ited availability and reimbursement.
of choice for BP measurement, rather than manual methods, which are Another addition to the statement is
more prone to human error. These and other key points are emphasized a section on HBPM, which studies have
in the American Heart Association’s (AHA) new statement on BP mea- shown is more strongly related to car-
surement, published online in Hypertension on March 4. The new state- diovascular risk than office BP. HBPM
ment updates AHA’s 2004 recommendations. can also assist in identifying white-coat
and masked hypertension. Pharmacists
“We tried to address those areas used repeatedly over several years, should advise patients who do HBPM to
where new science has emerged that regular servicing is advised “to protect use validated machines with an upper-
we hope will lead to more accurate against loss of accuracy.” arm cuff (rather than finger or wrist
blood pressures being taken,”  Paul monitors) that have memory to store
Muntner, writing group chair, told White-coat hypertension readings along with their respective
Pharmacy Today. The AHA statement also addresses dates and times.
white-coat hypertension, in which
Automated measurement patients who are not on BP medication Pharmacy monitoring
For example, improved electronic are hypertensive during clinic visits The growing body of research sup-
oscillometric devices are ideal for but normotensive otherwise. Newer porting pharmacist-based interven-
routine clinical use “because they research suggests that AOBP monitor- tions is also highlighted in the AHA
require fewer skills” than ausculta- ing—particularly with the observer statement. For example, patients who
measure their BP in pharmacies may
be less likely to experience a white-
“Blood pressures measured in pharmacies may be better coat effect. The authors suggested that
than what’s measured in doctors’ offices.” pharmacy-measured BP may soon
be an alternative to ABPM or HBPM
when these options are not available or
tory methods that involve listening for are not preferred.  However, repeated
Korotkoff sounds, said Muntner, associ- training of pharmacists and validation
ate dean for research at the University and calibration of BP devices are criti-
of Alabama at Birmingham’s School of cal, they noted.
Public Health. One-touch automated “Blood pressures measured in phar-
machines also enable medical staff to macies may be better than what’s mea-
leave the room—consequently allowing sured in doctors’ offices,” Muntner said,
patients to relax—while multiple mea- describing the pharmacy as a “more
surements are obtained. natural environment that people are
Furthermore, there are “strong data used to.”
supporting their use,” Muntner said of Katherine Cabral, PharmD, a board-
the automated devices. Measurements removed from the room—may be certified cardiology pharmacist at
taken with automated office blood pres- one way to decrease the prevalence Albany College of Pharmacy and
sure (AOBP) monitors may also more of this phenomenon, according to the Health Sciences in New York, said the
closely resemble awake out-of-office BP statement’s authors.  They noted that AHA statement had her thinking about
measurements than auscultatory mea- annual ambulatory blood pressure BP measurement techniques in her own
surements, the statement indicated. monitoring (ABPM) or home blood practice and how she can make sure
One caveat to the use of these elec- pressure monitoring (HBPM) should be machines are validated and calibrated.
tronic devices is their need for vali- considered for untreated individuals to “Accurate measurement really does
dation, calibration, and maintenance. identify those who transition to persis- have an impact on management,” she
They are usually validated only once tent hypertension. told Today.  
“at the beginning of a new line of ABPM for 24 hours can also confirm
production,” wrote Muntner and col- hypertension diagnoses, the statement Charnicia Huggins, PharmD,
leagues.  Because they are typically mentions. This method requires use contributing writer

www.pharmacist.com MAY 2019 • PharmacyToday 19

BP Measurement_05_19.indd 19 4/22/2019 3:31:30 PM