Home blood pressure monitoring, 3 minutes of speed reading essentials | guidelines consensus

2020/12/15

Family blood pressure monitoring has become an indispensable means to effectively improve the awareness and control rate of hypertension.Home blood pressure monitoring is strongly recommended in several recently published national or regional guidelines for hypertension.

How to do a good job in family blood pressure monitoring?

☆ In the diagnosis, treatment and management of hypertension, in addition to the measurement of blood pressure in the clinic, ambulate blood pressure monitoring, but also to recommend patients to carry out home blood pressure monitoring.

☆ It is recommended for hypertension patients to choose the upper arm oscillogram automatic electronic sphygometer which has been verified for accuracy in accordance with the standard protocol, and choose the appropriate size of cuff according to the circumference of the upper arm.

☆ Family blood pressure monitoring 2 ~ 3 times a day in the morning and night, interval 1 min, take the average.Blood pressure should be measured for 5-7 days before the first visit, early treatment, or if the blood pressure has not reached the target after treatment.When blood pressure is well controlled, measure at least 1 day a week.

☆ Family blood pressure measurement is an effective means to improve the awareness rate of hypertension. Therefore, it is recommended that family members without hypertension diagnosis should also have their blood pressure regularly measured at home, at least once a year;If the family blood pressure does not meet the diagnostic criteria for hypertension, but the level is high (130 ~ 134/80 ~ 84 mmHg), the blood pressure should be measured more times, at least once a month.

☆ Hypertension managers should actively promote family blood pressure monitoring, including current hypertensive patients receiving antihypertensive treatment, and current normal blood pressure;Instruct patients with hypertension to choose appropriate sphygmomanometer, cuff and other accessories, and train patients with blood pressure measurement knowledge and methods;Refer to the patient's home blood pressure monitoring records when formulating or changing treatment plans.

How to monitor family blood pressure?

1. Family blood pressure monitoring conditions

If an upper arm sphygmomanometer is used for home blood pressure monitoring, the general conditions for measuring blood pressure are approximately similar to those for measuring blood pressure in the clinic.

Sit in a chair with a back and rest for at least 5 minutes before starting to measure blood pressure.To measure blood pressure, place the forearm on one side of the cuff on the table. The midpoint of the upper arm of the cuff is at the same level as the heart. Relax your legs and land on the floor.You can also opt for more comfortable seating, such as a lower seat such as a sofa, but make sure the midpoint of the upper arm where the cuff is tied is level with the heart.

2. Choose the right size cuff and airbag

When purchasing a sphygmomanometer, the seller should be required to provide a cuff of the appropriate size that matches the upper arm circumference of the primary user of the sphygmomanometer.

Currently, most electronic sphygmomanometers are equipped with a standard cuff (upper arm circumference & LT;32 cm) and a large cuff for those with large upper arm circumference (upper arm circumference ≥32 cm).Small cuff should be used for blood pressure measurement in children, adolescents or other persons with excessive upper arms.

3. Record the measured blood pressure values

Records should include the person's name, date and time of measurement, systolic, diastolic and pulse, and if the sphygmomanometer provides the mean or pulse pressure, they should also be recorded.

Electronic sphygmomanometer with automatic transmission function has prominent advantages in remote hypertension management and is the preferred choice for family blood pressure monitoring.

Learn how to use the sphygmomanometer

During or after the purchase of the sphygmomanometer, you should have a detailed understanding of the sphygmomanometer usage. If necessary, you can also seek help from the medical institution to verify or correct the accuracy of the sphygmomanometer.

How to select (verify) and calibrate a sphygmomanometer?

1. Select an electronic sphygmomanometer that has been verified by a standardized protocol

The electronic sphygmomanometer shall be verified for accuracy in accordance with a standardized verification protocol.Recently, the European Society for Hypertension (ESH), the International Standards Organization (ISO) and the American National Standards Body/Medical Devices Association (ANSI/AAMI) jointly developed a unified protocol for the accuracy verification of AAMI/ESH/ISO blood pressure monitors.

In the future, through the cooperation with government regulators and the business community, this scheme will become the only accuracy verification scheme for sphygmomanometer, and will be promoted and applied worldwide.Clinically proven blood pressure monitors can be found on the relevant websites (www.dableducational.org or www.bhsoc.org).

2. The sphygmomanometer needs to be calibrated regularly

The sphygmomanometer should be calibrated regularly during use, at least once a year.You can ask for help at the purchase or medical office to perform calibration.Companies with a well-established sales network will also often provide calibration services for the blood pressure monitors they sell.

3. Different types of blood pressure monitors

(1) Electronic sphygmomanometer with upper arm automatic oscillograph method: The verified electronic sphygmomanometer with upper arm automatic oscillograph method has good accuracy and repeatability, abundant clinical research evidence and easy to master measurement method, which is the preferred recommendation for family blood pressure measurement.

(2) automatic wave method in wrist electronic blood pressure monitor: carry more convenient, don't need to be exposed upper arm, when used in or take off your clothes in cold region is not convenient (disabled) is used more convenient, but the placement of forearm method differences between different blood pressure is larger, so if you choose to use wrist sphygmomanometer, should be carried out in strict accordance with the instructions on the use of the blood pressure cuff blood pressure measurement.

(3) Finger automatic oscillographic electronic sphygmomanometer: it is not recommended.

(4) Auscultation mercury sphygmomanometer: the use of mercury sphygmomanometer for home blood pressure monitoring is not recommended.

(5) Auscultation simulation of mercury or barometer: not recommended for home blood pressure monitoring.

(6) All types of sleeveless tape blood pressure measurement: not recommended.

How often (times), how often, how long, how often?

In the process of family blood pressure monitoring, blood pressure should be measured early and late every day. Each measurement should be taken 2 to 3 times with an interval of 1 min after resting for 5 min in the sitting position.

Patients who are newly diagnosed and whose blood pressure is at an early stage of treatment or whose blood pressure is not up to standard after treatment should be measured continuously for 5-7 days before treatment.When blood pressure is well controlled, measure at least 1 day a week.

Generally, blood pressure should be measured in the morning within 1 h of getting up, before taking blood pressure medications, before breakfast, and before strenuous activity.Considering that Chinese residents have an early dinner time, it is suggested that blood pressure should be measured in the evening after dinner and before going to bed.

Pay attention to emptying the bladder before measuring blood pressure in the morning or at night.To ensure the quality of home blood pressure monitoring, the time of getting up, going to bed, meals and medication should be recorded during the monitoring period.

What are the diagnostic and therapeutic criteria for family blood pressure?

Hypertension can be diagnosed when the average family blood pressure is ≥135/85 mmHg, or the blood pressure is not under control.When the room blood pressure ≥140/90 mmHg, and family blood pressure & LT;At 135/85 mmHg, it can be diagnosed as "white-coat hypertension" or "white-coat uncontrolled hypertension";And when the clinic blood pressure & LT;When the family blood pressure is ≥135/85 mmHg, 140/90 mmHg can be diagnosed as "hidden hypertension" or "hidden uncontrolled hypertension".

Family blood pressure monitoring can also be used to assess the blood pressure in the morning and at night. According to whether the average blood pressure in the morning and at night is ≥135/85 mmHg, morning and evening hypertension can be diagnosed.In patients receiving antihypertensive therapy, determine whether blood pressure in the morning and evening has been effectively controlled.

What is the significance of family blood pressure monitoring?

1. Improve the awareness rate of hypertension: timely detection of elevated blood pressure through regular blood pressure measurement, so as to timely diagnosis and treatment of hypertension and prevent the occurrence of cardiovascular and cerebrovascular complications.

2. Improve the accuracy of hypertension diagnosis: Family blood pressure monitoring can reflect a person's blood pressure level in daily life more accurately and comprehensively, and can effectively identify "white coat hypertension" or "white coat uncontrolled hypertension" and "hidden hypertension" or "hidden uncontrolled hypertension".

3. Improve the accuracy of prognosis judgment of hypertension patients: Compared with the blood pressure in the clinic, family blood pressure monitoring has certain advantages in prognosis judgment.

4. Improve the compliance rate of antihypertensive treatment: timely detection of uncontrolled blood pressure to provide a basis for the adjustment of antihypertensive treatment.