AHA High Blood Pressure Toolkit

7 DIAGNOSING The appropriate diagnosis of elevated BP or hypertension should involve accurate measurement of BP, self-monitoring of BP in the home, screening for white-coat hypertension or masked hypertension and for secondary causes of hypertension, and evaluating the use of BP-increasing medications and substances. In addition, BP readings from self- monitoring should be integrated into practice to confirm the diagnosis. For patients with a diagnosis of stage 1 hypertension, the ASCVD Risk Calculator should be used to estimate the patient’s 10-year and lifetime risk for atherosclerotic CVD. This estimate is a factor in determining the most appropriate treatment. A team-based approach is recommended. Measuring BP Accurate measurement of BP is essential to proper prevention, detection and management of BP. Errors in measuring BP can have a substantial effect on BP, with estimated changes of 2 to 50 mm Hg. Recognizing the importance of accurate measurement of BP, the 2017 guideline focuses on the standards for accurate measurement of BP. A team-based approach to care is recommended. Such an approach has been associated with lower systolic and diastolic measurements as well as an increased proportion of people with controlled BP. Teams consisting of physicians, nurses, physician assistants and pharmacists Diagnosing BP can have the greatest impact on improving the monitoring and management of blood pressure. The guideline describes six key steps for proper measurement of BP. Use of the wrong size cuff is the most common error in measuring BP. The discrepancy in systolic BP can be as great as 10 mm Hg if the cuff is too small; the difference in diastolic BP can be as great as 8 mm Hg. To ensure accurate measurements, the guideline offers the following recommendations for selecting the appropriate size cuff. Arm Circumference (cm, inches) Usual Cuff Size 22-26 (8.5-10.2) Small adult 27-34 (10.6-13.3) Adult 35-44 (13.8-17.3) Large adult 45-52 (17.7-20.5) Adult thigh In Practice Download the ASCVD Risk Calculator or launch a web version. AHA recommended blood pressure levels BLOODPRESSURECATEGORY SYSTOLICmmHg (uppernumber) DIASTOLICmmHg (lowernumber) NORMAL LESS THAN120 and LESS THAN 80 ELEVATED 120-129 and LESS THAN 80 HIGHBLOODPRESSURE (HYPERTENSION)STAGE 1 130-139 or 80-89 HIGHBLOODPRESSURE (HYPERTENSION)STAGE 2 140ORHIGHER or 90ORHIGHER HYPERTENSIVECRISIS HIGHER THAN 180 and/or HIGHER THAN 120 © 2018AmericanHeartAssociation, Inc.,All rights reserved. *For auscultatory determinations,use a palpated estimate of radial pulse obliteration pressure to estimateSBP. Inflate the cuff 20-30mmHg above this level for an auscultatory determination ofBP level.For auscultatory readings,deflate the cuff pressure, 2mmHg per second and listen forKorotkoff sounds. **For auscultatory technique, recordSBP andDBP as onset of the firstKorotkoff sound and disappearance of allKorotkoff sounds respectively,using the nearest even number. AmericanHeartAssociation’s efforts to improve healthy choices related to livingwith high blood pressure is proudly supported byTYLENOL ® . SEATPATIENTWITH FEET FLATONTHE FLOOR,RELAXEDANDQUIET FOR 5MIN. HAVEPATIENTEMPTYBLADDERANDAVOID CAFFEINE,EXERCISEANDSMOKING FOR 30MINUTES.REMOVECLOTHING FROMARM. 1 2 USEPROPERLYVALIDATED, CALIBRATEDBPMEASUREMENT DEVICE.SUPPORTPATIENT’SARM ANDPOSITIONCUFFONBAREARM ATLEVELOFTHERIGHTATRIUM. USECORRECTCUFFSIZE. Usual sizesbasedonarm circumference: 22-26 cm=SmallAdult 27-24 cm=Adult 35-44 cm= LargeAdult 45-52 cm=Adult Thigh FIRSTVISIT,RECORDBP INBOTH ARMS,USING THEARMWITH HIGHERREADING.SEPARATE REPEATEDMEASUREMENTS BY 1-2MINUTES.* 3 RECORDSBPANDDBP**.NOTE TIMEOFMOSTRECENTBPMED TAKENBEFOREMEASUREMENT. 4 USEANAVERAGEOF 2READINGS OBTAINEDON2OCCASIONS TOESTIMATE THE INDIVIDUAL’S LEVELOFBP. 5 PROVIDEPATIENT THE SBP/DBPREADINGSBOTH VERBALLYAND INWRITING. 6 STEPS FOR ACCURATE BP MEASUREMENT LEARN MOREAT HEART.ORG/HBPROUTINE