Blood pressure measurement is likely the most important diagnostic test performed in modern medicine because it is the leading cause of death or disability in the world, affecting nearly 1.5 billion individuals globally. As we move into the era of population health and big data, it is clear that having the capability of implementing large systematic blood pressure management programs has the potential for huge impact in preventing morbidity and mortality, and creating large cost savings for patients and systems.
To roll out a blood pressure management program, we need to clearly define what is an accurate blood pressure measurement and how is it obtained. Who performs the blood pressure measurement? Is it the physician or other clinical staff? How do you make sure that appropriate person is trained to take accurate measurements? Or maybe the better question, given the hectic workflow of most clinics, how can systems change to support taking accurate BP measurements?
Or would an even better question be how useful is the clinic blood pressure measurement? How do you make sure the patient isn’t suffering from White Coat Hypertension? Or maybe isn’t stressed about the White Coat, but is stressed about the 30 minutes it took to find parking before rushing into the clinic? How many measurements does it take to label a patient with hypertension?
Given the era of home blood pressure machines, do we think that hypertension should be diagnosed and managed with clinic blood pressure readings alone? How do we incorporate home blood pressure readings?
Most recently, the American Medical Association published the results of a Blood Pressure Check Challenge for medical students. They took 159 medical students from around the country and tested them on their ability to perform 11 key elements of a blood pressure check during a mock exam during a simulated encounter with a patient actor. Only 1 student scored 100%. On average, students performed just over 4 of the 11 skills correctly. One expert commented that these results suggest that the medical students were “falling well below what we would expect in terms of basic clinical competency.”
Does this study suggest that there is a larger problem with blood pressure measurements? Is it limited to medical students? Are nurses, physician assistants, medical assistants, and pharmacists receiving the training they should be receiving? How should this be addressed?