Automated BP Cuffs, Home Monitoring and Hypertension Definitions
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the appropriate steps to improve accuracy of BP measurements 2. State the definitions of hypertension categories according to the ACC/AHA guidelines
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from through , participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
The AHA has released a statement on taking BP measurements, a topic also addressed in detail as part of the most recent ACC/AHA task force document. Appropriate preparation is vital to obtaining accurate BP measurements. Following recommended protocols when obtaining a BP measurement can improve accuracy
Prior to Obtaining BP Measurement
Ask about the following when taking the family and personal history
Medication history (BP and non-BP meds)
If patient is on BP meds, is patient currently taking as prescribed
If not taking medications appropriately, identify barriers
Discuss physical activity and diet
If either/both are limited, determine why
Caffeine, exercise and smoking should be avoided at least 30 minutes before BP measurement
When Obtaining BP Measurement
Ensuring the following will prevent artificial increase in BP levels
Use correct cuff size
Bladder should encircle 80% of the arm
Remove clothing covering cuff placement
Place and support arm at heart level (atrium / mid-sternum)
Ask patient to uncross legs
Patient should sit on chair, feet on floor and back supported for > 5 min before taking pressure (not lying or sitting on an exam table)
No talking while measurement is taken
Have patient empty bladder
The new ACC/AHA taskforce
guidelines have resulted in a change with respect to lowering the threshold for
making the diagnosis of hypertension. However, accuracy in obtaining the
measurements in critical for accurate management and treatment plan. The AHA has
released a scientific statement (2019), maintaining that validated
oscillometric devices allow accurate BP measurement in the outpatient setting,
while reducing human errors associated with the auscultation. The AHA document
further states that
Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation
Hypertension Definitions (ACC/AHA)
Systolic <120 mmHg and diastolic <80 mmHg
Systolic 120 to 129 mmHg and diastolic <80 mmHg
Stage 1: Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
Stage 2: Systolic ≥140 mmHg or diastolic ≥90 mmHg
‘White Coat’ hypertension
Elevated BP in the office but not outside the office
Checking for ‘White Coat’ hypertension using either daytime Ambulatory Blood Pressure Monitoring (ABPM) or Home Blood Pressure Monitoring (HBPM) is “reasonable” if
Office SBP is >130 but <160 mm Hg or
Office diastolic BP (DBP) >80 but <100 mm Hg
Elevated BP out-of-office but not in-office
Checking for ‘masked’ hypertension with daytime ABPM or HBPM is “reasonable if”
Office SPB is 120 to 129 and DBP is <80
Hypertensive emergency (formerly called ‘malignant hypertension’)
Severe hypertension: SBP ≥180 mmHg or DBP ≥120 mmHg
Consider this a medical emergency which may need ICU care
Uncontrolled BP despite treatment ≥3 antihypertensive agents (one of which is usually a diuretic)
Making the Diagnosis (ACC/AHA)
Use an average based on ≥2 readings obtained on ≥2 occasions
Out-of-office and self-monitoring can be used to
Confirm the diagnosis of hypertension
Titrate BP-lowering medication
Counsel via Telehealth
Night-time ABPM: 120/70
24-hour ABPM: 130/80 mm Hg
In adults with untreated systolic BP (SBP) >130 but <160 mm Hg or diastolic BP (DBP) >80 but <100 mm Hg, “it is reasonable” to screen for the presence of white coat hypertension using either
Daytime ABPM or HBPM
Note: The diagnosis of hypertension requires integration of HBPM or ABPM in addition to measurements made in the clinical setting
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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