Hypertension

Updated 04 July 2014

BP readings often inaccurate, expert warns

Although more accurate measures are available, South African doctors are still using out-dated equipment to measure blood pressure, an expert has warned.

The onset of new medical technology has paved the way for a more modern and convenient way to measure blood pressure which, although having met great success internationally, is yet to be widely adopted in South Africa. The adoption of the more accurate ambulatory blood pressure devices is a valuable tool to more accurately diagnose and stabilise hypertension in South Africa.

This is according to Professor Brian Rayner, head of the Southern African Hypertension Society, speaking at a media briefing hosted by Cipla Medpro held in Cape Town on Tuesday.

Rayner says although more accurate measures are available, South African doctors are still using out-dated equipment to measure blood pressure. "Although blood pressure can be relatively easily checked, in doctors’ offices, pharmacies and clinics, recent research has shown that one blood pressure reading is often inaccurate and misleading," he says.

Rayner points to studies presented at this year's American Society of Hypertension's annual meeting which found that many "healthy" people are unknowingly living with "pre-" conditions such as diabetes and high blood pressure, that are not picked up in a single reading.

"Given that high blood pressure is one of the leading causes of heart attacks, strokes, kidney failure and premature death among South Africans, this is a real concern. It has become more important than ever to monitor people’s health in the most accurate ways possible," he says.

Rayner explains that the mercury sphygmomanometer device currently used by most medical practices in South Africa is a device that is over 100 years old. He adds that devices containing mercury are being withdrawn due to safety concerns.

'Fraught with inaccuracy'

"Affectionately attached though we may be to this clinical measurement, we must acknowledge that the technique is fraught with inaccuracy and that the age of technology has brought more accurate alternative methodologies. However, we must ensure that the automated devices that are replacing the conventional technique are validated independently for accuracy," he says.

Rayner says more accurate readings are possible by using 24-hour ambulatory blood pressure monitoring (ABPM), or home blood pressure monitoring (HBPM), rather than be based solely on measurements of blood pressure taken in the clinic.

According to Rayner, the use of ABPM has been written into the NICE (National Institute for Health and Care Excellence) recommendations in the UK. NICE guidelines set the standards for healthcare and healthy living and are used by the NHS, local authorities, employers voluntary groups and anyone involved in delivering healthcare or promoting wellbeing. 

"In one of the biggest changes to NICE's previous guidance published in 2006, the guideline recommends that a diagnosis of primary hypertension should be confirmed using 24-hour ambulatory blood pressure monitoring (ABPM). I’m confident that this addition into the guidelines is set to significantly improve the way health professionals diagnose and treat high blood pressure in the NHS in England and Wales," he says.

Rayner says the recommendation draws on substantial new evidence, suggesting that ABPM is more accurate than both clinic and home monitoring in defining the presence of hypertension.

Taking BP at specific intervals

"With ABPM, multiple automatic measurements of blood pressure are obtained at specific intervals throughout a 24-to 48-hour period, enabling the clinician to assess the level of blood pressure control under conditions of a normally active day," Rayner explains.

Rayner says although ABPM is not applicable to all hypertensive patients, it is particularly useful in patients with borderline hypertension, white-coat hypertension, suspected autonomic dysfunction, and episodic hypertension. It also is useful in the evaluation of drug resistance and medication compliance.

"It is also expected that the implementation of a diagnostic strategy for hypertension using ambulatory monitoring following an initial raised clinic reading would reduce misdiagnosis and save considerable costs for the NHS in the UK. The South African medical industry has much to gain from considering the same changes to the way that blood pressure is monitored and we strongly support recommendations for the widespread use of ABPM," he says.

Cipla Medpro press release

 

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Hypertension expert

Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.

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