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When Getting Blood Pressure Taken At Doctor's Office, How You Sit Matters
Millions of people with normal blood pressure might be misclassified as having blood pressure that is too high because of improper positioning when measurements are taken, new research suggests.
Guidelines from the American Heart Association and the American College of Cardiology call for a person to be seated in a chair with feet flat on the floor, back supported and the arm wearing the blood pressure cuff supported at heart level. Doing so helps ensure an accurate reading.
But many health care professionals take blood pressure measurements while the patient is seated on an examining table, leaving legs dangling and back and arm unsupported.
"That's not conducive to taking blood pressure accurately," said Dr. Randy Wexler, a primary care physician at The Ohio State University Wexner Medical Center in Columbus who was a researcher in he new study.
Being misclassified with high blood pressure, also called hypertension, can lead to "people undergoing treatment who don't need it," Wexler said. "People may not need to be on as much medication, which has side effects. That's where having good and accurate blood pressure measurements becomes important."
In the study, 150 adults were randomly assigned to one of three groups. In one group, blood pressure readings were taken on a fixed-height exam table and then in an exam chair with adjustable positioning. A second group had the same readings taken in reverse order. A third group had both sets of readings taken in the exam chair. There was a rest period before each set of readings. Results were pooled, and the average of three measurements taken on the table were compared to the average of those taken in the chair.
For readings taken on the exam table, the average systolic (top number) blood pressure was 7 mmHg higher and the average diastolic (bottom number) reading was 4.5 mmHg higher than those taken seated in the chair, adhering to guideline-recommended positioning.
The researchers concluded that the difference in results was large enough to misclassify millions of people as having hypertension when it was actually in the normal range.
"We were not surprised there was a difference," Wexler said. "We were surprised at how much of a difference there was."
The findings were published in September in the journal eClinicalMedicine.
Nearly half of all U.S. Adults are estimated to have high blood pressure. Hypertension is diagnosed when measurements consistently reach or exceed 130 mmHg systolic or 80 mmHg diastolic.
People given medication to lower blood pressure when they don't need it are at risk for pushing their blood pressure too low, a condition known as hypotension, said Dr. Jordana Cohen, a nephrologist at Penn Medicine in Philadelphia who was not involved in the new research. Low blood pressure can cause dizziness, lightheadedness and fainting and can lead to falls.
"We need to make sure we measure blood pressure correctly and treat it correctly," said Cohen, who is also an associate professor of medicine at the University of Pennsylvania. "Health systems need to prioritize this. We have to convince them it is economically smart to do so because it will lead to better outcomes."
Health care professionals see so many patients with so many chronic conditions that they often don't have enough time to take blood pressure measurements properly, Wexler said.
Research suggests that primary care providers would need more than 26 hours per day to follow all preventive and chronic disease care guidelines for seeing patients, or more than nine hours per day when providing team-based care.
"We need to make things more efficient," Wexler said. "But how do we make changes that are doable without slowing down the process of the visit?"
Single Dose Of An Experimental Drug Helped Lower Blood Pressure For 6 Months
An investigational drug called zilebesiran has been found to be safe and effective in reducing systolic blood pressure in people with mild-to-moderate high blood pressure for up to six months with just one injection.
These findings from the drug's phase 2 clinical trial were recently presented at the American Heart Association's Scientific Sessions 2023.
Over 1 billion people around the world have high blood pressure, medically known as hypertension.
Past studies show that having high blood pressure increases a person's risk for several cardiovascular issues, such as stroke, heart failure, and atrial fibrillation.
Additionally, people with hypertension have a higher chance of kidney damage, metabolic syndrome, dementia, and vision issues.
High blood pressure is treated through medications and lifestyle changes, such as a healthy diet and increased physical activity.
However, previous research shows not all people with high blood pressure adhere to their prescribed medication, with many stopping taking the drugs after one year. This leaves them open to risks associated with uncontrolled hypertension.
According to Dr. George L. Bakris, professor of medicine and director of the American Heart Association Comprehensive Hypertension Center at the University of Chicago Medicine and lead author of this study, over 70% of people with hypertension either do not take their medications or do not take them as prescribed.
"Hence (we) have less than 30% of people with hypertension controlled in the country," Dr. Bakris told Medical News Today. "This is in spite of the fact that we have over 100 antihypertensive medications for use."
Dr. Cheng-Han Chen, a board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA — who was not involved in this study — agreed:
"It is thought that a large percentage of patients do not take their blood pressure medications as prescribed. When patients are not completely adherent to their medication regimen, (the) chances of their blood pressure not being under control increase, which in turn increases their risk of a cardiovascular event.
A big problem is simply the large number of prescribed medications that patients need to keep track of, some of which need to be taken multiple times a day."
Dr. Jennifer Wong, a board-certified cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, told MNT she has found that compliance with high blood pressure medication can be difficult with any daily medication that does not have an immediate tangible effect.
"Uncontrolled hypertension is a major risk factor for developing atherosclerotic diseases," Dr. Wong continued. "And often it's such a future event that many patients find it difficult to take …medication regularly. Every 10 mm drop in blood pressure can significantly reduce their risk for these diseases."
Zilebesiran is an investigational RNA interference agent targeting angiotensinogen (AGT). AGT is a hormone mainly produced in the liver that helps regulate a person's blood pressure.
"Zilebesiran blocks the message within the cell that stimulates (the) production of a substance called angiotensinogen," Dr. Bakris explained. "This is the substance that is transformed into angiotensin II — (a) potent agent that causes arteries to constrict and raises blood pressure."
"Angiotensin II has many purposes but, in excess, can raise blood pressure," he added. "Thus, blocking its production reduces the likelihood of blood pressure elevation and will lower pre-existing high blood pressures."
For this study, Dr. Bakris and his team recruited about 400 people with mild-to-moderate high blood pressure, defined as systolic blood pressure of 135-160 mm Hg. All participants were either untreated for high blood pressure or on stable therapy with up to two antihypertensive medications.
Study participants received either 150mg, 300mg, or 600mg doses once every six months, a 300mg dose once every three months of zilebesiran, or a placebo.
After six months, researchers found participants who received zilebesiran were significantly more likely to experience 24-hour average systolic blood pressure reductions of 20 mm Hg or more without needing to take additional high blood pressure medications.
Study participants taking zilebesiran were also more likely to reach 24-hour average systolic blood pressure measurements of 130 mm Hg or less at six months.
"I was pleasantly surprised that the effect lasted six months, but based on what I knew about the drug, I expected three months. Also, I did not expect the magnitude of the fall to be as great as 14-15 mm Hg, but more like 7-8 mm Hg, which is what the pills deliver. But then again, zilebesiran more effectively blocks the system."
– Dr. George L. Bakris
After reviewing this research, Dr. Ian del Conde, cardiologist and director of vascular medicine at Miami Cardiac & Vascular Institute, part of Baptist Health South Florida, told MNT that this is an exciting study that marks a new era in the treatment of high blood pressure.
"I do not think most doctors anticipated a therapy such as this just a few years ago," Dr. Del Conde continued. "The idea that a chronic condition that is extremely prevalent in all societies in the world and has been clearly shown to increase the risk of premature death can be effectively and safely treated with a single injection administered every six months or so is a game changer."
"[D]espite the availability of several classes of blood pressure-lowering drugs that are effective, safe, and expensive, there are still many patients who do not have our code for pressure control. Adherence or tolerance to the usual therapies is a common cause of uncontrolled blood pressure. This new treatment may change the way you treat high blood pressure in the future."
Prof. Sir Nilesh Samani, Medical Director at the British Heart Foundation, also reviewed the study and told MNT:
"This study shows that an injection which could be given as little as twice a year is effective at lowering blood pressure. Further work is needed to show that it reduces heart attacks and strokes but if this is the case, then this could be a game-changing new treatment for high blood pressure."
Dr. Chen told MNT that doctors do not currently have any effective blood pressure medications for such a long time after a single dose.
"This type of dosing interval gives us a tool to improve blood pressure over a prolonged period of time without having to rely on consistent daily medication adherence," he added.
"This drug significantly lowered systolic blood pressure (by) at least 10 mm Hg on average, and sometimes 20 mm Hg or more on average," Dr. Chen continued. "As the average systolic blood pressure at the start of this study was 142mmHg, this meant that a patient's blood pressure could be brought to a 'normal' range simply with this injection, without the help of additional blood pressure medications."
Disposable Blood Pressure Cuffs Market Is Expected To Reach US$ 859.1 Million By 2033-FMI Study
The disposable blood pressure cuff market is expected to develop at a 12.3% CAGR between 2023 and 2033. It is anticipated that sales of disposable blood pressure cuffs will increase from US$ 268.7 million in 2023 to US$ 859.1 million by 2033.
The disposable blood pressure cuffs industry is experiencing substantial growth due to several key drivers. One major factor is the increasing prevalence of chronic diseases such as hypertension and cardiovascular disorders, leading to rising demand for blood pressure monitoring devices. Additionally, the emphasis on infection control in healthcare settings has boosted the adoption of disposable medical products, including blood pressure cuffs. The convenience offered by disposable cuffs, eliminating the need for cleaning and sterilization, has become an attractive feature for healthcare facilities, further driving their demand.
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While the disposable blood pressure cuffs industry is witnessing significant growth, it also faces certain restraints that impact its expansion. One major challenge is the higher cost of disposable cuffs compared to their reusable counterparts. Although disposable cuffs offer infection control benefits, their higher cost per use can pose budgetary constraints for healthcare facilities. Furthermore, environmental concerns related to increased medical waste generation from disposable products are also influencing the industry. The need for sustainable solutions and eco-friendly materials has prompted manufacturers to develop more environmentally conscious disposable cuffs, but this remains an ongoing challenge.
The disposable blood pressure cuffs industry is ripe with opportunities for growth and innovation. The increasing adoption of telemedicine and remote patient monitoring has opened up new avenues for disposable cuffs, as they are convenient for single use and provide accurate readings. Moreover, the expansion of healthcare facilities in developing regions presents a significant opportunity for market penetration. Manufacturers can tap into these emerging markets to meet the rising demand for cost-effective and hygienic blood pressure monitoring solutions.
The disposable blood pressure cuffs industry is witnessing several notable trends that are shaping its landscape. One prominent trend is the integration of advanced technologies, such as wireless connectivity and digital sensors, into disposable cuffs. This enables seamless data transmission to electronic health records and remote monitoring systems, enhancing patient care and data accessibility for healthcare professionals. Another trend is the development of disposable cuffs specifically designed for different patient populations, such as neonates, pediatric patients, and bariatric individuals, catering to diverse healthcare needs.
Key Takeaways:
What are Key Players Doing to Thrive in the Disposable Blood Pressure Cuffs Market?
The disposable blood pressure cuffs industry is characterized by intense competition and a diverse range of players vying for market share. Leading companies in this sector are continually striving to innovate and meet the evolving needs of healthcare professionals and patients.
In this highly competitive landscape, companies are continuously investing in research and development, strategic collaborations, and product innovations to gain a competitive edge. The disposable blood pressure cuffs industry is expected to witness further advancements and market growth as manufacturers focus on meeting the demands of a rapidly evolving healthcare landscape.
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