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3 readings must for correct BP diagnosis

April 15, 2019 06:35 AM

courtESY TOI APRIL 15

3 readings must for correct BP diagnosis
TIMES NEWS NETWORK

Mumbai:

Chances of a patient’s blood pressure readings not being accurate are high if not taken thrice during a visit, finds a new Indian study.


The study by the Public Health Foundation of India and AIIMS has calculated that there is a 63% higher prevalence of hypertension if only the first blood pressure reading is considered for diagnosis in comparison to the mean of the second and third readings.

“Improper measurement can lead to inaccurate classification, overestimation of true BP, unnecessary treatment, and misinterpretation of the true prevalence of hypertension,” said the authors of the study published in the Journal of Human Hypertension.


Current blood pressure practice leads to unwanted treatment

The normal blood pressure for a young person in the thirties is below 120/80 mmHg. However, it is known that blood pressure readings fluctuate with moods, meals, fever, among other factors. There also is a well-chronicled phenomenon called the white coat syndrome in which a person’s blood pressure rises merely by being around doctors. It is, hence, commonly recommended that a person’s BP readings should be repeated if the first one is abnor mal.

In current clinical practice (either due to large patient load or lack of awareness among physicians), often a single BP measurement is used to diagnose and manage hypertension in busy clinics, said the authors. This results in a large number of patients being labelled as having high BP and receiving treatment that may not be needed.

Dr Hemant Thacker from Jaslok Hospital on Pedder Road said, “An astute doctor understands a patient coming to him for the first time could be overwhelmed by the environment, the white coat, and history taking. This could result in a wrong reading.” He, however, said readings should be repeated only if the first one seems abnor mal.

Although there are American and European guidelines on measurement of blood pressure, there is no consensus on the number of recommended measurements at a single visit or the method of arriving at final clinic BP reading.

Hence the PHFI-AIIMS study analysed the data of the National Family Health Survey (NFHS-4) conducted in India from 2015 to 2016. Using statistical analysis, they found a 63% higher prevalence of hypertension when only the first reading was considered instead of a mean reading. “In the young population, based on a single BP measurement, the prevalence of hypertension was 16.5% and when the average of second and third readings was taken, the prevalence reduced to 10.1%,” said the study.

PHFI’s Dr Dorairaj Prabhakaran, one of the authors, said, “This large reduction in the number of people needing treatment has huge implications for the individual (in terms of avoiding unnecessary treatments) as well as the health system (by reducing footfalls to hospitals as well as decreasing healthcare costs).”

As the Centre is planning to set up wellness clinics across the country, Dr Prabhakaran said clearcut guidelines are needed about repeat BP readings for community health workers and Accredited Social Health Activists (ASHAs) to follow.

Dr Thacker said the dictum is that if a doctor gets an abnormal reading, then he should check the patient’s reading again while sitting and once while lying down. He added that the limit at which patients should be started on antihypertensive drugs depends on their age, mental status and health. “If a 30-year-old patient has a reading of 140/90, I would put him on medication, but would only recommend lifestyle modifications if the reading is for a middle-aged patient. A senior citizen with that reading needs no medication,” added Dr Thacker

 
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