Challenges in standardization of blood pressure measurement at the population level.

Hanna Tolonen,Tarja Palosaari,Grazyna Broda,Satu Männistö,Kari Kuulasmaa,Androniki Naska,Päivikki Koponen

doi:10.1186/s12874-015-0020-3

Abstract

BackgroundAccurate blood pressure measurements are needed in clinical practice, intervention studies and health examination surveys. Blood pressure measurements are sensitive: their accuracy can be affected by measurement environment, behaviour of the subject, measurement procedures, devices used for the measurement and the observer. To minimize errors in blood pressure measurement, a standardized measurement protocol is needed.MethodsThe European Health Examination Survey (EHES) Pilot project was conducted in 2009–2012. A pilot health examination survey was conducted in 12 countries using a standardized protocol. The measurement protocols used in each survey, training provided for the measurers, measurement data, and observations during site visits were collected and evaluated to assess the level of standardization.ResultsThe EHES measurement protocol for blood pressure was followed accurately in all 12 pilot surveys. Most of the surveys succeeded in organizing a quiet and comfortable measurement environment, and staff instructed survey participants appropriately before examination visits. In all surveys, blood pressure was measured three times, from the right arm in a sitting posture. The biggest variation was in the device used for the blood pressure measurement.ConclusionsIt is possible to reach a high level of standardization for blood pressure measurements across countries and over time. A detailed, standardized measurement protocol, and adequate training and monitoring during the fieldwork and centrally organized quality assessment of the data are needed. The recent EU regulation banning the sale of mercury sphygmomanometer in European Union Member States has set new challenges for the standardization of measurement devices since the validity of oscillometric measurements is device-specific and performance of aneroid devices depends very much on calibration.

Highlights

Accurate blood pressure measurements are needed in clinical practice, intervention studies and health examination surveys
The aim of this paper is to evaluate the level of standardization of blood pressure measurement in the European Health Examination Survey (EHES) Pilot Project
Most of the EHES pilot surveys were conducted in a clinical setting, either in the facilities of the local health care system or in temporary clinics set up for the survey

Summary

Introduction

Accurate blood pressure measurements are needed in clinical practice, intervention studies and health examination surveys. Blood pressure measurements are sensitive: their accuracy can be affected by measurement environment, behaviour of the subject, measurement procedures, devices used for the measurement and the observer. Accuracy of blood pressure measurement is important in clinical practice, intervention studies and health examination surveys. Traffic noise, telephone ringing, and people entering the room) during the measurement may affect the outcome [2]. Activities such as strenuous physical exercise, smoking, heavy meals or drinking of coffee, tea or alcohol, or an uncomfortably full bladder are known to alter blood pressure [3,4]. The arm used for the measurement, Tolonen et al BMC Medical Research Methodology (2015) 15:33 posture of the subject (sitting or supine) and the arm during the measurement, support of the back and feet, crossed legs, placement of the cuff over the clothing or on the bare arm, and talking during the measurement each affect the outcome [3,4,5,6,7,8,9,10,11,12]

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