by Roxanne Lopez

The hype on Hypertension

Do we have accurate hypertension measurement devices?

Are we using outdated measures?
The hype around hypertension

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. 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.”.

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 He adds that devices containing mercury are being withdrawn due to safety concerns.

“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. 

“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.

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