Author: Chen Luyuan
Source: Medical Community Cardiovascular Channel
High blood pressure, as the first of the three highs, is a common cardiovascular disease. According to the National Hypertension Control Survey released by the National Center for Cardiovascular Diseases, the prevalence of hypertension in mainland China has reached 23.2%, but its awareness rate is less than 50%, and the control rate is only 15.3%. It can be seen that the control rate of hypertension in mainland China is still not ideal.
As one of the ways to control hypertension, blood pressure measurement is the basis and key to the diagnosis of hypertension, the evaluation of prevention and treatment effects, and the monitoring of blood pressure. Nowadays, many patients with high blood pressure can monitor their blood pressure at home, and measuring blood pressure seems simple, but without the guidance of professional medical personnel, they will fall into the "pit" if they don't make up their minds, so how can they measure blood pressure correctly?
The following is an in-depth discussion on "hypertension measurement" by Professor Chen Luyuan from the Department of Cardiology of Guangdong Provincial People's Hospital, let's take a look~
Is an electronic sphygmomanometer less accurate than a mercury sphygmomanometer?
What should I do if I don't have it?
"An electronic blood pressure monitor of a few hundred yuan is not accurate at all, it must be a fake." Uncle Liu looked worried.
"I said it, the electronic sphygmomanometer is not accurate, and the mercury sphygmomanometer is accurate, you have to buy it." Aunt Liu said.
......
Nowadays, many hypertensive patients think that electronic blood pressure monitors are not as accurate as mercury blood pressure monitors, in fact, this is a wrong perception, and for this problem, Professor Chen Luyuan gave us a detailed explanation.
The mercury sphygmomanometer was invented more than 100 years ago, and it is equipped with a cuff that can be inflated by itself, which temporarily blocks the circulation of blood in the body after inflation. At this time, the doctor auscultates the pulse and reads the corresponding value on the scale at the same time, which is the measured blood pressure value. Professional doctors use mercury sphygmomanometer to measure, and the accuracy is relatively high. However, inaccurate measurements may occur if the measurer is not skilled or affected by the environment (e.g., lack of concentration or hearing loss during auscultation, noisy environment during auscultation, nervousness during patient measurement).
The principle of the electronic sphygmomanometer is to obtain the blood pressure value by measuring the vibration of the blood vessel wall when the blood flow is generated, and the value can be displayed directly on the screen, and the value can be accurate to the single digit. Since the electronic sphygmomanometer is composed of electronic components, it is sensitive to the ambient temperature, and if there is a large temperature difference, the accuracy of the electronic sphygmomanometer measurement may be affected. Moreover, the electronic sphygmomanometer is a machine after all, and when the measurement value is not accurate, it is also necessary to consider whether it is aging. In general, the lifespan of an electronic sphygmomanometer is 6-10 years. If patients want to accurately measure their blood pressure at home, Professor Chen Luyuan here puts forward the following 3 suggestions, which can be chosen (quickly pick up a small notebook and write it down~):
1. Measure three times and take the average.
2. Measure three times, taking the average of the two closest passes.
3. Discard the first reading and take the average of the second and third readings.
How to choose the location of hypertension measurement?
How to choose the measurement site when measuring blood pressure has always been a "tangled" place for the majority of hypertensive patients. For example, the mainland recently released the "Chinese Expert Consensus on Adult Limb Blood Pressure Measurement", and Hypertension also released a study suggesting that people who self-measure blood pressure at home should measure blood pressure in both upper limbs. So, which part of the blood pressure measurement should patients with high blood pressure choose?
Here, Professor Chen Luyuan proposed that no matter which part of the blood pressure is measured, patients should abide by the measurement principle of "high not low", and gave suggestions for "personalized" blood pressure measurement for different situations, as follows:
- For hypertensive patients who require hospitalization, it is recommended to measure blood pressure in the extremities.
- For patients with high blood pressure who are treated at home, it is recommended to measure blood pressure in both upper extremities.
- 1. The difference in blood pressure between the upper limbs ≤ 10mmHg, which is within the normal range;
- 2. If the blood pressure difference between the upper limbs is 10mmHg-19mmHg, it is necessary to consider whether there is arteriosclerosis and stenosis;
- 3. If the blood pressure difference between the upper limbs ≥ 20mmHg, you may have more serious diseases, such as aortic aneurysm, aortic stenosis, aortic dissection, etc., and you must go to the hospital for diagnosis and treatment in time.
Professor Chen Luyuan also emphasized that although the wrist-based electronic blood pressure monitor can calculate blood pressure by monitoring the propagation speed of the pulse wave along the arteries of the hand, the use of wrist-based electronic blood pressure monitor is generally not recommended! Because the wrist electronic blood pressure monitor actually measures the pulse pressure value of the wrist, there is a certain deviation from the brachial artery of the upper arm measured by standard blood pressure. In addition, because the elbow joint needs to be at the same level as the heart during measurement, it is required to put the wearing hand on the chest, and the measurement is not accurate in the state of exertion. However, it is suitable for patients who have difficulty undressing (people with disabilities), those whose upper arms are too thick, and those who are in the field.
How to control the timing and frequency of hypertension measurement?
What do I need to pay attention to when measuring?
The time and frequency of hypertension measurement are directly related to the accuracy of hypertension measurement, so hypertensive patients need to strictly control the measurement time and frequency. Here, Professor Chen Luyuan reminded: Then, Professor Chen Luyuan made a specific explanation, "The so-called 'stable' means that the blood pressure value is about the same for three consecutive days, at this time, it can be changed to once a week." ”
The number of blood pressure measurements is known, but the question arises again, which time of day should be better to measure blood pressure?
Professor Chen Luyuan recommends that it is advisable to measure blood pressure in the morning and evening for patients with newly diagnosed hypertension or patients with unstable blood pressure (patients with high mental anxiety are not recommended to self-measure blood pressure at home), as follows (see Table 1):
Table 1
The "Internet + hypertension" management model can be expected in the future
In recent years, with the rapid development and popularization of smart devices and Internet technology, their role in the management of chronic diseases such as hypertension has become prominent. Therefore, the use of "Internet+" to realize the intelligent management of hypertension may become a trend in the prevention and control of hypertension in the future.
The "Chinese Expert Consensus on Out-of-Hospital Internet Management of Hypertension" was released in 2021 last year, which is the first consensus on Internet management related to cardiovascular diseases in China, aiming to promote the standardization and normalization of the Internet (online) management of hypertension outside hospitals, benefit the majority of hypertensive patients, and reduce the burden of cardiovascular diseases in mainland China.
In this regard, Professor Chen Luyuan pointed out that the launch of the "Chinese Expert Consensus on Internet Management of Hypertension Outside Hospitals" has filled the gap in the field of online management of hypertension outside hospitals in mainland China, which is of pioneering significance.
The hypertension out-of-hospital Internet management team is composed of specialists from hierarchical hospitals, general practitioners from primary medical institutions and auxiliary management teams, with Internet companies as technical support and medical institutions and medical staff as practitioners. Information collection and management, data storage and security are the guarantees for the Internet management of hypertension outside the hospital.
"Out-of-hospital management of hypertension" mainly takes the standardization of out-of-hospital blood pressure monitoring and management as the starting point, and the management content also includes hypertension risk assessment, standardized drug treatment, lifestyle guidance, improvement of treatment compliance and patient health education, involving all aspects of hypertension from diagnosis to prognosis. In addition, the "out-of-hospital management of hypertension" can customize the corresponding regular consultation and follow-up according to the individualized situation of the follow-up subjects, and adjust the online and offline management plans in real time according to the changes in the patient's condition (see Figure 1 for details).
Fig.1 Flow chart of out-of-hospital blood pressure management in hypertensive patients
In general, "hypertension out-of-hospital management" can better integrate online and offline resources, give full play to the support and service role of the "Internet + medical health" model in the prevention and control of hypertension, make the out-of-hospital Internet management of hypertension more safe, standardized, efficient and convenient, protect the vital interests of doctors and patients, and truly promote the improvement of hypertension management!
Summary:
Although over the years, the awareness, treatment and control rate of hypertension in mainland China is still not ideal, which also requires us to take action, whether it is self-monitoring or self-management, we need to scientifically measure and manage blood pressure under the guidance of physicians. We also believe that with the continuous advancement of technology, the management of "Internet + hypertension" will develop further and benefit patients with hypertension.