Blood pressure measurement

doi:10.1136/bmj.322.7294.1110

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Part IIIAutomated sphygmomanometry: ambulatory blood pressure measurement

Eoin O'Brien,
Gareth Beevers,
Gregory Y H Lip

In recent years, the accuracy of the conventional Riva-Rocci/Korotkoff technique of blood pressure measurement has been questioned and efforts have been made to improve the technique with automated devices. In the same period, recognition of the phenomenon of white coat hypertension, whereby some subjects with apparent elevation of blood pressure have normal, or reduced, blood pressures when measurement is repeated away from the medical environment, has focused attention on methods of measurement that provide profiles of blood pressure behaviour rather than relying on isolated measurements under circumstances that may in themselves influence the level of blood pressure recorded.

This article has been adapted from the newly published 4th edition of ABC of Hypertension. The book is available from the BMJ bookshop and at http://www.bmjbooks.com/

These methodologies have included repeated measurements of blood pressure using the traditional technique, self measurement of blood pressure in the home or workplace, and ambulatory blood pressure measurement (ABPM) using innovative automated devices.1

Essential messages

Consider carefully which monitor to buy
Consider which type of service is best suited to your needs
Consider analysis and presentation of data
Exclusion of white coat hypertension is a major indication
The technique is valuable in the elderly
The technique is being increasingly used in pregnancy

Setting up an ambulatory blood pressure measurement service

Which monitor to buy?

A large variety of ambulatory blood pressure measurement devices are now available on the market, and the number will increase as the technique of ambulatory blood pressure measurement becomes more widespread. A number of factors should influence this choice, among which the most important is to ensure that the device has been validated independently according to either the protocol of the British Hypertension Society (BHS),2 and/or that of the Association for the Advancement of Medical Instrumentation (AAMI).3