Dr Campin is quite correct in pointing out that our recent article in BCMJ highlighting some of the new developments and challenges associated with blood pressure measurement did not address the issue of inter-arm difference in blood pressure and its significance. This was in part because of space limitations and in part because using proper BP measurement techniques should be followed regardless of the device used or setting.
Unfortunately, proper manual BP measurement techniques are rarely followed in routine clinical practice—especially measuring BP in both arms, repeating the measurement on the arm with the higher reading and, if significant difference exists, using that arm for all subsequent assessments. It was for this reason that we have emphasized the relative advantages of using automated office BP devices. One validated office BP device that is now available simultaneously measures BP in both arms during an initial assessment, allowing the practitioner to accurately see if there is an inter-arm difference.
As to the pharmacy measurement issue, the major supplier of BP kiosk devices in Canada is now providing a unique tapered cuff setup (to allow for accurate measurement in arms of most sizes) that swivels to allow a patient to sit backwards on the kiosk and do the measurement in the opposite arm. Dr Campin’s comments further underscore our recommendations that more readings are better than fewer readings, that all readings should be done in accordance with current guidelines, and that clinicians should not rely on a reading obtained from a hastily performed manual office BP measurement when making critical decisions about the care of patients.
—Janusz Kaczorowski, PhD
—Martin Dawes, MB, BS, MD, FRCGP
—Mark Gelfer, MD
1. Saladini F, Benetti E, Masiero S, et al. Accuracy of Microlife WatchBP Office ABI monitor assessed according to the 2002 European Society of Hypertension protocol and the British Hypertension Society protocol. Blood Press Monit 2011;16:258-261.
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