This article was stimulated by me seeing an article by Dean Piccone and colleagues [1] in the JAMA. I thought that all blood pressure (BP) monitors that are sold in the UK would be equally valid, but apparently not!

Why is measuring BP important? We know that elevated systolic BP is a risk factor for death. It is estimated that 10 million people die globally each year due to high BP [2].  So, identifying patients with elevated blood pressure, therefore, makes sense, so that BP lowering interventions can be made or suggested.

I like to measure my patients BP when I first see them, and annually at their review, if they are attending for regular care. Sometimes it can be very high when I first see a patient, and this might be very relevant, if the patient is complaining of left shoulder pain, for instance. Other times I might notice that it is creeping upwards year-on-year

In-clinic measurements are commonly elevated, giving a false impression of risk, due to ‘white coat syndrome’. [3, 4]. This might result in an inappropriate referral of the patient to their GP for BP meds. We often ask patients to measure their BP at home. These patients will obviously need to have their own BP monitor.

You need to ensure that your BP monitor has been validated. Not all monitors have been validated, because the regulations governing their sale are apparently as much about electrical safety as measurement accuracy. You can check yours at the National Registry  run by the British and Irish Hypertension Society.

You can learn how to reliably measure your own BP an on-line course (yes, really) here which takes about an hour [5]. Most people just follow the instructions that come with the BP equipment that they buy

If you want to learn more, read the article by Piccone and colleagues (link below). Shout out to them for a really useful article. Awesome!

• 1.         Picone, D.S., et al., Validation Status of Blood Pressure Measuring Devices Sold Globally. JAMA, 2022. 327(7): p. 680-681.
• 2.         Collaborators, G.R.F., Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020. 396(10258): p. 1223-1249.
• 3.         Celis, H. and R.H. Fagard, White-coat hypertension: a clinical review. Eur J Intern Med, 2004. 15(6): p. 348-357.
• 4.         Dolan, E., et al., Determinants of white-coat hypertension. Blood Press Monit, 2004. 9(6): p. 307-9.
• 5.         Campbell, N.R.C., et al., Brief online certification course for measuring blood pressure with an automated blood pressure device. A free new resource to support World Hypertension Day Oct 17, 2020. J Clin Hypertens (Greenwich), 2020. 22(10): p. 1754-1756.