Hypertension: Some hand conditions can lead to high blood pressure

• Accurately reading blood pressure is an important part of preventive health care.
• Researchers at Johns Hopkins Medicine have found that some wristbands commonly used to check blood pressure may be producing inaccurately high readings.
• Scientists believe that these inaccurate blood pressure readings can lead to misdiagnosis of blood pressure.

Measuring blood pressure is an important part of preventive health care. That’s because having too high blood pressure – known as hypertension – or too low – called hypotension – blood pressure can indicate health problems.

Abnormally high or low blood pressure can also cause problems such as heart disease, stroke, organ problems and dementia.

“Accurate blood pressure measurement is critical to the diagnosis and treatment of hypertension, which is key to our efforts to prevent heart disease,” said Tammy M. Brady, MD, PhD, associate professor of chair for clinical research in the Department of Pediatrics. Johns Hopkins University School of Medicine, medical director of the pediatric hypertension program at Johns Hopkins Children’s Center, assistant director of the Welch Center for Prevention, Epidemiology and Clinical Research said. Medical News Today.

Brady is the senior author of a new study recently published in the journal JAMA Internal Medicine. The study found that some commonly used sites for reading blood pressure can result in inaccurate high readings and misdiagnosis of high blood pressure.

“There are different patients steps to prepare and levels recommended in blood pressure measurement guidelines – many of these measures take time and sometimes require additional resources to adhere to. Several studies have shown that health care providers do not always adhere to these measures. Both direct observation and research have shown that blood pressure is often measured with the arm resting on the lap or hanging at the side,” Brady explained.

“With this in mind – and in the hope that we can simplify blood pressure measurement – my fellow researchers and I wanted to examine how important hand support and position are to the accuracy of blood pressure level,” he added.

For this study, Brady and his team recruited 133 adults aged 18 to 80.

Participants were randomly assigned to two blood pressure measurement groups with their arm positioned in one of three directions when the reading was taken – arm resting on the table, arm resting on the lap theirs, or an unsupported arm hanging from their side.

At the end of the study, the researchers found that the systolic blood pressure for the participants who rested their hands on their thighs was about 4 mmHg higher, while the figures for those who placed their hands not supported by their sides they had excessive systolic blood pressure of about 7 mmHg.

“When the hand is on the thigh or side, the blood vessels in the hand are too far from the heart. Gravity increases the pressure in these blood vessels. It is also difficult for blood to return to the heart when the hand is lower than the heart; to compensate for this, and to improve the return of blood, the blood vessels in the hand. In addition, when the hand is not supported, the muscles do not completely relax and contract. All of these body responses lead to high blood pressure readings. ”
– Tammy M. Brady, MD, PhD

Brady said that although they expected to find a difference in blood pressure between different areas of the arm, they were surprised by the magnitude of the difference.

“Our experiment shows that the inappropriate position of the hand and the support can lead to excessive blood pressure and can lead to the diagnosis of high blood pressure and excessive treatment,” he said. .

Brady shared his hope that this study sensitizes health care providers and patients alike to the importance of hand position and support in relation to blood pressure measurement.

“It’s more than just putting on a cuff and pressing a button. The room where blood pressure is measured should be set up in such a way that there is a chair with a back that is placed next to a table or desk at a suitable height for the arm to rest. in the middle cuff, the heart condition,” he continued.

“I also hope that (healthcare professionals) realize the need for staff training/certification and retraining for the accuracy of blood pressure measurement and the need to educate patients when they give home blood pressure measurements.”
– Tammy M. Brady, MD, PhD

“Although it may take an investment in time and resources to ensure that the blood pressure measurement setting is set for the correct measurement, the return on investment is likely to be significant in terms of monitoring without a patient with fewer errors, but with savings in time (patients returning for measurements), resources (repetition of appointments, health care staff), and money (lost work, examination costs , medical expenses),” Brady added.

MNT also spoke with Cheng-Han Chen, MD, board-certified cardiologist and medical director of the Structural Heart Program at Memorial Saddleback Medical Center in Laguna Hills, CA, about this research that suggested that he thinks it’s a very useful lesson that highlights the importance of proper blood pressure measurement methods so that people can get the most accurate blood pressure readings.

“They found a difference of 4 to 7 millimeters of mercury in systolic blood pressure just depending on the difference in how they measured it, whether the arm was supported or hanging sideways,” Chen he explained.

“And while four to seven points may not seem like a huge difference, that’s enough to push a person’s blood pressure into high levels, which can end up starting new medications or changing medications when they wouldn’t need those medications,” he explained.

“So people taking blood pressure should remember to keep it propped up, like a table next to a chair. And this is important, regardless of whether the blood pressure is taken at home or blood pressure taken from a doctor.”
—Cheng-Han Chen, MD