The most recent American College of Cardiology/ American Heart Association clinical practice guidelines define hypertension as systolic BP greater or equal to 130 mmHg or diastolic BP greater or equal to 80 mmHg. Patients are then classified as having either stage 1 or stage 2 hypertension. Stage 2 usually requires medication in addition to lifestyle modifications to control blood pressure. If the diastolic and systolic blood pressure readings fall into different classifications, the higher classification is used. To make a clinical diagnosis of hypertension, two or more blood pressure readings obtained over two or more visit must fall into a particular classification (but not during acute illness or pain).
最新的美国心脏病学会/美国心脏协会临床实践指南将高血压定义为收缩压大于或等于 130 mmHg 或舒张压大于或等于 80 mmHg。然后将患者归类为患有 1 期或 2 期高血压。2 期高血压除了改变生活方式外，通常需要药物治疗来控制血压。如果舒张压和收缩压读数属于不同的分类，则使用较高的分类。为了对高血压进行临床诊断，在两次或多次就诊中获得的两个或多个血压读数必须属于特定类别（但不是在急性疾病或疼痛期间）。
Accurate blood pressure measurement is critical for diagnosing hypertension and determining whether blood pressure is controlled. Nurses can’t directly measure blood pressure in the clinic (direct measurement requires an arterial line), so a noninvasive approach is used. Traditionally, nurses take blood pressure manually. however, a recent 2019 AHA scientific statement on blood pressure measurement recommends that clinicians use an oscillometer technique with an automated (or semiautomated) blood pressure device. The 2019 recommendations indicated that automated blood pressure are closer to out-of-office blood pressure readings compared to those taken manually, making them more reflective of daily blood pressure. Automated devices also require less time and can take multiple readings (for orthostatic BP checks or to compare measurements over time).
准确的血压测量对于诊断高血压和确定血压是否得到控制至关重要。传统上，护士手动测量血压。然而，最近 2019 年 AHA 关于血压测量的科学声明建议临床医生使用带有自动（或半自动）血压设备的示波器技术。2019年的建议表明，与手动血压相比，自动血压更接近办公室外血压读数，使其更能反映每日血压。自动化设备还需要更少的时间，并且可以获取多个读数（用于直立血压检查或用于比较一段时间内的测量值）。
Several common errors can result in inaccurate BP readings. Patient-related errors include taking a BP shortly after the patient has been eating, drinking, or smoking; when they are moving or have a full bladder; or when they are wearing restrictive clothing above the BP cuff. Device-related errors include using a nonvalidated BP machine in the hospital, office or home setting. Procedure-related errors include placing the cuff in the wrong arm position, talking during measurement or being in a noisy location, taking repeated measurements too close together, and inaccurately documenting blood pressure measurement. the most common source of error is using the wrong size blood pressure cuff. if the cuff is too small, the blood pressure will be falsely elevated, if it’s too large, the blood pressure will be falsely low.
一些常见错误可能导致血压读数不准确。与患者相关的错误包括在患者进食、饮水或吸烟后不久测量血压;当他们移动或膀胱充盈时;或者当他们穿着血压袖带上方的限制性衣服时。与设备相关的错误包括在医院、办公室或家庭环境中使用未经验证的血压计。与程序相关的错误包括将袖带放在错误的手臂位置、在测量过程中说话或处于嘈杂的位置、重复测量距离太近以及不准确记录血压测量。最常见的错误来源是使用错误尺寸的血压袖带。如果袖带太小，血压会假性升高;如果它太大，血压就会假性地低。
Upper arm measurements are considered the gold standard for ensuring accurate blood pressure. The blood pressure cuff length should be 75% to 100% of the arm’s circumference and the width should be 37% to 50% of the arm’s circumference. Use a paper measuring tape to measure the arm circumference. For arms 22 to 26 cm, use a small adult size cuff. For patient’s whose arms measure 27 to 34 cm, choose an adult size cuff. Use a large adult size cuff if the arm circumference is 35 to 44 cm and an extra-large size blood pressure cuff if the arm circumference is 45 to 52 cm.
上臂测量被认为是确保准确血压的黄金标准。使用纸卷尺测量臂围。对于 22 至 26 厘米的手臂，请使用成人尺寸的小袖带。对于手臂尺寸为 27 至 34 厘米的患者，请选择成人尺寸的袖带。如果臂围为 35 至 44 厘米，请使用成人大号袖带，如果臂围为 45 至 52 厘米，请使用超大号血压袖带。
If a thigh cuff is too small or doesn’t fit adequately, a wrist cuff is the best alternative. If using a wrist cuff, make sure the patient’s wrist is at heart level (mid-sternum) and the elbow is supported on a desk or table (the patient shouldn’t be holding up the arm during measurement). Finger cuffs produce falsely low blood pressure readings and shouldn’t be used.
如果大腿袖带太小或不够合适，腕带是最佳选择。如果使用腕带，请确保患者的手腕与心脏齐平（胸骨中部），肘部支撑在桌子或桌子上（测量过程中患者不应举起手臂）。
Home blood pressure readings can better predict cardiovascular risk and organ damage compared to one-time office readings. Providers can use home blood pressure readings for risk stratification when determining treatment goals and whether treatment should be intensified. In addition, home monitoring can help rule out white coat hypertension (when clinic blood pressure readings are higher than home readings) and masked hypertension (when clinic readings are lower than home readings). Both situations are important to recognize when determining whether the patient actually has hypertension and whether medications should be started or intensified.
与一次性诊所读数相比，家庭血压读数可以更好地预测心血管风险和器官损伤。在确定治疗目标和是否应加强治疗时，医生可以使用家庭血压读数确定治疗目标。此外，家庭监测可以帮助排除白大衣高血压（当诊所血压读数高于家庭读数时）和隐蔽性高血压（当诊所读数低于家庭读数时）。在确定患者是否真的患有高血压以及是否应该开始或加强药物治疗时，这两种情况都很重要。
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