Hypertension 高血压 (reading & sharing) #2

The hypertension guidelines recommend that high risk patients should begin medications if their average BP is ≥130/80 mmHg. For lower risk patients (no history of cardiovascular disease or an ASCVD risk <10%) medications are recommended for primary prevention when their average BP is ≥140/90 mmHg.

高血压指南建议，如果高危患者的平均血压为 ≥130/80 mmHg，则应开始药物治疗。对于低风险患者（无心血管疾病病史风险 <10%），当平均血压为 ≥140/90 mmHg 时，建议使用药物进行一级预防。

How to take an accurate BP 如何准确的检查血压 (Follow these steps when measuring blood pressure in a seated adult测量坐着的成人血压时，请按照以下步骤操作):

1. Prepare the patient
   • Ensure the patient has had no caffeine, exercise, or tobacco within 30 minutes of taking a BP 确保在检查血压前 30 分钟内没有摄入咖啡因、运动或烟草
   • Have the patient empty their bladder before taking the measurement在进行测量之前让患者排空膀胱
   • Remove restrictive clothing on the arm being used for measurement脱掉用于测量的手臂上的限制性衣服
   • Seat the patient with legs uncrossed, feet flat on the floor, and back supported让患者坐下，双腿不交叉，双脚平放在地板上，背部支撑 (the patient shouldn’t be sitting on the exam table)
   • Ask the patient to sit still for 3 to 5 minutes before taking the BP.在检查血压前让患者静坐 3 至 5 分钟。
   • The patient, family, and staff shouldn’t talk during the measurement.患者、家属和工作人员在测量过程中不应交谈。
2. Use proper technique
   • Use an upper arm BP device使用上臂血压装置
   • Support the patient’s arm on a flat surface (desk or table)在平坦的表面上支撑患者的手臂
   • Place the BP cuff on bare skin in the middle of the arm 将血压袖带放在手臂中间裸露的皮肤上(at heart level在心脏水平)
   • Ensure the BP cuff is the correct size确保 BP 袖带尺寸正确
   • Pull the cuff taut拉紧血压袖带 (one finger should fit easily between the cuff and arm from the top and bottom一根手指应从顶部和底部轻松放在血压袖带和手臂之间)
3. Ensure proper diagnosis and management
   • If this is the first clinic visit or if diagnosing hypertension, record BP in both arms.
   • Use the arm with the higher reading going forward
   • Separate readings by 1-2 minutes
   • If taking a manual BP, first palpate systolic BP until radial pulse is absent, then pump cuff up to 20 to 30 mmHg more to ausculate BP
   • Deflate the cuff by 2 mmHg per second
4. Document correctly
   • Record the systolic and diastolic BP to the nearest even number
   • Note which arm was used and the BP cuff size
   • Note the time of the most recent BP medication (if applicable)
5. Average the BP readings
   • Use an average of greater or equal to 2 readings obtained on greater or equal to 2 occasions to estimate the patient’s BP
6. Provide BP readings to the patient
   • Provide the patients with results (in writing) with interpretation and personalized BP goal.

Validating Home Blood Pressure Monitoring Devices验证家用血压监测设备:

Home blood pressure monitoring devices should be validated for accuracy. The best way to do that is to compare the home device to the provider’s device. Ask the patient to bring the home monitoring device to their next provider visit, and follow the steps below: (Use the same arm for each measurement, and allow at least 2 minutes between readings. Use the systolic BP readings for comparison.) 家用血压监测设备应验证准确性。最好的方法是将家庭设备与医生诊所的设备进行比较。

• Take five measurements, alternating the home and office devices
  • First, second, and fourth measurements are with the home device.
  • Third and fifth measurements are with the office device.
• Average the second and fourth BPs from the home monitor (ignore the first measurement)
• Compare the average from the home device readings to the office device (third measurement), and calculate the difference:
  • If <5 mmHg, home device can be used.
  • If >10 mm Hg, home device should be replaced.
  • If between 5 and 10 mmHg, go to the next step.
• Compare the average from the home device to the fifth measurement from the office device and calculate the difference:
  • If ≤10 mmHg, home device can be used.
  • If >10 mmHg, replace the home device.

Home BP monitoring allows patients to be more engaged in their healthcare, which frequently increases treatment adherence. To implement home BP monitoring, ensure the patient has a validated monitor and uses the correct size BP cuff. 家庭血压监测使患者能够更多地参与他们的医疗保健，这通常会增加治疗依从性。
Based on the AHA/American Medical Association 2020 self-measured BP monitoring at home joint policy statement, patients should take their BP at least twice in the morning and twice in the evening (each reading separated by
1 to 2 minutes) for a week, to obtain 28 or more readings, ideally over 7 days (minimally, 12 total readings over 3 days). Patients can submit their findings to their provider via their patient portal or bring a copy of the recordings to each
clinic visit. Providers typically discard the first day’s readings for patients newly implementing home monitoring because the readings tend to be falsely elevated until the patient becomes comfortable with home monitoring. On average, home BP readings will be 5 mmHg lower than clinic readings. If most of the remaining
readings are above the desired target, the provider may consider intensifying medications and lifestyle modifications. After the BP is controlled, patients should continue home monitoring a few times a week to note whether BPs remain at or below goal. In the week before the next clinic visit, they should obtain daily readings for a week as they did initially.

TO BE CONT.