Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research: JACC Scientific Expert Panel

2017 National Heart, Lung, and Blood Institute Working Group

doi:10.1016/j.jacc.2018.10.069

Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research: JACC Scientific Expert Panel

2017 National Heart, Lung, and Blood Institute Working Group

Research output: Contribution to journal › Review article › peer-review

117 Scopus citations

Abstract

The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. Restricted use of mercury devices, increased use of oscillometric devices, discrepancies between clinic and out-of-clinic BP, and concerns about measurement error with manual BP measurement techniques have resulted in uncertainty for clinicians and researchers. The National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health convened a working group of clinicians and researchers in October 2017 to review data on BP assessment among adults in clinical practice and clinic-based research. In this report, the authors review the topics discussed during a 2-day meeting including the current state of knowledge on BP assessment in clinical practice and clinic-based research, knowledge gaps pertaining to current BP assessment methods, research and clinical needs to improve BP assessment, and the strengths and limitations of using BP obtained in clinical practice for research and quality improvement activities.

Original language	English (US)
Pages (from-to)	317-335
Number of pages	19
Journal	Journal of the American College of Cardiology
Volume	73
Issue number	3
DOIs	https://doi.org/10.1016/j.jacc.2018.10.069
State	Published - Jan 29 2019

Bibliographical note

Funding Information:
This work was supported by the Division of Cardiovascular Sciences (DCVS) of the National Heart, Lung, and Blood Institute (NHLBI). Dr. Muntner has received grant support from the American Heart Association (15SFRN2390002) and from Amgen Inc. Dr. Whelton has received grant support from the National Institute of General Medical Sciences of the National Institutes of Health (NIH) (P20GM109036). Dr. Bello has received grant support from the National Center for Advancing Translation Sciences (5KL2TR001874-02) and the National Heart, Lung, and Blood Institute (NHLBI) (K23HL136853-01A1). Dr. Green has received grant support from the Patient-Centered Outcomes Research Institute (CER-1511-32979 and IHS-1507-31146), and NHLBI (1R01HL136575). Dr. Jones has received grant support from the National Institute of General Medical Sciences (1U54GM115428). Dr. Juraschek has received grant support from NHLBI (7K23HL135273-02). Dr. Margolis has received grant support from the Patient-Centered Outcomes Research Institute (IHS-1507-31146) and NHLBI (R01HL090965). Dr. Navar has received grant support from NHLBI (K01 HL133416). Dr. Schwartz has received grant support from NHLBI (P01 HL47540). Dr. Shimbo has received grant support from NHLBI (K24-HL125704, R01HL117323, and P01 HL47540). Dr. Cushman has received institutional grant support from Eli Lilly; and has been a consultant to Sanofi and an uncompensated consultant to Novartis and Takeda. Dr. Navar has received institutional research support from Amgen, Amarin, Janssen, Regeneron, and Sanofi; and has been a consultant/served on advisory boards for Amarin, NovoNordisk, Amgen, and Sanofi. Dr. Rakotz is an employee of the American Medical Association. Dr. Stergiou has received institutional research support from iHealth, InBody, Maisense, and Microlife; and consulting fees from Maisense, Microlife, and Omron. The views expressed in this report are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the Department of Health and Human Services. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the American Medical Association. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Funding Information:
An approach to ensure BP measurement procedures are followed will likely require collaboration between policymakers, insurers, health care systems, EMR vendors, device manufacturers, and professional organizations (American Academy of Family Physicians, ACC, American College of Physicians, AHA, American Medical Association, and others). Agencies such as the Centers for Medicare and Medicaid Services provide incentives to health care plans/organizations for meeting quality metrics, including the percentage of the population with hypertension who have controlled BP. Currently, however, BP control is determined using only a single BP measurement or the lowest SBP or DBP of 2 or more measurements taken on the same day, rather than averaging at least 2 BP measurements on 2 or more occasions, as is recommended in clinical practice guidelines. Also, the United States Preventive Services Task Force and ACC/AHA guidelines recommend out-of-clinic BP measurement to confirm the diagnosis of hypertension (1,5). No quality assurance metrics guide the appropriate measurement of BP, and little reimbursement supports the clinical procedure of BP assessment, whether in-clinic or out-of-clinic, despite the potential high cost of under- and overtreatment of a condition, hypertension, that affects about one-half of the U.S. adult population (2). Additionally, health insurers could provide increased time and adequate reimbursement to correctly measure BP.

Publisher Copyright:
© 2019 American College of Cardiology Foundation

Keywords

blood pressure
hypertension
measurement

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10.1016/j.jacc.2018.10.069

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@article{dc27b9def3f94d41a2724678da2a028d,

title = "Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research: JACC Scientific Expert Panel",

abstract = "The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. Restricted use of mercury devices, increased use of oscillometric devices, discrepancies between clinic and out-of-clinic BP, and concerns about measurement error with manual BP measurement techniques have resulted in uncertainty for clinicians and researchers. The National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health convened a working group of clinicians and researchers in October 2017 to review data on BP assessment among adults in clinical practice and clinic-based research. In this report, the authors review the topics discussed during a 2-day meeting including the current state of knowledge on BP assessment in clinical practice and clinic-based research, knowledge gaps pertaining to current BP assessment methods, research and clinical needs to improve BP assessment, and the strengths and limitations of using BP obtained in clinical practice for research and quality improvement activities.",

keywords = "blood pressure, hypertension, measurement",

author = "{2017 National Heart, Lung, and Blood Institute Working Group} and Paul Muntner and Einhorn, {Paula T.} and Cushman, {William C.} and Whelton, {Paul K.} and Bello, {Natalie A.} and Drawz, {Paul E.} and Green, {Beverly B.} and Jones, {Daniel W.} and Juraschek, {Stephen P.} and Margolis, {Karen L.} and Miller, {Edgar R.} and Navar, {Ann Marie} and Yechiam Ostchega and Rakotz, {Michael K.} and Bernard Rosner and Schwartz, {Joseph E.} and Daichi Shimbo and Stergiou, {George S.} and Townsend, {Raymond R.} and Williamson, {Jeff D.} and Wright, {Jackson T.} and Appel, {Lawrence J.}",

note = "Funding Information: This work was supported by the Division of Cardiovascular Sciences (DCVS) of the National Heart, Lung, and Blood Institute (NHLBI). Dr. Muntner has received grant support from the American Heart Association (15SFRN2390002) and from Amgen Inc. Dr. Whelton has received grant support from the National Institute of General Medical Sciences of the National Institutes of Health (NIH) (P20GM109036). Dr. Bello has received grant support from the National Center for Advancing Translation Sciences (5KL2TR001874-02) and the National Heart, Lung, and Blood Institute (NHLBI) (K23HL136853-01A1). Dr. Green has received grant support from the Patient-Centered Outcomes Research Institute (CER-1511-32979 and IHS-1507-31146), and NHLBI (1R01HL136575). Dr. Jones has received grant support from the National Institute of General Medical Sciences (1U54GM115428). Dr. Juraschek has received grant support from NHLBI (7K23HL135273-02). Dr. Margolis has received grant support from the Patient-Centered Outcomes Research Institute (IHS-1507-31146) and NHLBI (R01HL090965). Dr. Navar has received grant support from NHLBI (K01 HL133416). Dr. Schwartz has received grant support from NHLBI (P01 HL47540). Dr. Shimbo has received grant support from NHLBI (K24-HL125704, R01HL117323, and P01 HL47540). Dr. Cushman has received institutional grant support from Eli Lilly; and has been a consultant to Sanofi and an uncompensated consultant to Novartis and Takeda. Dr. Navar has received institutional research support from Amgen, Amarin, Janssen, Regeneron, and Sanofi; and has been a consultant/served on advisory boards for Amarin, NovoNordisk, Amgen, and Sanofi. Dr. Rakotz is an employee of the American Medical Association. Dr. Stergiou has received institutional research support from iHealth, InBody, Maisense, and Microlife; and consulting fees from Maisense, Microlife, and Omron. The views expressed in this report are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the Department of Health and Human Services. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the American Medical Association. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: An approach to ensure BP measurement procedures are followed will likely require collaboration between policymakers, insurers, health care systems, EMR vendors, device manufacturers, and professional organizations (American Academy of Family Physicians, ACC, American College of Physicians, AHA, American Medical Association, and others). Agencies such as the Centers for Medicare and Medicaid Services provide incentives to health care plans/organizations for meeting quality metrics, including the percentage of the population with hypertension who have controlled BP. Currently, however, BP control is determined using only a single BP measurement or the lowest SBP or DBP of 2 or more measurements taken on the same day, rather than averaging at least 2 BP measurements on 2 or more occasions, as is recommended in clinical practice guidelines. Also, the United States Preventive Services Task Force and ACC/AHA guidelines recommend out-of-clinic BP measurement to confirm the diagnosis of hypertension (1,5). No quality assurance metrics guide the appropriate measurement of BP, and little reimbursement supports the clinical procedure of BP assessment, whether in-clinic or out-of-clinic, despite the potential high cost of under- and overtreatment of a condition, hypertension, that affects about one-half of the U.S. adult population (2). Additionally, health insurers could provide increased time and adequate reimbursement to correctly measure BP. Publisher Copyright: {\textcopyright} 2019 American College of Cardiology Foundation",

year = "2019",

month = jan,

day = "29",

doi = "10.1016/j.jacc.2018.10.069",

language = "English (US)",

volume = "73",

pages = "317--335",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

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number = "3",

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T1 - Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research

T2 - JACC Scientific Expert Panel

AU - 2017 National Heart, Lung, and Blood Institute Working Group

AU - Muntner, Paul

AU - Einhorn, Paula T.

AU - Cushman, William C.

AU - Whelton, Paul K.

AU - Bello, Natalie A.

AU - Drawz, Paul E.

AU - Green, Beverly B.

AU - Jones, Daniel W.

AU - Juraschek, Stephen P.

AU - Margolis, Karen L.

AU - Miller, Edgar R.

AU - Navar, Ann Marie

AU - Ostchega, Yechiam

AU - Rakotz, Michael K.

AU - Rosner, Bernard

AU - Schwartz, Joseph E.

AU - Shimbo, Daichi

AU - Stergiou, George S.

AU - Townsend, Raymond R.

AU - Williamson, Jeff D.

AU - Wright, Jackson T.

AU - Appel, Lawrence J.

N1 - Funding Information: This work was supported by the Division of Cardiovascular Sciences (DCVS) of the National Heart, Lung, and Blood Institute (NHLBI). Dr. Muntner has received grant support from the American Heart Association (15SFRN2390002) and from Amgen Inc. Dr. Whelton has received grant support from the National Institute of General Medical Sciences of the National Institutes of Health (NIH) (P20GM109036). Dr. Bello has received grant support from the National Center for Advancing Translation Sciences (5KL2TR001874-02) and the National Heart, Lung, and Blood Institute (NHLBI) (K23HL136853-01A1). Dr. Green has received grant support from the Patient-Centered Outcomes Research Institute (CER-1511-32979 and IHS-1507-31146), and NHLBI (1R01HL136575). Dr. Jones has received grant support from the National Institute of General Medical Sciences (1U54GM115428). Dr. Juraschek has received grant support from NHLBI (7K23HL135273-02). Dr. Margolis has received grant support from the Patient-Centered Outcomes Research Institute (IHS-1507-31146) and NHLBI (R01HL090965). Dr. Navar has received grant support from NHLBI (K01 HL133416). Dr. Schwartz has received grant support from NHLBI (P01 HL47540). Dr. Shimbo has received grant support from NHLBI (K24-HL125704, R01HL117323, and P01 HL47540). Dr. Cushman has received institutional grant support from Eli Lilly; and has been a consultant to Sanofi and an uncompensated consultant to Novartis and Takeda. Dr. Navar has received institutional research support from Amgen, Amarin, Janssen, Regeneron, and Sanofi; and has been a consultant/served on advisory boards for Amarin, NovoNordisk, Amgen, and Sanofi. Dr. Rakotz is an employee of the American Medical Association. Dr. Stergiou has received institutional research support from iHealth, InBody, Maisense, and Microlife; and consulting fees from Maisense, Microlife, and Omron. The views expressed in this report are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the Department of Health and Human Services. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the American Medical Association. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: An approach to ensure BP measurement procedures are followed will likely require collaboration between policymakers, insurers, health care systems, EMR vendors, device manufacturers, and professional organizations (American Academy of Family Physicians, ACC, American College of Physicians, AHA, American Medical Association, and others). Agencies such as the Centers for Medicare and Medicaid Services provide incentives to health care plans/organizations for meeting quality metrics, including the percentage of the population with hypertension who have controlled BP. Currently, however, BP control is determined using only a single BP measurement or the lowest SBP or DBP of 2 or more measurements taken on the same day, rather than averaging at least 2 BP measurements on 2 or more occasions, as is recommended in clinical practice guidelines. Also, the United States Preventive Services Task Force and ACC/AHA guidelines recommend out-of-clinic BP measurement to confirm the diagnosis of hypertension (1,5). No quality assurance metrics guide the appropriate measurement of BP, and little reimbursement supports the clinical procedure of BP assessment, whether in-clinic or out-of-clinic, despite the potential high cost of under- and overtreatment of a condition, hypertension, that affects about one-half of the U.S. adult population (2). Additionally, health insurers could provide increased time and adequate reimbursement to correctly measure BP. Publisher Copyright: © 2019 American College of Cardiology Foundation

PY - 2019/1/29

Y1 - 2019/1/29

N2 - The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. Restricted use of mercury devices, increased use of oscillometric devices, discrepancies between clinic and out-of-clinic BP, and concerns about measurement error with manual BP measurement techniques have resulted in uncertainty for clinicians and researchers. The National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health convened a working group of clinicians and researchers in October 2017 to review data on BP assessment among adults in clinical practice and clinic-based research. In this report, the authors review the topics discussed during a 2-day meeting including the current state of knowledge on BP assessment in clinical practice and clinic-based research, knowledge gaps pertaining to current BP assessment methods, research and clinical needs to improve BP assessment, and the strengths and limitations of using BP obtained in clinical practice for research and quality improvement activities.

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Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research: JACC Scientific Expert Panel

Abstract

Bibliographical note

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