Serial Blood Pressures Versus a Single Repeat Blood Pressure in a Family Medicine Clinic.

Abstract

Purpose. The best method to measure blood pressure (BP) in a clinic setting is debatable. This study was conducted to compare serial BPs to a single repeat BP after an initial elevated reading. Methods. For this quality improvement process, instead of obtaining a second BP measurement after an initially elevated BP, medical assistants (MA) obtained serial BP readings two minutes apart. Rooming BP was compared to the first serial BP reading (current process), and to the average of the last two BP readings. Results. Seventy-eight patients were included. The average rooming BP was 155.5 ± 15.3 mmHg systolic (mean ± standard deviation) and 88.7 ± 11.8 mmHg diastolic, which decreased to 146.05 ± 18.2 mmHg systolic and 85.7 ± 11.8 mmHg diastolic for the first BP and 147.5 ± 16.2 mmHg systolic and 86.9 ± 12.1 mmHg diastolic for the average BP. Compared to the rooming BP, both readings were significantly decreased (first BP: p<0.001 SBP, p=0.006 DBP; average BP: p<0.001 SBP, p=0.011 DBP), but results were not significant when first BP was compared to average BP (p=0.756 SBP, p=0.278 DBP). A total of 26.9% and 23.1% of patients reached a BP goal of <140/90 mmHg with the first BP (p<0.001), and average BP (p<0.001), respectively. Conclusion. In patients presenting to an outpatient clinic with an initial elevated BP reading, simply repeating a single BP measurement shortly after completing the rooming process resulted in significantly reduced BP readings, and was equal to obtaining serial readings. In a busy clinic or pharmacy setting, healthcare providers can be reasonably confident that a single repeat blood pressure is an accurate reflection of a patient's true BP.