School of Population Health

Spotlight on blood pressure measurement needed to prevent silent killer

Measuring blood pressure

High blood pressure (hypertension) is the leading preventable risk factor for death globally and significantly increases the risk of life-threatening conditions such as heart attack, stroke and kidney disease. Over 1 billion people globally have hypertension, two-thirds of which are living in low- and middle-income countries.

Professor Alta Schutte, hypertension specialist and co-chair of the non-communicable diseases research program at UNSW School of Population health and Theme Lead for Cardiac, Vascular and Metabolic Medicine at the UNSW Faculty of Medicine and Health, is co-author of several recent internationally significant publications on hypertension which are part of a broader push to shift global practice to improve blood pressure measurement and treatment.

“High blood pressure is a silent killer as it has few symptoms and as such, accurate blood pressure measurement is fundamental for screening, diagnosing and managing the condition early on,” says Professor Schutte. “Yet, the lack of access to accurate, affordable blood pressure devices remains a major barrier to properly treating the condition, especially in low-resource settings.”  

Most blood pressure devices have not been validated, which means they are likely to give readings that are too high or too low resulting in underdiagnosis or overdiagnosis of hypertension, explains Alta.  

“In recent years, automated blood pressure measurement devices have started to replace manual devices – the challenge is worldwide clinicians, healthcare workers, and those responsible for the procurement of blood pressure devices are often uninformed about the importance of using devices that have been validated for accuracy,” she says.

In response to growing concerns around the accuracy of these automated devices, in 2020 the World Health Organization (WHO) published the WHO technical specifications for automated non-invasive blood pressure measuring devices with cuff.

“Previous technical specifications from the WHO were published over 15 years ago but much has changed in the blood pressure scene with many new devices available, and particularly inaccurate devices flooding the market,” says Alta. “The challenge is that these devices are often cheaper than validated devices and thus are the devices of choice.”

Alta was a co-author of these guidelines, and more recently of the publication, A call for action to improve blood pressure measurement: The 2020 WHO technical specifications for automated non-invasive blood pressure measuring devices with a cuff published in Hypertension in March 2021, to reinforce the urgent need to  implement these guidelines into practice.

In its report, the WHO outlines the technical specifications for automated non-invasive clinical blood pressure measurement using a blood pressure cuff, (a device which applies pressure to the arteries in the arm). Applicable to various settings, the report provides steps for governments, manufacturers, health care providers, and their organisations to implement the recommendations to ensure accurate blood pressure measurement.

“Although, health and scientific organizations have had similar recommendations for many years, the WHO carries a lot more weight - we hope the WHO specifications will provide the impetus to enhance the accuracy of blood pressure assessment worldwide,” says Alta.

In COVID-19 times there is a great emphasis on home blood pressure monitoring as part of telecare and, with many more patients are taking up this option, this has become a good way to keep track of blood pressure measurement without help of a doctor.  

“COVID-19 has put a spotlight on hypertension as it is one of the primary chronic conditions associated with complications from the virus, yet many more people die from hypertension-related causes than from COVID-19,” says Alta.

“There are millions of people unaware they have hypertension and who have never had their blood pressure measured. We must ensure early detection and treatment continues to be prioritised - if not measured properly, it cannot be treated properly.”

Hypertension experts around the world have established STRIDE BP where device validation can be easily checked prior to purchase. It provides international guidance and practice tools on the methodology and technology for accurate blood pressure evaluation according to the latest scientific evidence.

Further reading:
How to check whether a blood pressure monitor has been properly validated for accuracy - Picone - 2020 - The Journal of Clinical Hypertension - Wiley Online Library.

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UNSW School of Population Health