A lack of standardized blood pressure (BP) training among doctors, physician assistants (PAs), nurses, and other healthcare professionals is preventing the country's medical community from curbing hypertension, according to the American Medical Association (AMA). Hypertension affects about half of US adults and is a leading contributor to cardiovascular disease.
First-year medical students typically read about BP measurement in a textbook and possibly attend a lecture before practicing using a manual cuff a few times on classmates, said Martha Gulati, MD, professor and director of preventive cardiology at Cedars-Sinai.
The dearth of BP instruction is alarming because inaccurate readings contribute to under- and overtreatment of hypertension, she told Medscape Medical News.
The AMA hopes $100,000 in grants to five health education schools will help improve BP instruction. The group recently announced it would give $20,000 each to five schools that train health professionals, expanding on a 2021 program to improve BP measurement training.
The new grants for interactive lessons will benefit nearly 5000 students from Johns Hopkins University in Maryland, Nova Southeastern University in Florida, University of Washington, Stony Brook University in New York, and University of Pittsburgh in Pennsylvania.
In a 2021 survey of 571 clinicians, most of whom were cardiologists, Gulati found that only 23% performed accurate BP measurements despite the majority saying they trusted BP readings taken in their clinic. Accurate readings were defined as routinely checking BP in both arms, checking BP at least twice each visit, and waiting 5 minutes before taking the reading.
Med students fare no better when it comes to BP skills. In a 2017 study of 159 students from medical schools in 37 states, only one student demonstrated proficiency in all 11 elements necessary to measure BP accurately. Students, on average, performed just four of them correctly.
The elements of proper BP measurement include patients resting for 5 minutes before the measurement with legs uncrossed, feet on floor and arm supported, not talking, reading or using cell phone; BP taken in both arms with correct size of cuff placed over bare arm; identifying BP from the arm with the higher reading as clinically more important and as the one to use for future readings.
Manual BP readings require an appropriately sized BP cuff, sphygmomanometer, and a clinician skilled in using a stethoscope and auscultatory method. Meanwhile, automated readings require a clinician to place the cuff, but a digital device collects the measurement. Though preference depends on the setting and clinician, automated readings are more common. In Gulati's study, automated BP assessment was used by 58% of respondents.
Depending on the BP device and technique, significant variations in readings can occur. In a 2021 study, Current Hypertension Reports found that automated readings may more closely reflect the patient's baseline BP and produce results similar to ambulatory monitoring by a medical professional. An earlier JAMA Internal Medicine analysis found that clinicians' manual readings reflect higher BP measurements than automated readings.
Though the AMA offers a free online series on BP measurement for students, making the training available to more healthcare team members can help improve hypertension control, said Kate Kirley, MD, director of the AMA's chronic disease prevention and programs.
Concern over the lack of standardized BP techniques isn't new. In 2019, the American Heart Association and the AMA created an online BP course for healthcare workers. Two years later, the AMA offered grants to five medical schools for training courses.
Most of the new training sessions already on the AMA website take students about 15 minutes to complete. Kirley says since equipment varies across settings, participants will learn how to conduct manual, semi-automated, and automated office BP readings and identify workarounds for less than ideal room setups that can skew results. They will also explore how to guide patients in performing BP readings at home.
Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.
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Cite this: AMA Funds Standardized BP Training for Medical, PA, and Nursing Schools - Medscape - Sep 28, 2023.