Recording of blood pressure & hypertension screening

Hypertension is a common condition affecting about 18% of the population and is a major risk factor for heart disease and stroke.

Knowledge of the aetiology of hypertension and associated risk factors.
To record an accurate blood pressure measurement.
To screen for associated risk factors and discuss importance of healthy lifestyle.
To interpret readings and arrange follow up or referral.

Welcome and check identity of patient
Check source of referral
Seat and reassure
Explain procedure and answer questions, obtain consent.
Relax patient
Apply appropriate sized cuff with tubes running down the antecubital. The bladder within the cuff should have a width of about 40% of the circumference of the arm (12-14cm average). The length of the bladder should be about 80% of this circumference (almost long enough to encircle the arm).
Support forearm and elbow at level of heart.
If no previous guiding measurements check systolic pressure using radial pulse. Otherwise, pump up pressure steadily, then slowly release while listening with stethoscope over brachial artery (3-4 mm Hg per second).
Record phase 1 (systolic) and phase 5 - total fade out (diastolic).
Repeat on other arm on at least one occasion, if BP raised repeat readings on at least 2 more occasions.
Weight and height - BMI (discuss)
Urinalysis for protein and sugar
Lifestyle: smoking; diet; exercise; alcohol; salt (discuss)
Family history: I.H.D.; hypertension; diabetes Cont.
Blood tests: FBC; glucose; U&Es; lipids; urate.
Arrange follow or referral.
Update computer
Aneroid instruments need regular recalibration.

A Guide to Blood Pressure Classification in Adults
Bates, B (1995) A Guide to Physical Examination and History Taking 6th Ed. J.B. Lippincott, Philadelphia.
Chapman, J (1999) Treatment of Hypertension. Practice Nursing Vol 10 No 17 p29-30
Cowley, N (1999) What is Hypertension? Practice Nursing Vol 10 No 17 p 25-28