Chronic disease prevention and management in central coastal CA

Medical Assistant Boot Camp on Office Blood Pressure “vitalizing”

Today I’m putting the finishing touches on a Medical Assistant (MA) Boot Camp presentation. Our family practice offers is attempting to make more consistent our MA practices to suit provider expectations and improve flow and patient experience                                       BP Boot Camp 03.12.12

BP Boot Camp

BP definitions, terms and significance

Over 135/85 is true High Blood pressure, best monitored on home BP devices

130-135/80-85  pre-hypertension

nl BP 120/80 or less

Primary reason to treat HTN is to lower risk of stroke, heart failure and kidney disease

No single blood pressure reading diagnoses hypertension, instead one needs home BP monitoring over several days with protocol or we use three clinic elevations over a month long period. Lovibond K et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: A modelling study. Lancet 2011 Aug 24;

The commonest confounding dx is “white coat hypertension”, 796.2- typically non hypertensive, non diabetic, non smokers, and younger Hypertension. 2011;57:898-902

Technique points

BP is routine but errors abound because of faulty technique

  1. Size of arm/cuff

-bets BP is with patient supine, and arm at level of heart

-second best is seated with arm resting at level of heart

-cuff size must be correct

-the width should be approximately 40% of the circumference of the limb

-there are often recommendations on the cuff

-and the bladder must completely encircle the arm

-higher in right arm, can be as high as 15mmHg, so be sure to mention which

-for very large arms, can use arm cuff on the forearm and scope over radial pulse

2. Speed of deflation

-too slow deflation can decrease the systolic BP, and raise the diastolic B


-muscle activity like walking and talking can raise BP

-at least 1 minute between BP’s

-ideal time in between in clinic  is still not known, yet averaging 4-5 BP is acceptable

Ann Intern Med June 21, 2011 154:781-788;

Goal: To design Workflow for BP’s >140/90, needs repeating, but logistically how for our office


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