There are guidelines for antihypertensive treatment, and there are also guidelines for measuring blood pressure! Let’s compare your blood pressure measurement with the guidelines to see if you’re doing it right! Most people do not measure their blood pressure for a long time, and 2/3 of hypertensive patients do not know they have hypertension; most hypertensive patients do not monitor their blood pressure regularly, and some patients use medication based on their feelings. In order to raise awareness of the seriousness of the health hazards of hypertension and to draw the attention of all sectors of society to hypertension, the Ministry of Health has designated October 8 of each year as National Hypertension Day since 1998. Today is the 20th “National Hypertension Day”. China officially became a member of the World Hypertension League on May 12, 1989, and established the Chinese Hypertension League. In line with World Hypertension Day, the theme of National Hypertension Day has been “Know Your Blood Pressure” since 2014. In order to know your blood pressure, you need to take accurate measurements. There are also guidelines for measuring blood pressure! First, the basic requirements of blood pressure measurement 1, measurement before the preparation (1) patients: 30min before the blood pressure measurement do not drink coffee or alcohol, no strenuous exercise, stable mind. Empty the bladder, sit still and rest for 5 to 10 min. (2) Instruments: use qualified bench-top mercury sphygmomanometers, other styles of sphygmomanometers approved and regularly calibrated by the national metrology department, or ambulatory sphygmomanometers and electronic sphygmomanometers qualified by international standard verification. (3) Measurement conditions: A table suitable for the patient’s arm height and a chair with a backrest should be prepared for seated measurement; a treatment bed with the patient’s elbow abducted at 45° should be prepared for prone measurement. (4) Environmental conditions: appropriate space, suitable temperature, quiet environment, no noise. 2, measurement equipment (1) sphygmomanometer: it is recommended to use qualified desktop mercury sphygmomanometer, electronic sphygmomanometer, ambulatory sphygmomanometer. (2) Stethoscope: high-quality short-tube stethoscope should be used, the routine use of membrane chest piece, when listening to low-frequency Koch sound is recommended to use bell-type chest piece. (3) blood pressure unit: general clinical and research measurement of blood pressure unit with “mmHg” said. 3.Measuring personnel After the blood pressure measurement training of doctors, nurses and technicians to implement the office blood pressure and ambulatory blood pressure measurement. Trained patients, family members or other personnel to implement the home blood pressure measurement. 4.Measurement requirements (1) Routine measurement of upper arm blood pressure; routine measurement of wrist blood pressure and finger blood pressure is not recommended. (2) It is recommended that the blood pressure of both upper arms (at the brachial artery) be measured for the first time, and that the side with the higher blood pressure be used as the upper extremity for blood pressure measurement. (3) When the difference in blood pressure (systolic blood pressure) between the two arms is >20 mmHg, it is recommended that extremity blood pressure measurements be performed. (4) The elderly and patients with diabetes or certain diseases are prone to postural hypotension, and it is recommended that multiple postural blood pressure measurements be taken. (5) Blood pressure measurement in the standing position should be performed 3 min after changing from prone to standing. Second, the factors affecting the accurate measurement of blood pressure 1, the preparation of the subject Many factors related to the subject can cause deviations in blood pressure measurement. Such as room temperature, exercise, alcohol consumption or smoking, arm position, muscle tension, bladder filling, speech and environmental noise. The subject’s speech is a common factor, and the subject cannot speak during the blood pressure measurement, nor can the medical staff speak with the subject. The most commonly used position for blood pressure measurement is sitting or supine. It has been reported that the diastolic blood pressure measured in the sitting position is 5 mmHg higher than that in the supine position, and the difference in systolic blood pressure is not significant. Some patients need to measure blood pressure in the upright position, generally the systolic blood pressure in the supine position is 5-8mmHg higher than in the upright position, and the diastolic blood pressure is higher, 4-6mmHg. 3, the position of the arm The position of the balloon should be the same height as the level of the right atrium when measuring blood pressure. If the upper arm position is lower than the right atrial level, the measured value is higher; if the upper arm is higher than the heart level, the measured value is lower. In the sitting position, the right atrial level is located at the middle of the sternum, at the level of the fourth rib. In the lying position, the upper arm is supported by a small pillow so that the upper arm is at the same height as the mid-axillary line. 4. The difference between left and right arm blood pressure It is recommended that the left and right upper arm blood pressure should be measured at the first examination. A difference in blood pressure between the arms of >20 mmHg is highly suggestive of aortic arch narrowing and upper limb arterial occlusion. When the blood pressure in the left and right upper arms is not the same, the blood pressure value measured in the arm with the higher value is used. 5, the position of the sphygmomanometer The sphygmomanometer mercury column should be kept vertical during the measurement, and the line of sight must be kept perpendicular to the center of the sphygmomanometer scale surface when reading. 6, the accuracy of the sphygmomanometer All clinical use of sphygmomanometers need to be tested for accuracy. The benchtop mercury sphygmomanometer is an important tool for verifying the accuracy of other non-tabletop mercury sphygmomanometers, while the benchtop mercury sphygmomanometer should also be calibrated regularly. The amount of mercury in the scale tube of the mercury convex surface exactly in the scale “0” when the amount of mercury appropriate. 7, cuff size Currently, it is believed that the cuff air bag should cover at least 80% of the circumference of the upper arm. 8.Cuff position and winding elasticity The middle of the cuff airbag is placed above the brachial artery of the upper arm. The lower edge of the cuff is 2 to 3 cm above the elbow fossa, and it is generally believed that the tightness is appropriate when 2 fingers can be inserted. 9.Filling and deflation rate The slow and uniform deflation rate is 2~4mmHg per second, and the recommended deflation rate is 2mmHg per Bo heartbeat when bradycardia and arrhythmia are present. 10.Measurement times When measuring a patient several times, the first time is often higher. Therefore, each blood pressure measurement should be taken at least twice, with an interval of 1 min, and the average value should be taken as the patient’s blood pressure. If the difference between the two measurements is >5mmHg, the measurement should be taken again and the average blood pressure value calculated for three times. 11, the tail number preference The so-called tail number preference refers to the blood pressure reading habitually recorded as the last 0 or 5mmHg, this phenomenon should be avoided as far as possible, the bench-top mercury sphygmomanometer to measure blood pressure single record blood pressure value tail number should be accurate to 2mmHg. 12, other factors affecting the accuracy of blood pressure measurement factors are also reported as follows: the stethoscope chest piece stuffed under the cuff, through the clothes to measure blood pressure, winter off The blood pressure is measured immediately after taking off the shirt, and there are seasonal differences in blood pressure. Third, special populations and special status of blood pressure measurement 1, the elderly There is a higher incidence of simple systolic hypertension, white coat hypertension, postural hypotension and postprandial hypotension in the elderly, while the variability of blood pressure in the elderly is greater, so ABPM and HBPM are particularly important in elderly patients. The following conditions should also be noted when measuring blood pressure in the elderly: (1) Autonomic decline: may show significant blood pressure variability and hypotension in the middle of ABPM, and attention should be paid to identifying this type of hypotension. (2) Pseudohypertension: Pseudohypertension is the result of decreased arterial compliance and increased arterial stiffness. Peripheral muscular arteries must have higher pressure in the cuff to compress the artery due to progression of atherosclerosis, thus showing a large difference between cuff pressure measurement and direct measurement of blood pressure. (3) Postural hypotension: After the initial measurement of blood pressure and adjustment of medication, attention should be paid to the measurement of standing blood pressure. (1) For patients with severe bradycardia (ventricular rate <40 beats/min), the deflation rate should be slower than the normal heart rate when measuring blood pressure, usually the deflation rate should be no more than 2 mmHg per beat, which can avoid the phenomenon of low systolic blood pressure and high diastolic blood pressure caused by too fast deflation. (2) For cardiac arrhythmias, especially atrial fibrillation, the only way to overcome the problems caused by large beat-to-beat cardiac variability is through repeated measurements; and for bradycardia with severe arrhythmias, both of these aspects should be noted during blood pressure measurement. (3) direct arterial blood pressure continuous monitoring, is invasive technology, is not suitable for the application of outpatients. 3, obese obese patients usually have thicker arm circumference, pay special attention to the size of the cuff is appropriate, in practice the lack of adult large size cuff. The error of blood pressure measurement is precisely caused by the irregular application of cuffs. In abnormally obese patients with thick and short upper arms, the BHS recommends the use of a longer cuff (16cm*42cm) for the rare patient with an arm circumference of more than 50cm. When using a thigh cuff is also inappropriate, a suitable cuff can be wrapped around the forearm and the radial artery pulsation sounds can be auscultated to determine blood pressure, or a validated wrist sphygmomanometer can be used to measure the blood pressure of patients with thicker arm circumference using a standard adult cuff, which can cause deviations of excessive diastolic blood pressure. 4. Pregnancy In normal early and mid-pregnancy, systolic and diastolic blood pressure decreases by 5-10 mmHg compared to pre-pregnancy, and gradually returns to pre-pregnancy levels in late pregnancy. During a woman's pregnancy, blood pressure measurement is based on systolic pressure, and the first tone of the Koch sound is the systolic pressure. Diastolic blood pressure is more variable by pregnancy, and diastolic blood pressure in pregnant women is still determined by the complete disappearance of the tone, and in special cases it can be determined by the variable tone. ABPM is mainly used to identify white coat hypertension during pregnancy. HBPM is recommended for pregnant women and is measured once a month for those without hypertension, 2 to 3 times a week for those with general hypertension, and at least once a day in the morning and evening for those with severe hypertension. 5. Use of antihypertensive drugs When making a diagnosis of hypertension in a patient, it should first be clear whether the patient is taking antihypertensive drugs. In terms of the effect of antihypertensive drugs themselves on blood pressure levels, the following points need to be noted: (1) If you need to know the true blood pressure status of the patient when not taking medication, for patients who can stop taking antihypertensive drugs, it is recommended that blood pressure be measured after stopping the medication for more than 5 half-lives under close observation. (2) Time of blood pressure measurement: To understand the efficacy of antihypertensive drugs, blood pressure should generally be measured at the trough of the drug. (3) Blood pressure measurement method: In order to have a more comprehensive understanding of the blood pressure level of patients who have taken antihypertensive drugs, ambulatory blood pressure or home blood pressure can be added to the measurement of office blood pressure.