An analysis of blood pressure measurement in a primary care hospital in Swaziland
Date
2014-12
Journal Title
Journal ISSN
Volume Title
Publisher
AOSIS Publishing
Abstract
Background: Measurement of blood pressure (BP) is done poorly because of both human
and machine errors.
Aim: To assess the difference between BP recorded in a pragmatic way and that recorded using
standard guidelines; to assess differences between wrist- and mercury sphygmomanometerbased
readings; and to assess the impact on clinical decision-making.
Setting: Royal Swaziland Sugar Corporation Mhlume hospital, Swaziland.
Method: After obtaining consent, BP was measured in a pragmatic way by a nurse practitioner
who made treatment decisions. Thereafter, patients had their BP re-assessed using standard
guidelines by mercury (gold standard) and wrist sphygmomanometer.
Results: The prevalence of hypertension was 25%. The mean systolic BP was 143 mmHg (pragmatic)
and 133 mmHg (standard) using a mercury sphygmomanometer; and 140 mmHg for standard
BP assessed using wrist device. The mean diastolic BP was 90 mmHg, 87 mmHg and 91 mmHg
for pragmatic, standard mercury and wrist, respectively. Bland Altman analyses showed that
pragmatic and standard BP measurements were different and could not be interchanged clinically.
Treatment decisions between those based on pragmatic BP and standard BP agreed in 83.3% of
cases, whilst 16.7% of participants had their treatment outcomes misclassified. A total of 19.5% of
patients were started erroneously on anti-hypertensive therapy based on pragmatic BP.
Conclusion: Clinicians need to revert to basic good clinical practice and measure BP more
accurately in order to avoid unnecessary additional costs and morbidity associated with
incorrect treatment resulting from disease misclassification. Contrary to existing research,
wrist devices need to be used with caution.
Description
CITATION: Mlawanda, G., Pather, M. & Govender, S. 2014. An analysis of blood pressure measurement in a primary care hospital in Swaziland. African Journal of Primary Health Care & Family Medicine, 6(1): 1-9, doi: 10.4102/phcfm.v6i1.590.
The original publication is available at http://www.phcfm.org
The original publication is available at http://www.phcfm.org
Keywords
Blood pressure -- Measurement, Blood pressure -- Measurement -- Swaziland -- Evaluation, Primary health care -- Swaziland
Citation
Mlawanda, G., Pather, M. & Govender, S. 2014. An analysis of blood pressure measurement in a primary care hospital in Swaziland. African Journal of Primary Health Care & Family Medicine, 6(1): 1-9, doi: 10.4102/phcfm.v6i1.590