Alerting reaction and rise in blood pressure during measurement by physician and nurse.

TLDR

The study examined whether the alarm reaction and blood pressure/heart rate increases during cuff blood pressure measurement by a physician diminish with repeated visits and are less pronounced when performed by a nurse. Continuous intra‑arterial recordings were obtained in 46 subjects to monitor blood pressure and heart rate during cuff measurements by physicians and nurses. Repeated physician visits did not reduce the pressor or tachycardic responses, whereas nurse‑performed measurements produced 46.7% lower blood pressure and 42.1% lower heart rate increases, showing that the overestimation error can be mitigated by using a nurse.

Abstract

Blood pressure was monitored by a continuous intra-arterial recording in 46 subjects to investigate whether the alarm reaction and the blood pressure and heart rate increases that occur during cuff blood pressure measurement made by a physician 1) attenuate when the physician's visit is repeated several times and 2) are less pronounced if a nurse measures the blood pressure. In 16 subjects the peak mean blood pressure and heart rate rises that occurred in the early part of the physician's first visit (22.6 +/- 1.8 mm Hg and 17.7 +/- 1.7 beats/min) were virtually identical to those occurring during three subsequent visits by the same physician throughout a 2-day intra-arterial blood pressure monitoring. The less pronounced pressor and tachycardic responses observed in the last part of the physician's visit also were virtually identical among the four visits. In contrast, in 30 other subjects the blood pressure and heart rate rises that occurred during the nurse's visit were 46.7% and 42.1% less (p less than 0.01) than those occurring during the physician's visit. The late and less pronounced pressor and tachycardic responses to the visit were also significantly less (p less than 0.01) in the former than in the latter condition. These results indicate that the error of overestimation of blood pressure inherent in cuff blood pressure measurement by a physician cannot be avoided by repeated visits by the physician over a short time span. It clearly can be reduced, however, if blood pressure measurements are performed by a nurse.