Erika Campana et al. Bruno Daniel Ferrari
Cardiovascular diseases are the leading cause of death worldwide, and a key risk factor for these diseases—hypertension—is unquestionably the most prevalent disease in the population. Cardiovascular semiology is extremely important in the setting of hypertension (HTN), since the determination of blood pressure values through established indirect measurement techniques plays an essential role in initiating further diagnostic investigation, prompting treatment, and allowing monitoring of patients with HTN. The environment in which measurement is performed; the patient’s dietary habits, use of tobacco and alcohol, and engagement in physical activity before measurement; the adequacy of cuff size in relation to the limb; and proper cuff positioning are among the several important aspects which may interfere with measurement reliability. In this context, assessing the technical knowledge of healthcare providers is critical to preventing diagnostic errors.
Differences in magnitude between office BP and mean daytime BP can be attributed both to the environment and to the technical quality of blood pressure measurement by the examiner. Beckett et al. obtained an average of three manual BP readings from 481 hypertensive patients in family practices. The average clinic BP (151/83 mmHg) was significantly (P<0.001) higher than the daytime mean BP measured by ambulatory blood pressure monitoring (ABPM) (142/80 mmHg).
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