Original Research

An analysis of blood pressure measurement in a primary care hospital in Swaziland

Ganizani Mlawanda, Michael Pather, Srini Govender
African Journal of Primary Health Care & Family Medicine | Vol 6, No 1 | a590 | DOI: https://doi.org/10.4102/phcfm.v6i1.590 | © 2014 Ganizani Mlawanda, Michael Pather, Srini Govender | This work is licensed under CC Attribution 4.0
Submitted: 09 September 2013 | Published: 09 December 2014

About the author(s)

Ganizani Mlawanda, Faculty of Medicine and Health Sciences, Department of Interdisciplinary Health Sciences, Division of Family Medicine and Primary Care, University of Stellenbosch, Tygerberg, South Africa and Royal Swaziland Sugar Corporation (RSSC) Medical Services, Mhlume, Swaziland
Michael Pather, Faculty of Medicine and Health Sciences, Department of Interdisciplinary Health Sciences, Division of Family Medicine and Primary Care, University of Stellenbosch, Tygerberg, South Africa
Srini Govender, Faculty of Medicine and Health Sciences, Department of Interdisciplinary Health Sciences, Division of Family Medicine and Primary Care, University of Stellenbosch, Tygerberg and Khayelitsha Community Health Centre, Khayelitsha, South Africa


Share this article

Bookmark and Share

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 within correct treatment resulting from disease misclassification. Contrary to existing research,wrist devices need to be used with caution.


Keywords

No related keywords in the metadata.

Metrics

Total abstract views: 2360
Total article views: 6015

 

Crossref Citations

1. Blood pressure measurement techniques: Assessing performance in outpatient settings of a tertiary-level hospital in Rwanda
Jean Damascene Kabakambira, Zachee Niyonsenga, Marthe Hategeka, Grace Igiraneza, Genevieve Benurugo, Don Eliseo Lucero-Prisno III, Celestin Hategeka
The Journal of Clinical Hypertension  vol: 20  issue: 6  first page: 1067  year: 2018  
doi: 10.1111/jch.13303