Cardiovascular Disease: Hypertension

Appendix A: Blood Pressure Measurement

The relationship between blood pressure (BP) and risk of CVD events (heart attacks, strokes, heart failure, etc.) is continuous, consistent, and independent of other risk factors.2 Therefore, BP must be monitored on an annual basis following the procedures outlined by the American Heart Association.15, 16 

Self (home) and ambulatory BP measurements are useful for monitoring CVD.⁶ However, given the PSW’s possible conflicting interests, clinic or office readings must be used to determine duty status. Automatic office BP (unattended BP readings in a quiet space in the office) could be used in case of conflict between home BP and in-office BP. In addition, PSWs on anti-hypertensive medications must be evaluated and questioned about any possible job-impairing side effects, such as electrolyte disturbances or orthostatic hypotension (see chapter on Medications). The association between increasing BP and cardiovascular events rises with the presence of additional CVD risk factors and end-organ damage due to hypertension.3, 7-13, 16, 17

Therefore, all PSWs with hypertension should be screened for:

a) other CVD risk factors (diabetes mellitus, smoking, hyperlipidemia, obesity, and lack of exercise); and

b) hypertensive renal, cardiovascular, or eye damage (see Appendix B).

AHA-ACC Blood Pressure Measurement

Blood pressure (BP) measurements in the office or clinic setting, as adapted from Pickering et al.,4 and Black et al.5

• Caffeine, exercise, and smoking should be avoided for at least 30 minutes prior to measurement.
• The patient should be seated comfortably for 5 minutes with the back supported and the upper arm bared without constrictive clothing. The legs should not be crossed.
• The arm should be supported at heart level, and the bladder of the cuff should encircle at least 80% of the arm circumference.
• The mercury column should be deflated at 2 to 3 mm/s, and the first and last audible sounds should be taken as systolic and diastolic pressure. At least two measurements should be measured 1 minute apart with the averaged recorded. If there is >5 mm Hg difference between the first and second readings, additional (1 or 2) readings should be obtained and then the average of these multiple readings is used.
• Neither the patient nor the observer should talk during the measurement.