Hypertension Screening

Training video: how to read blood pressure

All HAPPY volunteers MUST carefully review the training video and the step-by-step guide throughout their service commitment with HAPPY. 
 

• Step-by-step guide to conducting blood pressure screenings

Blood Pressure Levels (cited from American Heart Association) 

Blood pressure is measured in millimeters of mercury (mm Hg). The classifications in the table below are for people who aren’t taking antihypertensive (blood pressure-lowering) drugs and aren’t acutely ill. When a person’s systolic and diastolic pressures fall into different categories, the higher category is used to classify the blood pressure status. Diagnosing high blood pressure is based on the average of two or more readings taken at each of two or more visits after an initial screening.

Classification of blood pressure for adults age 18 years and older

* Unusually low readings should be evaluated for clinical significance.

(From the Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure)

Educational references (source: MedicineNet.com)

• An elevation of the systolic and/or diastolic blood pressure increases the risk of end-organ damage, including developing heart (cardiac) disease, kidney (renal) disease, hardening of the arteries, eye damage, and stroke (brain damage). These complications of hypertension are often referred to as end-organ damage because damage to these organs is caused by chronically elevated blood pressure.
• High blood pressure is called “the silent killer” because it often causes no symptoms for many years, even decades, until it finally damages certain critical organs. 
• High salt intake, obesity, lack of regular exercise, excessive alcohol or coffee intake, and smoking may all increase risks of developing hypertension and complications. Conversely, one may improve their health condition by lowering salt intake, reducing to a healthy weight, doing regular physical exercises, and reducing alcohol, coffee, and smoking.
• Individuals with pre-hypertension may benefit from lowering of blood pressure by life style modification (life style changes are discussed above) and possibly medication especially if there are other risk factors for end-organ damage such as diabetes or kidney disease.
  Reporting your results to the community member:
  • • Only a qualified medical professional can interpret or diagnose a community member’s blood pressure. As a screener, you may NOT interpret a community member’s blood pressure or diagnose the community member. These values refer to healthy adults and are not inclusive; they are provided here for educational purposes only. Thresholds vary significantly for various community member populations, including elderly patients, diabetic patients, patients with impaired renal function, and other cases at the time of this blood pressure screening (blood pressures typically fluctuate over time). You may NOT under any circumstances diagnose the community member with hypertension or seek to interpret the blood pressure readings. You may NOT provide medical advice.
    • Refrain from making any interpretive statements specific to the community member’s case. In the hypothetical case above, you do not have the medical or legal authority to say that Mr. Smith does not have hypertension, or that Mr. Smith is healthy.
    • It is okay to provide educational information to the community member regarding hypertension in general terms,as long as you are not speaking with reference to the community member’s particular case, and as long as you are not making recommendations or giving medical advice.
      • For example, you may provide educational information (such as the education information above) about the risks typically associated with uncontrolledhypertension, but you may not advise the community member about his or her particular risk of morbidity.
      • You may use the educational materials in Resourcesprovided by HAPPY and Cornell Scott-Hill Health Center to provide general education about hypertension. You must not go beyond the level of these educational materials.
    • It is also your duty to ensure the community member understands that your screening and educational materialsare not intended as a substitute for medical advice or care. 
    • In cases where you have any question or uncertainty regarding what you can say, or if you are unsure of the answer to a community member’s question, you must defer to a medical professional. 
    • Ensure the community member understands that today’s blood pressure screening was just a snapshot of the community member’s overall health. It is not a physical exam and it is not conducted by a trained health care provider. If the community member’s blood pressure falls within normal range, encourage him or her to come back regularly, as blood pressure will often change over time.
      • For the homeless community members, their blood pressure may be particularly subject to fluctuation, due their lifestyle, poor diets, exposure to the elements, and sometimes alcohol, smoking, or drug abuse problems. As a result, you should make every effort to ask community members to check their blood pressure as often as possible. They should understand they need to monitor their blood pressure as part of a normal, self-management behavior to manage their blood pressure level. Even if their blood pressure falls into the normal range today, they should still keep monitoring their blood pressure.   
      • Screening for hypertension for only once is ineffective, since a diagnosis of hypertension can only be made on the basis of a series of measurements taken over a period of time. In fact, studies have shown that single reading screens result in 33 percent false negatives and up to 66 percent false positives. Therefore, it is extremely important that we encourage all community members to take a blood pressure reading with us as often as possible.  
    • If the community member’s blood pressure is above normal range, proceed to guidelines and instructions in Resources on connecting the community member to medical care at Cornell Scott-Hill Health Center.
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    • Frequently consult with the mandatory readings for educational purposes:

      Mandatory Reading List  

    • http://www.medicinenet.com/high_blood_pressure/article.htm
    • http://www.webmd.com/hypertension-high-blood-pressure/guide/blood-pressure-causes
    • http://www.cdc.gov/bloodpressure/
    • http://www.cdc.gov/nchs/fastats/hyprtens.htm