Cardiovascular Journal of Africa: Vol 30 No 2 (March/April 2019)

60 / 74

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 2, March/April 2019 126 AFRICA
systolic blood pressure by 2–8 mmHg.92 The key messages are
presented in Table 3.
Conclusion
The measurement of blood pressure in pregnancy and in
HDP requires careful consideration of physiological changes in
pregnancy and a need to be mindful of acute severe systolic and/
or diastolic hypertension. An appropriate device must be used to
ensure that an accurate blood pressure reading is obtained. Poor
technique will lead to medical error. Manufacturer-, patient-,
health system- and healthcare professional-related challenges
that affect blood pressure measurement in pregnancy and HDP
need to be addressed, and the recommendations provided in
the current review may be helpful to clinicians and healthcare
administrators.
References
1. Brown M, Magee LA, Kenny LC, Karumanchi SA, McCarthy F, Saito
S, et al. The hypertensive disorders of pregnancy: ISSHP classification,
diagnosis and management recommendations for international practice.
Pregnancy Hypertens 2018 May 23 pii: S2210-7789(18)30126-0 doi:
101016/jpreghy201805004 [Epub ahead of print].
2. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al.
Global, regional, and national levels and trends in maternal mortal-
ity between 1990 and 2015, with scenario-based projections to 2030:
a systematic analysis by the UN Maternal Mortality Estimation Inter-
Agency Group. Lancet 2016; 387(10017): 462–474.
3. World Health Organization. World health statistics 2016: monitor-
ing health for the SDGs, sustainable development goals. Geneva,
Switzerland: World Health Organization, 2016.
4. National Committee on the Confidential Enquiries into Maternal
Deaths. Saving Mothers 2014–2016: Seventh triennial report on confi-
dential enquiries into maternal deaths in South Africa: Short report.
Pretoria: South African Department of Health, 2018.
5. Nyfløt LT, Ellingsen L, Yli BM, Øian P, Vangen S. Maternal deaths
from hypertensive disorders: lessons learnt. Acta Obstet Gynecol Scand
2018 Apr 17 doi: 101111/aogs13357 [Epub ahead of print].
6. Magee LA, von Dadelszen P, Stones W, Mathai M. The FIGO Textbook
of Pregnancy Hypertension: An Evidence-based Guide to Monitoring,
Prevention and Management. 2016; Available from: -
Hypertension-Final.pdf (assessed 24 July 2017).
7. Bhatt H, Siddiqui M, Judd E, Oparil S, Calhoun D. Prevalence of pseu-
doresistant hypertension due to blood pressure measurement technique
in a hypertension specialty clinic. J Am Soc Hypertens 2016; 10(4):
e20–e21.
8. Ray G, Nawarskas J, Anderson J. Blood pressure monitoring technique
impacts hypertension treatment. J Gen Intern Med 2012; 27(6): 623–629.
9. Armstrong R. Nurses’ knowledge of error in blood pressure measure-
ment technique. Int J Nurs Pract 2002; 8(3): 118–126.
10. Woolsey S, Brown B, Ralls B, Friedrichs M, Stults B. Diagnosing hyper-
tension in primary care clinics according to current guidelines. J Am
Board Fam Med 2017; 30(2): 170–177.
11. Poppas A, Shroff SG, Korcarz CE, Hibbard JU, Berger D, Lindheimer
MD, et al. Serial assessment of the cardiovascular system in normal
pregnancy. Role of arterial complianceand pulsatile arterial load.
Circulation 1997; 95(10): 2407.
12. Hibbard JU, Korcarz CE, Nendaz GG, Lindheimer MD, Lang RM,
Shroff SG. The arterial system in pre-eclampsia and chronic hyperten-
sion with superimposed pre-eclampsia. Br J Obstet Gynaecol 2005;
112(7): 897–903.
13. Association for the Advancement of Medical Instrumentation,
American National Standards Institute, International Organization for
Standardization. Non-invasive sphygmomanometers: Part 2: Clinical
investigation of automated measurement type ANSI/AAMI/ISO 81060.
2nd edn. Arlington, VA: AAMI, 2013.
14. O’Brien E, Petrie J, Littler W, de Swiet M, Padfield P, Altman D, et al.
The British Hypertension Society protocol for the evaluation of blood
pressure measuring devices. J Hypertens 1993; 11(Suppl 2): S43–S62.
15. O’Brien E, Atkins N, Stergiou G, Karpettas N, Parati G, Asmar R, et al .
European Society of Hypertension International Protocol revision 2010
for the validation of blood pressure measuring devices in adults. Blood
Press Monit 2010; 15(1): 23–38.
16. Sharman JE, Avolio A, Baulmann J, Benetos A, Blacher J, Blizzard
CL, et al . Validation of non-invasive central blood pressure devices:
ARTERY Society task force consensus statement on protocol standardi-
zation. Eur Heart J 2017; 38(37): 2805–2812.
17. Stergiou GS, Alpert B, Mieke S, Asmar R, Atkins N, Eckert S, et al.
A universal standard for the validation of blood pressure measuring
devices: Association for the Advancement of Medical Instrumentation/
European Society of Hypertension/International Organization for
Standardization (AAMI/ESH/ISO) Collaboration Statement. J
Hypertens 2018; 36(3): 472–478.
18. Ngene NC, Moodley J. Baseline check of blood pressure readings of
an automated device in severe pre-eclampsia and healthy normotensive
pregnancy. Pregnancy Hypertens 2018; 12: 47–52.
19. Camara-Lemarroy CR, Escobedo-Zúñiga N, Villarreal-Garza
E, García-Valadez E, Góngora-Rivera F, Villarreal-Velázquez HJ.
Posterior reversible leukoencephalopathy syndrome (PRES) associated
with severe eclampsia: Clinical and biochemical features. Pregnancy
Hypertens 2017; 7: 44–49.
20. Martin JN Jr, Thigpen BD, Moore RC, Rose CH, Cushman J, Warren
M. Stroke and severe preeclampsia and eclampsia: a paradigm shift
focusing on systolic blood pressure. Obstet Gynaecol 2005; 105(2):
246–254.
21. Kajantie E, Eriksson J, Osmond C, Thornburg K, Barker D.
Pre-eclampsia is associated with increased risk of stroke in the adult
offspring: the Helsinki birth cohort study. Stroke 2009; 40(4): 1176–1180.
22. Leffert L, Clancy C, Bateman B, Bryant A, Kuklina E. Hypertensive
disorders and pregnancy-related stroke. Obstet Gynecol 2015; 125(1):
124–131.
23. Auger N, Fraser WD, Paradis G, Healy-Profitós J, Hsieh A, Rhéaume
M-A. Pre-eclampsia and long-term risk of maternal retinal disorders.
Obstet Gynaecol 2017; 129(1): 42–49.
24. Soma-Pillay P, Suleman FE, Makin JD, Pattinson RC. Cerebral white
matter lesions after pre-eclampsia. Pregnancy Hypertens 2017; Published
Table 3. Key messages
• Due to physiological changes that occur in pregnancy and in HDP, blood
pressure devices require validation in these conditions to avoid medical error.
• During a blood pressure measurement, an average of two or more readings
should be used to denote the blood pressure value.
• The use of a single blood pressure reading in clinical practice is widespread
and may impact on decision making and compromise patient safety.
• Manufacturer, patient, heath system, and healthcare professional’s related
factors must be addressed to maximise the value of blood pressure measure-
ment.
• An evidence-based and easy-to-follow algorithm on techniques of ausculta-
tory and automated BP measurement is provided in the article (Table 1).