Blood Pressure Checks for Diagnosing Hypertension: Health Professionals' Knowledge, Beliefs, and Practices

Beverly B. Green; Melissa L. Anderson; Kelly Ehrlich; Yoshio N. Hall; Laurel D. Hansell; Clarissa Hsu; Dwayne Joseph; Karen L. Margolis; Jennifer B. McClure; Sean A. Munson; Mathew J. Thompson

doi:10.3122/jabfm.2022.02.210318

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Figure 1.
Under optimal circumstances (such as no barriers to access, adherence) how accurate do believe the following screening procedures are in making a new diagnosis of hypertensions?* Abbreviations: BP, blood pressure.
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Figure 2.
When making a new diagnosis of hypertension how often do you (or the providers you work with) rely on BP measurements form each of the following types of monitors?* Abbreviations: BP, blood pressure.
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Figure 3.
How Easy Would it Be for Patients to Complete the Following BP Measurement Methods for Confirming a New Diagnosis of Hypertension?* Abbreviations: BP, blood pressure.
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Figure 4.
Provider Reported Target BP Thresholds Clinic, Home, And 24-Hour Ambulatory BP Measurements Used For Making A Diagnosis Of Hypertension.* Abbreviations: BP, blood pressure; MA, medical assistant; LPN, licensed practical nurse; RN, registered nurse; PA, physician assistant; APRN, advanced practice registered nurse.
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Table 1.

Health Professional Characteristics

	MA/LPN/RN	Physician/PA/APRN
	n = 163	n = 119
	n (%)	n (%)
Provider Type^*
Medical Assistant (MA)	99 (61.1)
Licensed Practical Nurse (LPN)	28 (17.3)
Registered nurse (RN)	33 (20.4)
Other	2 (1.2)
Physician		86 (72.3)
Physician Assistant (PA)		29 (24.4)
Advanced Practice Registered Nurse (APRN)		4 (3.4)
Age^{^†}
Under 30	21 (13.0)	5 (4.2)
30 to 39	48 (29.6)	43 (36.4)
40 to 59	77 (47.5)	55 (46.6)
60 and over	16 (9.9)	15 (12.7)
Sex^{^‡}
Male	7 (4.3)	38 (32.5)
Female	150 (92.6)	74 (63.3)
Other or prefer not to say	5 (3.1)	5 (4.3)

↵* Missing provider type, MA/LPN/RN, n = 1.
↵† Missing age, MA/LPN/RN, n = 1; Physician/PA/APRN, n = 1.
↵‡ Missing sex, MA/LPN/RN, n = 1; Physician/PA/APRN, n = 2.

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Table 2.

Use and Preferences for Ambulatory BP Monitoring and BP Measurement for Making a New Diagnosis of Hypertension

Provider Type	MA/LPN/RN	Physician/PA/APRN
	n = 163	n = 119
	n (%)	n (%)
Before reading the description knew what 24-hour ambulatory BP measurement was?^*
No	60 (37.0)	17 (14.3)
Yes	88 (54.3)	97 (81.5)
Uncertain	14 (8.6)	5 (4.2)
Over the past 12 months, how often have you ordered 24-hour ambulatory BP measurements?(Physician/PA/APRNs only)^{^†}
None	NA^§	69 (68.3)
1 to 2 times	NA	18 (17.8)
3 or more times	NA	14 (13.9)
If there were no barriers to access to different methods, obtaining BP data, which method would you prefer for making a new diagnosis of hypertension (choose 1, Physicians/PA/APRNs only)^{^‡}
Clinic BPs	NA^§	33 (29.0)
Home BPs	NA	11 (9.7)
Kiosk BPs	NA	1 (0.9)
24-hour ambulatory BP	NA	69 (60.5)

↵* Missing MA/LPN/RN, n = 1.
↵† Missing n = 18.
↵‡ Missing n = 5.
↵§ NA, not applicable (not asked).
Abbreviations: APRN, advanced practice registered nurse; BP, blood pressure; MA, medical assistant; LPN, licensed practical nurse; PA, physician assistant; RN, registered nurse.

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Appendix Table 1.

Physician and PA/APRN Characteristics

	Physician	PA/APRN
	n = 86	n = 33
	n (%)	n (%)
Age^{^†}
Under 30	5 (5.9)	0 (0.0)
30 to 39	26 (30.6)	17 (51.5)
40 to 59	43 (50.6)	12 (36.4)
60 and over	11 (12.9)	4 (12.1)
Sex^{^‡}
Male	26 (31.0)	12 (36.4)
Female	56 (66.7)	18 (54.6)
Other or prefer not to say	2 (2.4)	3 (9.1)

↵† Missing age, Physician, n = 1.
↵‡ Missing sex, Physician, n = 2.
Abbreviations: APRN, Advanced Practice Registered Nurse; PA, Physician Assistant.

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Appendix Table 2.

Physician and PA/APRN Use and Preferences for Ambulatory bp Monitoring and BP Measurement for Making a New Diagnosis of Hypertension

Provider Type	Physician	PA/APRN
	n = 86	n = 33
	n (%)	n (%)
Before reading the description knew what 24-hour ambulatory BP measurement was?
No	8 (9.3)	9 (27.3)
Yes	74 (86.1)	23 (69.7)
Uncertain	4 (4.7)	1 (3.0)
Over the past 12 months, how often have you ordered 24-hour ambulatory BP measurements?^*
None	48 (61.5)	21 (91.3)
1 to 2 times	16 (20.5)	2 (8.7)
3 or more times	14 (18.0)	0 (0.0)
If there were no barriers to access to different methods, obtaining BP data, which method would you prefer for making a new diagnosis of hypertension (choose 1)^{^†}
Clinic BPs	17 (20.2)	16 (53.3)
Home BPs	9 (10.7)	2 (6.7)
Kiosk BPs	1 (1.2)	0 (0.0)
24-hour ambulatory BP	57 (67.9)	12 (40.0)

↵* Missing, Physician, n = 8; PA/APRN, n = 10.
↵† Missing, Physician, n = 2; PA/APRN, n = 3.
Abbreviations: APRN, Advanced Practice Registered Nurse; BP, Blood pressure; PA, Physician Assistant.

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Appendix Table 3.

Physician and PA/APRN Responses to the Question: Under Optimal Circumstances (Such as No Barriers to Access, Adherence) How Accurate Do Believe the following Screening Procedures Are in Making a New Diagnosis of Hypertensions?^*

	Physician^{^†}	PA/APRN^‡
	n = 86	n = 33
	n (%)	n (%)
Clinic BP (Stethoscope)
Highly or very accurate	54 (62.8)	23 (69.7)
Moderately accurate	27 (31.4)	10 (30.3)
Not accurate or not very accurate	5 (5.8)	0 (0.0)
Clinic BP (Automated)
Highly or very accurate	42 (48.8)	9 (27.3)
Moderately accurate	36 (41.9)	15 (45.5)
Not accurate or not very accurate	8 (9.3)	9 (27.3)
Home BP (Upper Arm)
Highly or very accurate	39 (45.9)	3 (9.1)
Moderately accurate	38 (44.7)	23 (69.7)
Not accurate or not very accurate	8 (9.4)	7 (21.2)
Home BP (Wrist)
Highly or very accurate	4 (4.7)	2 (6.1)
Moderately accurate	26 (30.6)	4 (12.1)
Not accurate or not very accurate	55 (64.7)	27 (81.8)
Kiosk BP
Highly or very accurate	22 (25.9)	4 (12.1)
Moderately accurate	46 (54.1)	16 (48.5)
Not accurate or not very accurate	17 (20.0)	13 (39.4)
24-hour Ambulatory BP
Highly or very accurate	82 (97.6)	27 (81.8)
Moderately accurate	1 (1.2)	2 (6.1)
Not accurate or not very accurate	1 (1.2)	4 (12.1)

↵* Likert scale 1 to 5, Not accurate to Highly accurate.
↵† Missing data: none.
↵‡ Missing data: Home BP, upper arm (n = 1); Home BP, wrist (n = 1); Kiosk BP (n = 1); 24-hour ambulatory (n = 2).
Abbreviations: APRN, Advanced Practice Registered Nurse; BP, blood pressure; PA, Physician Assistant.

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Appendix Table 4.

Physician and PA/APRN Responses to the Question: When Making a New Diagnosis of Hypertension How Often Do You (or the Providers You Work with) Rely on BP Measurements Form Each of the following Types of Monitors?^*

	Physician^{^†}	PA/APRN^‡
	n = 86	n = 33
	n (%)	n (%)
Clinic BP
Always or almost always	83 (96.5)	32 (97.0)
Sometimes	3 (3.5)	1 (3.0)
Never or almost never	0 (0.0)	0 (0.0)
Home BP
Always or almost always	44 (51.2)	8 (24.2)
Sometimes	34 (39.5)	22 (66.7)
Never or almost never	8 (9.3)	3 (9.1)
Kiosk BP
Always or almost always	14 (16.5)	5 (15.2)
Sometimes	43 (50.6)	11 (33.3)
Never or almost never	28 (32.9)	17 (51.5)
24-hour Ambulatory BP
Always or almost always	27 (32.9)	13 (40.6)
Sometimes	7 (8.5)	4 (12.5)
Never or almost never	48 (58.5)	15 (46.9)

↵* Likert scale 1 to 5, Never to Always.
↵† Missing data: Home BP (n = 6); Kiosk BP (n = 1); 24-hour ambulatory (n = 4).
↵‡ Missing data: Home BP (n = 1); 24-hour ambulatory (n = 1).
Abbreviations: APRN, Advanced Practice Registered Nurse; BP, blood pressure; PA, Physician Assistant.

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Appendix Table 5.

Physician and PA/APRN Responses to the Question: How Easy Would It Be for Patients to Complete the following BP Measurement Methods for Confirming a New Diagnosis of Hypertension?^*

	Physician^{^†}	PA/APRN^{^‡}
	n = 86	n = 33
	n (%)	n (%)
Clinic BP
Easy or very easy	19 (22.1)	5 (15.2)
Moderately easy	39 (45.4)	17 (51.5)
Not very or not at all easy	28 (32.6)	11 (33.3)
Home BP
Easy or very easy	57 (66.3)	23 (69.7)
Moderately easy	26 (30.2)	9 (27.3)
Not very or not at all easy	3 (3.5)	1 (3.0)
Kiosk BP
Easy or very easy	28 (33.3)	10 (30.3)
Moderately easy	43 (51.2)	19 (57.6)
Not very or not at all easy	13 (15.5)	4 (12.1)
24-hour Ambulatory BP
Easy or very easy	15 (17.9)	12 (36.4)
Moderately easy	21 (25.0)	9 (27.3)
Not very or not at all easy	48 (57.1)	12 (36.4)

↵* Likert scale 1 to 5, Not at all easy to very easy.
↵† Missing data: Kiosk BP (n = 2); 24-hour ambulatory (n = 2).
↵‡ Missing data: none.
Abbreviations: APRN, Advanced Practice Registered Nurse; BP, blood pressure; PA, Physician Assistant.

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Appendix Table 6.

Physician and PA/APRN Reported Diagnostic bp Thresholds Used for Making a Diagnosis of Hypertension Using Clinic, Home, and Daytime Ambulatory BP Measurements.^*

	Physician^†	PA/APRN^‡
	n = 86	n = 33
	n (%)	n (%)
Clinic BP
130/80	3 (3.7)	1 (3.1)
135/85	0 (0.0)	0 (0.0)
140/90	72 (87.8)	24 (75.0)
Other	7 (8.5)	7 (21.9)
Home BP
130/80	4 (5.1)	3 (10.7)
135/85	14 (17.7)	1 (3.6)
140/90	52 (65.8)	19 (67.9)
Other	9 (11.4)	5 (17.9)
24-hour Ambulatory BP
130/80	6 (8.2)	2 (11.1)
135/85	9 (12.3)	1 (5.6)
140/90	48 (65.8)	11 (61.1)
Other	10 (13.7)	4 (22.2)

↵* Thresholds assessed via text field. All non-missing responses other than 130/80, 135/85, and 140/90 are classified as “other”.
↵† Missing data: Clinic BP (n = 4); Home BP (n = 7); 24-hour ambulatory (n = 13).
↵‡ Missing data: Clinic BP (n = 1); Home BP (n = 5); 24-hour ambulatory (n = 15).
Abbreviations: APRN, Advanced Practice Registered Nurse; BP, Blood pressure; PA, physician assistant.