Is blood pressure measurement an essential clinical skill?

Since the National High Blood Pressure Education Program was established in 1972 US, consensus and evidence-based guidelines for prevention, detection, management control of high-blood pressure (hypertension) have been developed most countries world disseminated to provide up-to-date information healthcare providers (doctors, nurses, pharmacists, other allied professions), with regular updates facilitate translation new evidence into clinical practice [1]. blood is single biggest risk factor making largest contribution global burden disease, disability death globally, low-and-middle-income (LMICs) [2,3]. However, despite great endeavours over past decades improve early effective strategies appropriate high pressure, latest figures from population studies show an unsatisfactory picture. During a screening 1 508 130 adults carried out 92 month May 2019, third those screened never had their measured, 34% hypertension (blood ≥140/90 mmHg) [4]. Of who hypertension, just half were aware condition, taking medications. Furthermore, only controlled targets, whereas 23.2% either untreated or inadequately treated hypertension. These shortcomings are generally attributed physicians’ inertia, inadequate use combination therapy [4] patients’ nonadherence prescribed medications because pill-burden comorbidities [5]. failure implement correct techniques measuring common, though neglected, contributing [6,7]. In last 3 years, we seen publication several [8–12]. All them include fundamental principles on how measure describe detail different measurements available, namely office, home, ambulatory automated assessments [13]. The suspicion that may still methods procedures therefore concern, given erroneous measurement can lead misdiagnosis, insufficient unnecessary drug therapy, resulting avoidable cardiovascular disease study by Todkar et al.[14] welcome as it systematically appraises heterogenous literature scoping review whether knowledge, perception health professionals pharmacists) regarding (in at devices) concordant current guidelines. They identified 72 including all four assessment. classified positive negative three main concepts -- perception, knowledge -– using definitions published reference Their analysis concluded whilst there optimal importance rigorous standardized methodology among both doctors nurses (especially office methods). concludes remains big concern lack implementation disappointing. authors call renewed focus educational programmes basic training continuous professional education. conclusions not completely unexpected they corroborate what happens real [15]. Healthcare systems being stretched more increasing demand met chronic limited resources. often delegated one-off on-line resource, no direct practical certification competency revalidation place. Therefore, scenes patient comfortably sitting after period rest, inappropriate cuff size, without necessary removal heavy garments, relying casual measurements, reporting readings digit preference, common primary secondary care busy day-to-day practices research compelling telling us important be taken accurately, seek reading interested comprehensive assessment requiring daytime night-time pressures. present confirms that, large, understand accurately important. Nevertheless, scarce poor too. Most reviewed Europe, North America Asia, little LMICs, especially Africa. Some evidence, however, suggests equally amongst Africa [16]. Hospital Nigeria, 70% participants level (poorer compared doctors) Nearly two-thirds sub-Saharan [2,3], where double high. quality used African could improved [17]. 62 recently surveyed, 26 (42%) offered formal national detection Six stand-alone guidelines, 10 embedded multiple conditions, followed WHO international After Appraisal Guidelines Research & Evaluation (AGREE) II instrument, one good-quality standard. stark reminder need improvement continent, which plans progress awareness, integral parts. few collective approach agencies has launches initiatives tailored LMICs increase awareness [4], guidance [12], [18,19] [19] needed. will remain essential skill worldwide ACKNOWLEDGEMENTS Conflicts interest F.P.C. Head Collaborating Centre Nutrition (UNK257) University Warwick.