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(In)accuracy of blood pressure measurement in 14 Italian hospitals

Manzoli, Lambertoa; Simonetti, Valentinaa; D’Errico, Marcello M.b; De Vito, Corradoc; Flacco, Maria Elenaa; Forni, Cristianad; La Torre, Giuseppee , f; Liguori, Giorgiog; Messina, Gabrieleh; Mezzetti, Andreaa; Panella, Massimilianoi; Pizzi, Carminej; Siliquini, Robertak; Villari, Paoloc; Cicolini, Giancarloa

doi: 10.1097/HJH.0b013e3283577b20

Objectives: The diagnosis and control of hypertension depend on accurate measurement of blood pressure (BP). The literature on the accuracy of BP recording by health professionals is, however, limited, and no study directly interviewed patients in the hospital setting. This multicenter cross-sectional study aimed at evaluating the compliance to current recommendations on BP measurement by health professionals directly from patients and to investigate potential predictors of higher quality in BP recording.

Methods: A trained nurse interviewed a random sample of adult patients hospitalized for an ordinary admission (except in the emergency room) lasting more than one night, without mental disorder, who had their BP routinely measured by the hospital personnel less than 3 h before. The questionnaire contained 15 items on the main procedures that are common to current guidelines.

Results: Fourteen public hospitals from seven regions of Italy participated, and 1334 questionnaires were collected. Nine of the recommended practices were followed in the majority (>70%) of BP recordings, whereas some others were infrequent or rare: in 98.6, 82.2 and 81.1% of the participants, respectively, the arm circumference was never recorded, BP was measured only once, and BP was never recorded in both arms. Overall, 10 or more recommended procedures were followed during 33.4% recordings. At multivariate analysis, physicians were less likely than nurses to provide a more accurate BP measurement.

Conclusions: The operator's compliance to some recommendations in BP measurement is unacceptably low. This survey provides detailed indications for medical directors on the procedures and settings to prioritize in educational programs, which are definitely needed.

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aDepartment of Medicine and Aging Sciences, University of Chieti, Chieti

bDepartment of Biomedical Sciences and Public Health, University of the Marche Region, Ancona

cDepartment of Experimental Medicine, Sapienza University of Rome, Rome

dDepartment of Muskuloscheletal Oncology, Rizzoli Institute, Bologna

eDepartment of Hygiene, Catholic University of the Sacred Heart, Rome

fEleonora Lorillard Spencer Cenci Foundation, Rome

gDepartment of Studies of Institutions and Territorial Systems, University Parthenope, Naples

hDepartment of Public Health University of Siena

iDepartment of Clinical and Experimental Medicine, Section of Public Health, Faculty of Medicine, University of Eastern Piedmont Amedeo Avogadro, Novara

jDepartment of Internal Medicine, Aging and Nephrologic Diseases, University of Bologna

kDepartment of Public Health, University of Turin, Italy

Correspondence to Carmine Pizzi, FESC, Dipartimento di Medicina Interna, dell’Invecchiamento, Malattie Nefrologiche (Padiglione 11), Università di Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy. Tel: +39 051 6364911; fax: +39 051 392486; e-mail:

Abbreviation: BP, Blood pressure; OR, odds ratio

Received 13 April, 2012

Revised 22 June, 2012

Accepted 27 June, 2012

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© 2012 Lippincott Williams & Wilkins, Inc.