Dr Carl Shakespeare consultant cardiologist  
       
 
   

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Hypertension Diagnostic Tools:

Blood pressure Cuff:
This is the standard test available in general practitioner and hospital clinics- so called: “office blood pressure”. Previously this consisted of a mercury manometer, but has superseded by the automated digital monitor. More recently there have been strong concerns as to the reliability and value of such readings.

From a practical point of view however, one must ensure that the cuff size is appropriate for the size of the arm. Not uncommonly, a smaller cuff on a brawnier arm will overestimate blood pressure.

  
Ambulatory Blood Pressure equipmentHome monitoring devices:

The value of this type of measurement is thought to be superior to the office blood pressure readings. For those patients purchasing equipment, please consult the "British Hypertension Society" advice on which device to buy. Generally, the arm cuffs are superior to the wrist cuffs. The devices need to be calibrated, by comparing with an office measurement occasionally.

Ambulatory blood pressure readings24 Hour BP monitor:

These devices are available in hospital outpatients and some general practices (shown right). As with home monitoring equipment are thought to be superior to office measurements. The measurement provides a more comprehensive assessment of blood pressure. It is the main tool we use to exclude white coat hypertension.

Central Aortic Blood Pressure and Pulse Wave Velocity Assessment:
TonometerCentral Aortic Blood PressureIt has long been thought that the more central blood vessels would be more important in the assessment of vascular risk. Previously, the arm was the only available site to measure pressure. It was never an ideal site to measure pressure as the effects would be dampened further away from the centre of the body. Now there is a well validated non-invasive technique that is able extrapolatethe central aortic pressure. Many research studies have highlighted that this technique provides a more accurate assessment of vascular risk. It is combined with a method of determining the rigidity of vessels (pulse wave velocity) which also measures vascular risk.

The technique involves placing a probe (tonometer) on the skin above the carotid artery in the neck and the groin artery at the top of the leg. The probe resembles a pen, and its application is painless and takes only a few minutes (See figure "Central Aortic Blood Pressure"). Measurements of central aortic pressure and aortic stiffness can be made which is probably a true reflection of real blood pressure and vascular risk.


   
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