CP 4.5: Blood Pressure Monitoring

Updated:
Reviewed: 

Purpose

• To provide guidelines for monitoring of patients with suspected or actual hypertension
• To assist the health care team in diagnosis of hypertension or to evaluate effectiveness of treatment for hypertension
  
  

Policy Statements

In response to a referral from a health authority or primary health care provider, the Community Paramedic (CP) will follow the monitoring guidelines as outlined below when a request for Blood Pressure Monitoring is made on the Request for Service form and care plan.

Procedure

1. OBTAIN and REVIEW patient’s health history and care plan prior to appointment.
2. REFER to Request for Service form and care plan for direction with respect to assessments requested and acceptable blood pressure (BP) ranges for systolic and diastolic BP.
3. OBSERVE patient’s physical state/general well-being.  Ensure patient has voided their bladder, and that they are sitting quietly and relaxed for at least 2 minutes with both feet flat on the floor with their arm outstretched and supported at heart level.  If patient is bed-bound, have him/her lay face up in bed with arm supported and no contact between cuff and bed or patient.
4. For orthostatic hypertension evaluation: MEASURE BP in lying (L) position and then immediately on standing (Std), report to primary care provider if systolic drops greater than 20 mm Hg or if patient is symptomatic.  If patient complains of dizziness when going from lying (L) to sitting (S) take and record BP. Do not proceed to standing
5. MEASURE blood pressure: for each BP recording, at least 2 consecutive measurements, at least 2 minutes apart, should be taken. Additional measurement should be taken when the first 2 measurements are quite different. Record the last 2
   • Monitoring Schedule: timing, frequency and duration
     • MEASURE BP twice daily (morning and late afternoon, prior to antihypertensive medications if patient on any) at about the same times every day or every other day for 6 to 7 measurements over 2 weeks
     • RECORD readings on BP Monitoring Log
     • CALCULATE average of readings, ignoring the 1^st day
6. REPORT readings to Health Care Provider if outside acceptable ranges as per care plan
   
   

Documentation

RECORD date, right (R) or left (L) arm, time, BP, pulse (P), patient position (S or L) or any changes in position (L → Std), and patient symptoms in log.

NOTIFY primary health care provider of findings and any concerns.

Example documentation on log:

References

1. American Heart Association. Home Blood Pressure Monitoring. 2016. [Link]
2. British Hypertension Society. Home Blood Pressure Monitoring Protocol. 2017. [Link] 
3. National Institute for Health and Clinical Excellence. The clinical management of primary hypertension in adults: Clinical Guideline. 2011. [Link]
4. Singh, V. (2015). Home blood pressure monitoring, practical aspects. 2015. [Link]