Standardized blood pressure measurement could improve hypertension prevention, care in the Americas

December 19, 2003

This release is also available in Spanish.

Hypertension (high blood pressure) affects approximately 140 million persons in the Western Hemisphere. Until now there has been no standard approach to measuring blood pressure that has been accepted for use in research studies in all the countries of the Americas.

A Hemisphere-wide group called the Pan American Hypertension Initiative (PAHI) has developed a solution to this problem. PAHI is recommending an 11-step procedure to accurately and uniformly measure blood pressure in research studies and community programs. This new approach will enable many countries to join together to survey large groups of people, in order to assess and compare general trends in the prevalence of high blood pressure. This will be useful for comparisons of prevention and education programs and ultimately for helping improve those programs and the health of the people of the Americas.

The proposed standard is described in an English-language article in the November 2003 issue of the "Revista Panamericana de Salud Pública/Pan American Journal of Public Health," a journal published monthly by the Pan American Health Organization (PAHO). That issue of the "Revista/Journal" also includes a Spanish-language translation of the article.

An English-language editorial published in that same "Revista/Journal" issue notes that without a uniform and consistent manner to measure blood pressure, "research results and program plans may not be transferable or applicable to other groups or nations. In addition, some research data cannot be compared or the results pooled, thus losing important opportunities for evidence-based information on national and hemispheric trends and impacts of national prevention, education, and control efforts."

The editorial adds that "adopting the common protocol would also help to disseminate 'best practices' and other successful experiences, making them examples that would further speed wider implementation by policymakers and health professionals." The editorial was co-authored by Dr. Mirta Roses Periago, the Director of PAHO, and by Dr. Claude Lenfant, the former Director of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), within the Department of Health and Human Services of the United States of America.

Currently, some studies of blood pressure prevalence define hypertension as 160/95 millimeters of mercury (mm Hg), while others use 140/90 mm Hg. In addition, prevalence studies have varied regarding the numbers of blood pressure readings to take on the persons being surveyed, the measurement equipment to be used, and the training methods needed for the health personnel who will perform the measurements.

To help deal with those problems, the suggested protocol includes 11 recommended steps, covering such issues as how many measurements to take for an individual, how the individual should be seated during the examination, and how to properly choose and position on the person's arm the cuff of the blood pressure measurement device.

The article covers a number of related issues, including proper types of equipment, calibrating the equipment, training and certification for the technicians who carry out the measurements, and quality-control procedures.

The Pan American Hypertension Initiative, the group that developed the suggested protocol, includes NHLBI, PAHO, and seven inter-American and worldwide scientific organizations concerned with cardiac health and hypertension: Inter-American Heart Foundation, Interamerican Society of Cardiology, Inter American Society of Hypertension, Latin American Society of Nephrology and Hypertension, Pan American Network of CARMEN Programs, World Heart Federation, and World Hypertension League.

Hypertension is a serious health concern in both the developed and developing countries of the Americas. The condition results in disability and millions of premature deaths each year from stroke and heart disease, heart failure, and kidney failure, with these illnesses causing suffering, reduced productivity, and economic losses in every nation in the Western Hemisphere.

Some prevalence surveys have indicated that hypertension is even more common in some countries of Latin America than it is in the United States. For example, a national survey carried out in 1988 through 1994 of persons aged 35 to 64 years in the U.S. found an overall hypertension prevalence level of 33%. Surveys of that same age group have found prevalence levels of 49% in Paraguay, 47% in Cuba, 42% in Venezuela, and 36% in Ecuador. Worsening the problem in Latin America and the Caribbean is the fact that hypertension is more likely to go undiagnosed than in the U.S., and, once diagnosed, only half as many patients achieve successful blood pressure control as in the U.S.
The full text of the English-language article describing the proposed standards, along with its Spanish-language translation and the English-language editorial describing the rationale for the standards, can be viewed for free in PAHO's Online Bookstore (

Issued monthly, the "Revista Panamericana de Salud Pública/Pan American Journal of Public Health" is the main scientific and technical periodical published by the Pan American Health Organization (PAHO).

PAHO, which also serves as the Regional Office for the Americas of the World Health Organization, was established in 1902. PAHO Member States include all 35 countries in the Americas. Puerto Rico is an Associate Member. France, the Kingdom of the Netherlands, and the United Kingdom of Great Britain and Northern Ireland are Participating States, and Portugal and Spain are Observer States.

Pan American Health Organization

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