Method	Office vs. Home	Machine vs. Manual	Threshold for HTN	‣ Adjustment	Additional Operation Note
Mean OBPM (Office BP Measurement, by HCP*3)	Office	Manual	≥ 180/110 (in 1 visit)	No adjustment
			≥ 140/90 + r/o WCH	≥ 130/80 (3 visits) + r/o WCH	(but ≤ 180/110)
AOBP (Automatic Office BP, = OBPM by machine*3-6)	Office	Machine	≥ 135/85 + r/o WCH	N/A*	Should be done with HCP out of the room
HBPM (Home BP Measurement)	Home	Manual	≥ 135/85	N/A*	Not covered by OHIP ($65), can be done at Pharmacy
ABPM (Ambulatory **BP Measurement) **	Home	Machine	≥ 135/85 day time; ≥ 130/80 overall	N/A*	2 readings BID x 1 week →average of day 2-7**

*Not defined, likely lower

*** Morning before breakfast, 2h after night, rest x5 min prior, avoid smoking and caffine*

Accuracy: ABPM (overall 130/80, DT 135/85) > HBPM (135/85) > ABPM (135/85) > OPBM (140/90)
False Positive: tobacco/smoke, caffeine, alcohol, or exercise in the last 30 minutes
PP = 50 except for the ≥ 180/110 cases (where PP = 70)

OBPM Blood Pressure (OSCE)

Preparation
1. Seated, with back support, feet on ground uncrossed OR laying flat,
2. Arm slightly flexed, antecubital crease at heart level
3. “Have you had any tobacco/smoke, caffine, alcohol, or exercise in the last 30 minutes?”
Put on the cuff
1. Select the appropriate cuff size
  - 40% of the circumference of the patient’s upper arm
2. Wrap around the arm, with the pointer pointing toward the brachial artery
  - Find the brachial artery by palpation on the medial side of the arm
3. Position cuff ~2 cm above the antecubital fossa
Palpation: sBP
- Palpate radial pulse
- Inflate
- Deflate by 2mmHg per second until the pulse returns
- Report the pressure as sBP
Based on palpation, the systolic blood pressure is 125 milimeters of mercury. I will now re-inflate the cuff to 20-30 higher than the palpated systolic pressure.
Auscultation: sBP and dBP
- Insert diaphragm over the brachial artery
- Inflate cuff to 20-30 mmHg above sBP determined by palpation (to avoid auscultatory gap)
- Report sBP identified at first Korotkoff sound, report dBP at disappearance of Koratkoff sound
  - Normal 90-140 mmHg for sBP and 60-90 mmHg for dBP
The blood pressure is 126 milimeters of mercury over 85 milimeters of mercury via auscultation, based on the first appearance and complete disappearance of the Korotkoff sounds. This blood pressure is normal.

Additional Concepts