P59
TIMING OF BLOOD PRESSURE MEASUREMENT IN THE TRANSPLANT CLINIC
AND ITS EFFECT ON AUDIT OR REGISTRY OUTCOMES
Jones MT, Farrell F, Moro-Azuela F, Hughes G, Almond MK, Harnett PR
Renal Unit, Southend University Hospital NHS Trust
Introduction
Data in the Renal Registry report 2011 placed our Hospital in the lower quartile for blood
pressure (BP) values for patients that have a functioning transplant. Southend had 16.2 % (95%
CI: 7.5 - 31.7) of patients achieving the Renal Registry target compared to 27.7% (95% CI: 26.7
- 28.7) for patients in England, Wales and Northern Ireland as a whole. No standard method or
timing of blood pressure recording in the transplant clinic is defined by the Registry. Blood
pressure was routinely taken on arrival in the clinic at Southend.
Hypothesis
Blood pressure values will change during the clinic visit and vary by method used to measure it;
this may lead to higher blood pressure results being reported to the registry1.
The effect of time – audit 1.
Blood pressures were measured at the time of arrival (1st), after 5-20 min (2nd) and at the time of
consultation (3rd). This took place for every patient attending the transplant clinic for a period of
2 months. N=55
1st
2nd
3rd
Average Systolic
144.9
141.4 p<0.001
140.7 p <0.02
Change of Practice
This audit indicated that there was a change in Systolic BP after a period of rest. It was decided
to make a change to practice in January 2013 to recording BP at the time of consultation and to
look at the effect of this change in achieving Registry BP standards
Method
Patients that had been seen in clinic for 18 months, and seen in both periods 01/04/2012 –
01/08/2012 and 01/04/2013 – 01/08/2013 were selected and BP results analysed.
Result of change in practice – audit 2
Number of patients meeting selection criteria = 50
PRE
POST
01/04/2012 – 01/08/2012 01/04/2013 – 01/08/2013
Systolic <130
21 (42%)
23 (46%)
Diastolic < 80
23 (46%)
32 (64%)
Sys <130 AND Dia<80
19 (36%)
28 (56%)
Average Systolic
135
128 p=0.001
Average Diastolic
76
74 p=0.29
 Numbers achieving the overall target SYS<130 and DIA <80 increased significantly
 This would have shifted our hospital results into the upper quartile of the registry table
 Further analysis shows greatest improvement in patients showing higher initial Systolic
Pressure with a significant correlation of R2 =0.53
Conclusions
Changing measurement practice can apparently improve audit results and Registry data.
However, patient care or outcome is unlikely to be changed with the exception that unnecessary
clinical intervention or medication is avoided. Review of Registry standards of measurement
techniques may be required and other areas where this effect may be apparent should be
reviewed..
“When measuring blood pressure in the clinic or in the home, standardise the environment
[…], with the person quiet and seated, and their arm outstretched and supported” 1.1.4 NICE
Guideline CG127 Hypertension 2011
1