Blood pressure measurement is one of the essential vital signs examinations and functions to diagnose hypertension. By checking blood pressure appropriately, it is hoped that treating as indicated and preventing overdiagnosis or overtreatment.

One of the appropriate blood pressure measurement procedures is the patient needs to rest before measurement. As per international recommendations, the resting time should be between 3−5 minutes. However, how clear is the research data regarding the ideal resting time?



Why should patients need a rest before checking blood pressure?

Before checking blood pressure, the patient needs to rest to the measurement result is precise, and the diagnosis of hypertension is established accurately. The wrong diagnosis will cause the patient to receive the wrong therapy.

Some studies show a tendency to misdiagnose patients with hypertension, for example, patients with white-coat hypertension who require ambulatory blood pressure testing.

White-coat hypertension (WHT) is described as blood pressure above 140/90 mmHg when examined in the doctor's examination room. While at home self-examination, the average blood pressure was not more than 135/85 mmHg.

Some studies suggest that cardiovascular disease risk is increased in patients with hypertension compared to white coat hypertension. Therefore, patients with white coat hypertension should not need antihypertensive therapy. White-coat hypertension therapy is still not well known.

A meta-analysis study by Briasoulis et al. stated that out of 29100 respondents, 4806 respondents had white coat hypertension. Some causes of white coat hypertension were improper examination time, stress factors, and the patient's position during the measurement.

The decreased blood pressure after resting is thought to be related to hemodynamic modifications in the body. At rest, the patient sits quietly and does not any activities. This stimulates the relaxation of the body and reduces the work of the sympathetic nervous system. This mechanism results in a gradual decrease in systemic vascular resistance.



How Long Shall the Patient Rest Before Check Blood Pressure?

Limited rest time given to patients who come to health facilities can cause an inaccurate diagnosis of hypertension. The average examination time for patients in health facilities is only 10.7 ± 6.7 minutes in European countries. The rest period required before a blood pressure check should be more than 3-5 minutes to achieve an accurate result. 

In 2017, the research by Mahe et al. found that the ideal resting time before blood pressure measurement is 25 minutes. The decreased blood pressure was started at 5 minutes and stabilized at 25 minutes. Bos et al. obtained similar research results. A stable blood pressure check occurred at 30 minutes. This study mentioned that decreased systolic pressure was 22.8 mmHg and diastolic pressure was 11.6 mmHg. This decrease occurred mainly in patients over 70 years of age.

Nikolic et al. also conducted a study to determine how long resting time is needed to lower blood pressure in health facilities and at home. This study's conclusion stated that the length of resting time to lower blood pressure in the examination at home is 5 minutes, and 10 minutes in health facilities. As many as 6.4% of respondents experienced a decrease in blood pressure with rest for 10 minutes than respondents who only rested for 5 minutes.

Njonnou et al. conducted a study on hypertensive patients with diabetes mellitus. They performed Blood pressure checks at 15, 30, and 45 minutes. There was decreased blood pressure at minute 30 of 8.3 mmHg for systolic and 3.1 mmHg for diastolic. The decrease also occurred at 45 minutes to 13.5 mmHg for systolic and 5.5 mmHg for diastolic. This study recommends checking blood pressure after resting for 45 minutes.

A meta-analysis study by Briasoulis et al. concluded that it takes at least 16 minutes to stabilize the patient's systolic and diastolic blood pressure. If check blood pressure is below this time, misdiagnosis can still occur. Peak blood pressure occurs at the 4th minute and begins to drop significantly at the 10th minute.



Conclusion
A blood pressure measurement is an element commonly used to diagnose hypertension. However, a blood pressure check that is not ideal can obscure the diagnosis of hypertension. One that affects is the rest period needed before the examination is carried out.

International recommendations say 3−5 minutes is the ideal resting time; however, this is considered irrelevant. Some studies suggest a longer resting time of between 10 and 30 minutes. These studies found a significant decrease in blood pressure if the rest period was extended by more than 5 minutes.

Through an ideal examination, it is hoped to minimize the diagnosis of white-coat hypertension. This will later also affect the number of patients receiving antihypertensive therapy.


References
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