Dear All,
Swerve ball to the ready so what happens when you have someone who needs HS and it cannot be performed due to raised BP and you refer them back to their GP for support and advice and then review and they remain high? I find GP's are quite dismissive of a 160 systolic ( unless under 40) and with an increasingly aging workforce I think we will find more that remain untreated as GP's wont treat and lifestyle changes that are advised won't be followed... Should they be removed from the areas?
Just being devils advocate...
D :)
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of janet powell
Sent: 04 January 2014 11:52
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] spirometry and hypertension
Hi Joanna
Yes amplivox advocated 160mmHg as a limit for systolic B.P when i attended their update last year, as it is estimated that you will have a rise of 40 mmHg whilst carrying out spirometry testing due to increased pressures. NICE updated there 2006 guidance in 2011 with regards to definitions of hypertension.
Good luck
Janet Powell
R/N SCHPH-OH
Sent from my iPhone
On 3 Jan 2014, at 16:00, "Joanna Edwards" <[log in to unmask]> wrote:
> Happy New Year to you……..its a wordy one – sorry!
>
> I’m writing a spirometry protocol and need some advice please. I’m not sure where the evidence is for excluding a patient from spirometry due to a raised blood pressure. We know that it raises intra-thoracic pressure and is likely to raise the BP even further but at what point might you decide that it is too high to risk carrying out spirometry?
>
> The spirometry course I took talks about “gross hypertension” as a reason to exclude someone, but I have no idea at what level hypertension becomes gross hypertension. The British Heart Foundation’s definition of a raised BP is one over 140/90, but as white coat syndrome affects probably half of the people who attend medical appts ( even me!) using that as an exclusion criteria might mean an almost blanket inability to assess lung function in a large percentage of those requiring it. The British Thoracic Society publication “Spirometry in Practice” doesn’t list any exclusion criteria at all, and makes no mention of hypertension or checking the blood pressure prior to carrying out the procedure.
> Local hospital spirometry guidelines say there are no absolute contraindications, and lists “unstable cardiovascular status” as a relative contraindication, so little information there that could be written into a protocol. Lastly I found “An update on contraindications for lung function testing” in Thorax journal online. This firstly appeared to suggest the mean arterial pressure should be at <130mm Hg; secondly that if the suspicion is that the patient has severe hypertension the blood pressure should be measured before testing (and table 3 of the article suggests this is a reading above 200 systolic/120 diastolic) which to me appears very high to use as a cut off point.
>
> I’d be very grateful if those of you carrying out spirometry would let me know at what point you would exclude someone from the procedure due to raised BP, and how you evidenced that decision.
>
> Many thanks
>
> Jo
>
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