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Hi Jo In the October 2013 Occupational Health magazine there is an article 'breathe deep'. This article cites systolic 160 mmHg as the upper limit. We changed our policy to reflect this. Hope this helps! Regards Rachel Sent from my Hudl 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 ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH