Factors affecting hospital inpatient blood pressure measurement as ranked by a Delphi survey

Current guidelines do not address the appropriate technique for accurate inpatient blood pressure (BP) measurement. Outpatient data suggest that technique matters for accurate readings. Given the substantial impact of BP treatment decisions, this study explored the relative importance of various factors for accurate inpatient BP measurement. This was a ranking-type Delphi survey conducted in two stages. Stage 1 involved document ratification (single round) where an international panel of 9 hypertension experts reviewed and validated source documents relevant to BP measurement. Stage 2 involved variable ranking across three iterative rounds: Rounds 1 and 2 required panellists to independently rank all 10 variables from most to least important with each variable receiving a unique rank; Round 3 used paired comparisons with forced choices to refine consensus. Binary decisions required > 80% agreement for consensus. Ranked order consensus required Kendall's coefficient > 0.7. The panel agreed with high consensus on the following 10 variables in order of importance: (1) at least two measurements, (2) correct cuff size, (3) not talking during measurement, (4) correctly fitted cuff, (5) cuff at heart level, (6) seated position, (7) contemporary device calibration, (8) legs uncrossed, (9) bare arm below cuff, and (10) supported back (Kendall's 0.97, P < 0.001). Understanding of true determinants of accurate inpatient BP measurement is still required. Meanwhile, expert consensus provides an intermediary step for prioritising factors in inpatient BP measurement to assess performance.