Blood Pressure Cross-Country Cross-Language Cross-Paradigm (Demo) IG, published by FO. This guide is not an authorized publication; it is the continuous build for version 0.5.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/frankoemig/bloodpressure/ and changes regularly. See the Directory of published versions

Protocols

Different types of "protocols" exist.

Therefore, the information models should cover all aspects that are needed to specify what to measure exactly.

To separate and distinguish between both, the first is called measurement setup, whereas the second is handled as executable protocol within this guide.

Measurement Setup

The measurement setup is used to specify the parameters for a single measurement.

Protocol	Description	Aspects to consider
AOBP	Automated Office Blood Pressure	measuring blood pressure in a clinical setting that uses an automated device to take multiple readings with the patient alone in a room, thereby eliminating the "white coat effect" and human error associated with manual measurements
SMBP	Self-measured Blood Pressure	patient measure BP outside a clinical setting—typically at home—to help diagnose and manage hypertension; use a validated, automated, upper-arm cuff device, untrusted device, typically measured at wrist

Both settings can be described by their attributes as follows:

Aspect	AOBP	SMBP
measurement setting	physician office	home
location at body	arm	wrist
body position	sitting	unknown
exertion	in rest	unknown
position of feet	down	unknown
device	professional, trusted	untrusted
…

Executable Protocols

An executable protocol typically should specify a sequence of measurements that are obtained for a certain purpose.

Protocol	Name	Description	aspects to consider
ABI	Ankle-Brachial Index	quick, non-invasive, and painless diagnostic procedure that compares blood pressure in the arm with blood pressure at the ankle to screen for Peripheral Artery Disease (PAD)
Bruce	Bruce treadmilll test	standardized treadmill stress test (ergometry) used to assess cardiovascular fitness and maximal oxygen uptake. It typically involves 3-minute stages, with speed and incline increasing every three minutes. Commonly used in cardiology, it serves to determine maximal physical performance, measured in METs.
Naughton	treadmill protocol	gently increase work by limiting each stage increase to approximately one metabolic equivalent (3.5 ml/kg/min VO 2 )
NHANES	National Health and Nutrititon Examination Survey
orthostatic		supine -> sitting -> standing	varying body position to examine what happens if patient stands up; difference is calculated
24h long-term		sequence of observations during 24 hours	measured all 15 minutes for 24 hours, at arm, arbitrary exertion, activity unclear
SPRINT	Systolic (Blood) Pressure Intervention Trial	clinical trial that found that treating high blood pressure (hypertension) to a lower goal of less than 120 mm Hg significantly reduced the risk of cardiovascular events and death compared to standard treatment (less than 140 mm Hg) in high-risk patients
tilt		sequence of measurements with increasing tilt	tilt angle
..	..

The aspects will be further specified…

Orthostatic

For orthostatic evaluations the difference in the sequence of lying (supine), over sitting to standing is calculated:

Tilting

This protocol examines whether the tilt of the body has an effect on the blood pressure. Therefore, the patient is turned around.

Long-term BP Measurement

Long-term measurements are usually done during the period of a day, using an automated device that cyclicly measures the blood pressure e.g every 10 or 15 minutes. Instead of providing all values, an average is calculated during special periods of the day, eg. the night.