Most of us use blood pressure measurements in patient management on a daily basis. Have you asked yourself, “Is this blood pressure reliable??” Below are some tips that, if used consistently, may help in getting some reliability in your measurements.

Be thoughtful when picking your patient to measure a BP. Not every single geriatric dog or cat needs a BP taken, as our small animal patients have a much lower incidence of essential, or idiopathic, hypertension purely due to aging compared to humans. Remember to interpret your BP measurements in tandem with your patient’s signalment, clinical signs, history, exam and lab results.

Patients that are apt to have hypertension are those with primary renal disease of any type, hyperadrenocorticism or other types adrenal diseases, hyperthyroidism and those with detached retinas or hyphema.

There is some debate over Doppler versus oscillometric machines in awake patients. Most internal medicine folks prefer Doppler in awake patients, then dealer’s choice in anesthetized ones. However, the data is all over the board on this one, so personal preference and consistency in one or the other is likely a good way to go.^1–3

In an ideal world, our patients lie still on their own, on their left sides, wag their tails and happily give kisses while we take their blood pressures. This is not the common scenario however, especially our feline friends. Some thoughts on getting closer to this ideal world are as follows:

1. Create a calm environment by dimming the lights, reducing noise and distractions, and keeping the patient comfortable. This can help reduce anxiety and stress in both the animal and the person taking the measurement. Let the patient be where they seem the most comfortable.
2. Use positive reinforcement to help decrease stress and make the animal feel more comfortable during the measurement. Offering treats or verbal praise to help your patient stay calm during the measurement.
3. Familiarize the patient with the equipment before getting started. Let them smell and explore the equipment so they become more comfortable with it. You can even pump up a cuff off the patient to let them hear the noise of the sphygmomanometer and letting the air out of the tubing.
4. Please, use warm gel!
5. Use the correctly sized cuff for each patient. A cuff that is too large or small can cause inaccurate readings. Try your best to use a cuff width to appendage circumference ratio of about 0.4:1. A good rule of thumb is to find a cuff that is between 2/3 and 1/2 the circumference.
6. Keep it low key as best as possible for the least amount of stress. Meaning, keep your voices low, don’t react loudly to things that may happen. Find your Zen!
7. Take multiple readings with a several second break in between each reading, say 10 seconds. Some people say to wait a few minutes between readings, but the limb/tail just need to be re-perfused, which only takes a couple seconds. Also, several readings can help ensure accuracy. This can also help the animal become more comfortable with the process with each reading. Ignore those weird, aberrant readings. Some people throw out the highest and the lowest readings, or the first and last readings. Do what you are comfortable with, be consistent and just get rid of those outliers.
8. Having a patient lie in lateral recumbency helps get the BP cuff in an even plane with their heart, which is ideal. (Think of your BP cuff on your biceps right next to your ticker.) Having them lie in sternal recumbency is absolutely fine as well, especially if using the tail or foreleg for a BP measurement. Standing will work too, but adds approximately 15-30 mmHg to the reading.
9. Try a single, pre-appointment dose of gabapentin at 100mg/cat 90 minutes prior to appointment time for kitties. It has been shown not to decrease blood pressure significantly.⁴
10. If the patient is stressed, anxious, fractious, wants to claw or bite you or anything of the sort, just call it a day.

The reality is, we do not have a great deal of data that validates the accuracy of measuring the blood pressure in awake cats and dogs. This holds true for hyper-, hypo- or normotensive pressures and on different machines. So, watching trends and using your common sense are great tools to trust. Good luck!

References: 

1. Wernick M, Hopfner R, Francey T, Howard J. Comparison of arterial blood pressure measurements and hypertension scores obtained by use of three indirect measurement devices in hospitalized dogs. JAVMA. 2012;240(8):962-968.
2. Vachon C, Belanger MC, Burns PM. Evaluation of oscillometric and doppler ultrasonic devices for blood pressure measurements in anesthetized and conscious dogs. Res Vet Sci. 2014;97(1):111-117. doi:10.1016/j.rvsc.2014.05.003
3. Bosiack AP, Mann FA, Dodam JR, Wagner-Mann CC, Branson KR. Comparison of ultrasonic Doppler flow monitor, oscillometric, and direct arterial blood pressure measurements in ill dogs. Journal of Veterinary Emergency and Critical Care. 2010;20(2):207-215. doi:10.1111/j.1476-4431.2010.00520.x
4. 4. Veronezi TM, Lopes DJ, Zardo IL, et al. Evaluation of the effects of gabapentin on the physiologic and echocardiographic variables of healthy cats: a prospective, randomized and blinded study. J Feline Med Surg. 2022;24(12):e498-e504. doi:10.1177/1098612X221131270
   

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 About the Author: Sarah Love, DVM, DACVIM (SAIM), DACVSMR

Dr. Sarah Love graduated from University of Minnesota in 2000, completed a rotating internship in Georgia and completed an internal medicine residency in 2004. She then went on to work in private specialty practice and then clinical work and training sled dogs in Alaska. She started her own practice in Colorado in 2016, Sport Dog Specialty Medicine, which is a mobile veterinary specialty practice encompassing her two specialties.