ARCHETYPE Blood pressure (openEHR-EHR-OBSERVATION.blood_pressure.v2)

Name: Blood pressure
License: http://creativecommons.org/licenses/by-sa/4.0/

ARCHETYPE ID	openEHR-EHR-OBSERVATION.blood_pressure.v2
Concept	Blood pressure
Description	The local measurement of arterial blood pressure which is a surrogate for arterial pressure in the systemic circulation.
Use	Use to record all representations of systemic arterial blood pressure measurement, no matter which method or body location is used to record it. The archetype is intended to capture blood pressure measurements in all clinical scenarios - for example: self-measurement with a home blood pressure machine; an emergency assessment of systolic using palpation and a sphygmomanometer; measurements taken in clinical consultations or during exercise stress testing; and a series of measurements made by a machine in Intensive Care. There is a rich state model that supports interpretation of measurements through identifying patient position, exercise, confounding factors and angle of a tilt table in research. Named events have been limited to average over a 24 hour period, however templates can further constrain the default 'any event' to cater for specific requirements for blood pressure measurements such as recording Blood Pressure against specific points in time, or over a range of intervals (+/- mathematical functions).
Misuse	Not to be used to record the measurement of arterial blood pressure which is NOT a surrogate for arterial pressure in the systemic circulation eg specific measurement of right pulmonary artery pressure. Use OBSERVATION.intravascular_pressure in this situation. Not to be used to record measurements of intravenous pressure. Use the appropriate specialisations of OBSERVATION.intravascular_pressure in this situation.
Purpose	To record the systemic arterial blood pressure of an individual.
References	O'Brien E, Asmar R, Beilin L, et al. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. Journal of Hypertension [Internet]. 2003 [cited 2009 Jul 30] ; 21(5):821-848. Available from http://www.bhsoc.org/bp_monitors/ESH_BP_rec.pdf Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, Morgenstern BZ. Human blood pressure determination by sphygmomanometry. Circulation [Internet]. 1993 [cited 2009 Jul 29] 88 (5): 2460. Available from: http://circ.ahajournals.org/cgi/reprint/88/5/2460
Copyright	© openEHR Foundation
Authors	Author name: Sam Heard Organisation: Ocean Informatics Email: sam.heard@oceaninformatics.com Date originally authored: 2006-03-22
Other Details Language	Author name: Sam Heard Organisation: Ocean Informatics Email: sam.heard@oceaninformatics.com Date originally authored: 2006-03-22
Other Details (Language Independent)	Licence: This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/. Custodian Organisation: openEHR Foundation References: O'Brien E, Asmar R, Beilin L, et al. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. Journal of Hypertension [Internet]. 2003 [cited 2009 Jul 30] ; 21(5):821-848. Available from http://www.bhsoc.org/bp_monitors/ESH_BP_rec.pdf Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, Morgenstern BZ. Human blood pressure determination by sphygmomanometry. Circulation [Internet]. 1993 [cited 2009 Jul 29] 88 (5): 2460. Available from: http://circ.ahajournals.org/cgi/reprint/88/5/2460 Current Contact: Heather Leslie, Atomica Informatics Original Namespace: org.openehr Original Publisher: openEHR Foundation Custodian Namespace: org.openehr MD5-CAM-1.0.1: 6C5243199E0CC4A559C0F4F32140E1F0 Build Uid: bf67fcb6-247c-4049-bf03-2d3a89852d6a Ip Acknowledgements: This artefact includes content from SNOMED Clinical Terms® (SNOMED CT®) which is copyrighted material of the International Health Terminology Standards Development Organisation (IHTSDO). Where an implementation of this artefact makes use of SNOMED CT content, the implementer must have the appropriate SNOMED CT Affiliate license - for more information contact http://www.snomed.org/snomed-ct/get-snomedct or info@snomed.org. Revision: 2.0.12
Keywords	observations, measurement, bp, vital signs, mean arterial pressure, pulse pressure, systolic, diastolic, RR, NIBP
Lifecycle	published
UID	1811b084-29c0-4bec-bde3-c70b7a5bc28e
Language used	en
Citeable Identifier	1013.1.3574
Revision Number	2.0.12
Archetype Concept Comment	Most commonly, use of the term 'blood pressure' refers to measurement of brachial artery pressure in the upper arm.
events
Any event	Any event: Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time.
24 hour average	24 hour average: Estimate of the average blood pressure over a 24 hour period. Math. function: Mean Interval width: 24 hours
state
Position	Position: The position of the individual at the time of measurement. at1000::Standing [Standing at the time of blood pressure measurement.] at1001::Sitting [Sitting (for example on bed or chair) at the time of blood pressure measurement.] at1002::Reclining [Reclining at the time of blood pressure measurement.] at1003::Lying [Lying flat at the time of blood pressure measurement.] at1014::Lying with tilt to left [Lying flat with some lateral tilt, usually angled towards the left side. Commonly required in the last trimester of pregnancy to relieve aortocaval compression.]
Confounding factors	Confounding factors: Comment on and record other incidental factors that may be contributing to the blood pressure measurement. For example, level of anxiety or 'white coat syndrome'; pain or fever; changes in atmospheric pressure etc.
Exertion	Exertion: Details about physical activity undertaken at the time of blood pressure measurement. Include: openEHR-EHR-CLUSTER.level_of_exertion.v1 and specialisations
Sleep status	Sleep status: Sleep status - supports interpretation of 24 hour ambulatory blood pressure records. at1044::Awake [The individual is fully conscious.] at1045::Sleeping [The individual is in the natural state of bodily rest.]
Tilt	Tilt: The craniocaudal tilt of the surface on which the person is lying at the time of measurement. Property: Angle, plane Units: -90.0..90.0 ° (UCUM: deg) Limit decimal places: 0
data
Systolic	Systolic: Peak systemic arterial blood pressure - measured in systolic or contraction phase of the heart cycle. Property: Pressure Units: 0.0..<1000.0 mmHg (UCUM: mm[Hg]) Limit decimal places: 0
Diastolic	Diastolic: Minimum systemic arterial blood pressure - measured in the diastolic or relaxation phase of the heart cycle. Property: Pressure Units: 0.0..<1000.0 mmHg (UCUM: mm[Hg]) Limit decimal places: 0
Mean arterial pressure	Mean arterial pressure: The average arterial pressure that occurs over the entire course of the heart contraction and relaxation cycle. Property: Pressure Units: 0.0..<1000.0 mmHg (UCUM: mm[Hg]) Limit decimal places: 0
Pulse pressure	Pulse pressure: The difference between the systolic and diastolic pressure. Property: Pressure Units: 0.0..<1000.0 mmHg (UCUM: mm[Hg]) Limit decimal places: 0
Clinical interpretation	Clinical interpretation: Single word, phrase or brief description that represents the clinical meaning and significance of the blood pressure measurement.
Comment	Comment: Additional narrative about the measurement, not captured in other fields.
protocol
Cuff size	Cuff size: The size of the cuff used for blood pressure measurement. Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, Morgenstern BZ. Human blood pressure determination by sphygmomanometry. Circulation 1993;88;2460-2470. at0015::Adult Thigh [A cuff used for an adult thigh.] at0016::Large Adult [A cuff for adults with larger arms.] at0017::Adult [A cuff that is standard for an adult.] at1008::Small Adult [A cuff used for a small adult.] at1009::Paediatric/Child [A cuff that is appropriate for a child or adult with a thin arm.] at1018::Infant [A cuff used for infants.] at1019::Neonatal [A cuff used for a neonate, assuming cuff is the appropriate size for maturity and birthweight of the neonate.]
Location of measurement	Location of measurement: Simple body site where blood pressure was measured. Choice of: Coded Text at0025::Right arm [The right arm of the person.] at0026::Left arm [The left arm of the person.] at0027::Right thigh [The right thigh of the person.] at0028::Left thigh [The left thigh of the person.] at1020::Right wrist [The right wrist of the individual.] at1021::Left wrist [The left wrist of the individual.] at1026::Right ankle [The right ankle of the individual.] at1031::Left ankle [The left ankle of the individual.] at1032::Finger [A finger of the individual.] at1051::Toe [A toe of the individual.] at1056::Dorsum of foot [The individual's dorsum of the foot.] at1053::Intra-arterial [Invasive measurement via transducer access line within an artery.] Text
Structured measurement location	Structured measurement location: Structured anatomical location of where the measurement was taken. Include: openEHR-EHR-CLUSTER.anatomical_location.v1 and specialisations
Method	Method: Method of measurement of blood pressure. at1036::Auscultation [Method of measuring blood pressure externally, using a stethoscope and Korotkoff sounds.] at1037::Palpation [Method of measuring blood pressure externally, using palpation (usually of the brachial or radial arteries).] at1039::Machine [Method of measuring blood pressure externally, using a blood pressure machine.] at1040::Invasive [Method of measuring blood pressure internally ie involving penetration of the skin and measuring inside blood vessels.]
Mean arterial pressure formula	Mean arterial pressure formula: Formula used to calculate the Mean Arterial Pressure (if recorded in data).
Systolic pressure formula	Systolic pressure formula: Formula used to calculate the systolic pressure from from mean arterial pressure (if recorded in data).
Diastolic pressure formula	Diastolic pressure formula: Formula used to calculate the diastolic pressure from mean arterial pressure (if recorded in data).
Diastolic endpoint	Diastolic endpoint: Record which Korotkoff sound is used for determining diastolic pressure using auscultative method. at1011::Phase IV [The fourth Korotkoff sound is identified as an abrupt muffling of sounds.] at1012::Phase V [The fifth Korotkoff sound is identified by absence of sounds as the cuff pressure drops below the diastolic blood pressure.]
Device	Device: Details about sphygmomanometer or other device used to measure the blood pressure. Include: openEHR-EHR-CLUSTER.device.v1 and specialisations
Extension	Extension: Additional information required to capture local context or to align with other reference models/formalisms. For example: Local hospital departmental infomation or additional metadata to align with FHIR or CIMI equivalents. Include: All not explicitly excluded archetypes
Other contributors	Karin Aarsheim, Helse Førde, Norway Tomas Alme, DIPS ASA, Norway Anne Pauline Anderssen, Helse Nord RHF, Norway Koray Atalag, University of Auckland, New Zealand Silje Ljosland Bakke, Helse Bergen HF, Norway (Editor) Johan Gustav Bellika, Norwegian Centre for Integrated Care and Telemedicine, Norway Knut Bernstein, MEDIQ, Denmark Lars Bitsch-Larsen, Haukeland University Hospital, Bergen, Norway Fredrik Borchsenius, Oslo universitetssykehus, Norway Pål Brekke, OUS Rikshospitalet, Norway Marja Buur, Medisch Centrum Alkmaar, Netherlands Rong Chen, Cambio Healthcare Systems, Sweden Lisbeth Dahlhaug, Helse Midt - Norge IT, Norway Beatriz de Faria Leão, Zilics, Brazil Paul Donaldson, Nursing Informatics Australia, Australia Torsten Eken, Oslo universitetssykehus HF, Ullevål, Norway Jose Florez Arango, Universidad de Antioquia, Colombia Einar Fosse, UNN HF, Norwegian Centre for Integrated Care and Telemedicine, Norway Gerard Freriks, ERC, Netherlands Sebastian Garde, Ocean Informatics, Germany Soon Ghee Yap, Singapore Health Services Pte Ltd, Singapore Anneke Goossen, Results 4 Care, Netherlands Bjørn Grøva, Helsedirektoratet, Norway Atle Hansen, Universitetssykehuset Nord-Norge, Norway Sam Heard, Ocean Informatics, Australia Kristian Heldal, Telemark Hospital Trust, Norway Karsten Heusser, Hannover Medical School, Germany Omer Hotomaroglu, Turkey Evelyn Hovenga, EJSH Consulting, Australia Derek Hoy, United Kingdom Pieter Hummel, Medisch Centrum Alkmaar, Netherlands Eugene Igras, IRIS Systems, Inc., Canada Sundaresan Jagannathan, Scottish NHS, United Kingdom Tom Jarl Jakobsen, Helse Bergen, Norway Andrew James, University of Toronto, Canada Karl Trygve Kalleberg, Oslo Universitetssykehus, Norway Sabine Leh, Helse-Bergen, Norway Heather Leslie, Atomica Informatics, Australia (Editor) Rikard Lovstrom, Swedish Medical Association, Sweden Hallvard Lærum, Oslo Universitetssykehus HF, Norway Luis Marco Ruiz, NST, Spain Rohan Martin, Ambulance Victoria, Australia Ian McNicoll, Ocean Informatics, United Kingdom Lars Ivar Mehlum, Helse Bergen HF, Norway Jeroen Meintjens, Medisch Centrum Alkmaar, Netherlands Udo Müller-Oest, CompuGROUP Software, Germany Bjørn Næss, DIPS ASA, Norway Rune Pedersen, Universitetssykehuset i Nord Norge, Norway Melvin Reynolds, United Kingdom Steinar Sandvik, Helse Vest IKT, Norway Thomas Schopf, University Hospital of North-Norway, Norway Tony Shannon, NHS, United Kingdom Thor-Einar Stemland, Helse Bergen, FOU Seksjon for e-helse, Norway Line Sæle, Helse Vest IKT, Norway Hwei-Yee Tai, Tan Tock Seng Hospital, Singapore Micaela Thierley, Helse Bergen, Norway Kevin Thon, SKDE, Norway Camilla Tøndel, Haukeland University Hospital, Norway John Tore Valand, Haukeland Universitetssjukehus, Norway (Editor) Stef Verlinden, Vivici, Netherlands Ole Øyen, Oslo University Hospital, Norway
Translators	German: Sebastian Garde, Jasmin Buck, Ocean Informatics, University of Heidelberg Russian: Igor Lizunov, i.lizunov@infinnity.ru Swedish: Kirsi Poikela, Sofia Janstad, Manna Vosta, Tieto Sweden AB, SLL, Karolinska University Hospital, ext.kirsi.poikela@tieto.com, sofia.lang-janstad@sll.se, manna.vosta@regionstockholm.se Finnish: Vesa Peltola, Heidi Koikkalainen, Tietoevry, Finland, vesa.peltola@tieto.com, heidi.koikkalainen@freshehr.com Other Contributors: Riikka Lahtela, Istekki, Finland; Henri Huttunen, Una Oy, Finland; Anna-Leena Karvonen, Tietoevry, Finland Korean: Seung-Jong Yu, NOUSCO Co.,Ltd., seungjong.yu@gmail.com, Certified Board of Family Medicine in South Korea Portuguese (Brazil): Jussara Rözsch, OpenEHR Foundation, jussara.macedo@gmail.com, Medical Doctor, Psychiarist, Clinical Modeller, openEHR Diretor, ehealth infostructuture WG ccoordinator- brazilian ehealth program Greek: Erasmia Partafylla, Sigmasoft, c.partafylla@sigmasoft.gr Arabic (Syria): Mona Saleh Chinese (PRC): Chunlan Ma; Lin Zhang, Ocean Informatics; Taikang Insurance Group, chunlan.ma@oceaninformatics.com; linforest@163.com Spanish (Spain): Pablo Pazos, Clara Calleja Vega, CaboLabs, CatSalut. Servei Català de la Salut., ccalleja@catsalut.cat Spanish (Argentina): Domingo Liotta, Universidad de Morón, domingo_liotta@hotmail.com, Universidad de Morón Norwegian Bokmål: Lars Bitsch-Larsen, Haukeland Uinversity Hospital, Bergen, Norway, lbla@helse-bergen.no, MD, DEAA. specialist in anaesthesia and tropical medicine. Japanese: Shinji Kobayashi, NPO openEHR Japan, skoba@moss.gr.jp Farsi: Shahla Foozonkhah, Ocean Informatics, shahla.foozonkhah@oceaninformatics.com Dutch: Marja Buur, Sebastian Iancu, M.C.A., Code24 BV, m.buur-krom@mca.nl, sebastian@code24.nl Catalan: Manuel José Zafra Doménech, TRADCREA, S.L., mzafra@tradcrea.com Other Contributors: Servei Català de la Salut