Blood Pressure Methodology Study Phase 1

Attachment 12b

Blood Pressure Methodology Phase 1 Form

Form Approved OMB No. 0920-0950 Exp. Date xx/xx/20xx

Assurance of Confidentiality – All information which would permit identification of an individual, a practice, or an establishment will be held confidential, will be used only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347). By law, every employee as well as every agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you.

NOTICE-Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-74, Atlanta, GA 30333. ATTN: PRA (0920-0950).

This attachment captures the time needed for participants to have the MEC physician obtain Blood Pressure (BP) values as usually done in NHANES using mercury and to have the health technicians obtain BP values using the Omron device.

Suggested Script

For Phase One: “We are doing a blood pressure device comparison study. Your participation is voluntary. The purpose of this study is to compare the results of two devices that take blood pressure (will point to the two devices). For this study we need to take your blood pressure six times. You may feel pressure each time the BP cuff is inflated. We will stop the study if you feel uncomfortable when the BP cuff is inflated. The physician will take your BP again and report to you the BP values. If the physician already took your BP, we are going to take your BP again but because the physician already told you the results, we are not going to give you the results.”

Blood Pressure (ages 8 years and older)*

Have you had any of the following in the past 30 minutes? (food, coffee, alcohol, cigarettes) Check all that apply:

Arm selected Right/left/Could not obtain

Cuff size selected Infant/Child/Adult/Large Arm/Thigh

Heart Rate/Pulse Beats per minute

Pulse type

Radial/Brachial

Maximum Inflation Level mm Hg

Systolic Blood Pressure (Readings 1,2,3) mm Hg

Diastolic Blood Pressure (Readings 1,2,3) mm Hg

Average Blood Pressure mm Hg (mean of last 2 measurements will be used)