POOR ACCURACY OF BLOOD PRESSURE MEASUREMENT IMAGES ON STOCK PHOTO WEBSITES: IMPLICATIONS FOR PUBLIC HEALTH EDUCATION

Objective: Blood pressure is the most common measurement in clinical practice and increasingly done at home. Media and online websites often display an image of blood pressure measurement to represent clinical medicine, but many images deviate from clinical guidelines. This may wrongly influence perceptions on how measurement should be done. We evaluated the accuracy of blood pressure measurement images on major stock photo websites according to the 2023 International Consensus on Standardized Clinic Blood Pressure Measurement. Design and method: We evaluated the first ∼100 photos from each of 11 major sites. Two independent investigators graded each image, and any disagreement was discussed and resolved. Photo settings included 63% clinical and 37% home-based; 73% by healthcare providers, 24% by patients, 3% other settings. Results: Only 14% of images (N=1106) were accurate on all criteria, ranging from 7% at Flickr or Freepik to 28% at iStock. Based on the percentage accurate photos per site, iStock ranked one, Adobe ranked two, and 123rf ranked three. Images were penalised for the following deviations from guidelines: back unsupported (73%); fore-arm not resting on surface (55%); manual and not electronic device (52%); feet not flat on the floor (36%); doctor or observer talking/laughing (23%); mid-arm not at heart level (19%); patient talking/laughing (18%); legs crossed (13%); cuff on clothing (12%); patient not sitting (5%). Some accuracy aspects were not captured on all images, and thus only the aspects that were included were scored. There were differences in average accuracy scoring by setting (clinical, 8% vs home 25%, p<0.001) and assessors (healthcare provider 7%, self 35%, and other/family member 13%, p<0.001). Conclusions: To conclude, only 1 in 7 online stock photo images of blood pressure measurement aligns with clinical guidelines. Media houses, website developers and the general public should be educated on appropriate measurement techniques to ensure accurate blood pressure measurement in the clinic and at home.