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Abstract

Objectives

This survey of small animal veterinarians endeavored to: (1) determine current methods of indirect blood pressure measurement; (2) detail techniques used to reduce situational hypertension; and (3) better understand the obstacles to performing blood pressure measurement in cats.

Methods

An online survey was produced and circulated to members of the Veterinary Information Network. A total of 733 veterinarians who saw cats in their practice and had access to at least one indirect blood pressure device completed the entirety of the survey.

Results

Ninety-six percent (703/733) of veterinarians who completed the survey reported measuring indirect blood pressure in cats in their practice, with veterinary technicians conducting most (600/703; 85.3%) of these measurements. Few veterinarians (30/733; 4.1%) did not measure blood pressure, with these veterinarians citing several obstacles including: difficulty interpreting results with the occurrence of fear, anxiety and stress in cats (20/30; 66.7%); difficulty performing measurements in cats (17/30; 56.7%); and technical staff being uncomfortable performing measurements (12/30; 40.0%). Most veterinarians (300/435; 69.0%) in this survey preferred an ultrasonic Doppler flow detector with sphygmomanometry, with many (272/300; 90.7%) perceiving that the results obtained with this device were more trustworthy compared with results obtained with oscillometry. Ninety percent (633/703) of veterinarians employed techniques to reduce situational hypertension in cats. Techniques perceived to be most helpful among veterinarians included: using a quiet location (454/633; 71.7%); minimizing restraint (316/633; 49.9%); performing blood pressure prior to other procedures (eg, phlebotomy, cystocentesis) (302/633; 47.7%); avoiding other animals (219/633; 34.6%); and allowing time for acclimation (167/633; 26.4%).

Conclusions and relevance

This survey study of veterinarians helps clarify obstacles to routine blood pressure measurement in conscious cats. Veterinarians reported several strategies that they felt reduced situational hypertension in cats. The data inform modifications of techniques to increase the frequency and perceived reliability of blood pressure measurement in at-risk cats.

Keywords

Oscillometry Doppler indirect blood pressure survey

Introduction

Systemic hypertension increases in prevalence with age and disease in cats, and causes damage to target organs including the eyes, central nervous system, kidneys and heart.^1–6 Pathologic hypertension occurs in association with disease (most commonly chronic kidney disease and hyperthyroidism), medications, or toxins known to cause hypertension (ie, secondary hypertension) and, in cats, can occur in the absence of identifiable disease (ie, idiopathic hypertension).⁷ Secondary and idiopathic hypertension are diagnosed and treated only after exclusion of a transient increase in blood pressure that occurs due to excitement, fear, stress, and anxiety from being in hospital or in response to pain (ie, situational hypertension).^6,8–10

Consensus statements by the American College of Veterinary Medicine, International Society of Feline Medicine, and, most recently, an educational toolkit developed by the American Association of Feline Practitioners (AAFP) include guidelines for the diagnosis, management and treatment of systemic hypertension in cats.^6,8,11 These resources provide recommendations for veterinarians to use in practice, including methods to reduce situational hypertension in the hospital.

Veterinarians usually obtain non-invasive blood pressure (NIBP) measurements in conscious cats either by the use of a Doppler ultrasonic flow detector, or a traditional or high-definition oscillometric (HDO) device. Several studies have evaluated best practices for measuring indirect blood pressure in conscious (ie, non-anesthetized) cats including the choice of device, cuff size and artery.^12–18 Studies have evaluated the efficacy of only a select number of methods to reduce false increases in NIBP measurements in conscious cats, including management of the clinical setting, acclimation to the environment and the use of feline facial pheromone analogues.^4,17,19–21 In general, the optimal approach to NIBP measurement in conscious cats remains controversial and the preferences of practicing veterinarians on this subject are unknown.

To improve the efficacy of obtaining an accurate blood pressure measurement in cats, it is important to understand current practices of small animal veterinarians. The objectives of this survey study were to, by means of an online survey of Veterinary Information Network (VIN) members: (1) document preferred methods among small animal veterinarians who measure blood pressure; (2) detail preferred methods to reduce the likelihood of situational hypertension; and lastly (3) better understand the obstacles to performing blood pressure measurements in conscious cats.

Materials and methods

Utilizing the VIN, an online survey was circulated to a network of first-opinion veterinarians. An email invitation with a cover letter and a link to the survey was sent to all 41,559 VIN members who were practicing veterinarians on 29 December 2020 and an email reminder was sent on 14 January 2021. The survey consisted of 33 multiple-choice questions evaluating NIBP measurements in conscious cats, including 12 questions that provided an ‘other’ option allowing for free-text responses. Questions focused largely on the availability of one or more different types of NIBP measuring devices within the practice, individual preferences for or aversions toward the use of these devices, and the practices and clinical decisions surrounding how and when said devices were used in cats (see questionnaire in the supplementary material).

In order to participate in the survey, veterinarians were required to see cats in their practice and have access to at least one NIBP device (oscillometric [either traditional or high-definition] or Doppler). All responses were anonymized. Responses were transferred into a spreadsheet application for quantitative analysis (Excel, Microsoft Office), and data were cleaned of duplicate responses (using unique identifiers assigned to respondents) and partial or incomplete responses. The number of responses for each answer choice was quantified and established as a percentage of the total number of responses for each choice. Open-ended responses to questions that included ‘other’ as an answer choice were interpreted and summarized.

Results

A total of 756 veterinarians who saw cats in their practice provided analyzable responses. Twenty-three (23/756; 3.0%) of these respondents worked in practices that did not have an NIBP device and were not prompted to complete the remainder of the survey questions. Therefore, 733 veterinarians completed the questionnaire and had access to at least one NIBP measuring device. Most of these respondents were from the USA (601/733; 82.0%) and Canada (75/733; 10.2%), accounting for a combined 92.2% (676/733) of the results received. Other countries represented included Australia (22/733; 3%), England (7/733; 1.0%) and Belgium, Bulgaria, China, Finland, France, Germany, Hong Kong, India, Japan, Mexico, Netherlands, New Zealand, Serbia, Singapore, Slovenia, South Africa, Spain, Sweden and Thailand (fewer than five responses each). Veterinarian demographics and practice descriptions are summarized in Table 1. Most veterinarians were general practitioners (664/733; 90.6%) working in either a first-opinion, primary care, general practice or an emergency clinic (625/733; 85.3%) with a patient population of 25–75% cats (588/733; 80.2%).

Table 1

The demographics and patient population of 733 veterinarians who responded to the survey

Variable	Category	Number of veterinarians (%)
Practice type	Private practice	698 (95.2)
	Mobile practice	21 (2.9)
	Clinical academia	11 (1.5)
	Shelter medicine	3 (0.4)
Specialty certification	Specialists	69 (9.4)
	General practitioners	664 (90.6)
Year of graduation	2011–2020	176 (24.0)
	2001–2010	167 (22.8)
	1991–2000	200 (27.3)
	1981–1990	156 (21.3)
	1971–1980	27 (3.7)
	1961–1970	6 (0.8)
	Prior to 1960	1 (0.1)
Patient population	<25% cats	76 (10.4)
	25–75% cats	588 (80.2)
	>75% cats	5 (0.7)
	Cat exclusive	64 (8.7)

Most veterinarians had more than one type of NIBP device (ie, oscillometric [traditional or high-definition] or Doppler) in their practice (446/733; 60.8%), while the remaining veterinarians (287/733; 39.2%) reported having one type of NIBP device in their practice. More veterinarians had an oscillometric NIBP device (653/733; 89.1%) followed by Doppler (547/733; 74.6%). Of the veterinarians with access to an oscillometric device, most had traditional oscillometric devices (393/653; 60.2%) rather than HDO devices (50/653; 7.7%). Approximately one third of veterinarians with access to an oscillometric device were unsure of the type (210/653; 32.2%).

Most veterinarians (703/733; 95.9%) reported that their practice measured blood pressure in conscious cats. Technicians performed blood pressure measurements in most practices (600/703; 85.3%), with fewer performed by veterinarians (418/703; 59.5%), veterinary assistants (ie, a person that cares for pets under the supervision of a veterinarian or technician) (228/703; 32.4%) and veterinary students (22/703; 3.1%). This question allowed multiple responses (1268 responses from 703 veterinarians). Those that had access to a NIBP device, but did not measure blood pressure in conscious cats (30/733; 4.1%), were asked to indicate reasons why they did not measure blood pressure using a multiple response question prior to ending the survey (62 responses from 30 veterinarians). Of these respondents, most (20/30; 66.7%) found it difficult to interpret readings in hospital owing to fear, anxiety or stress in cats. Other reasoning included difficulty performing measurements in cats (17/30; 56.7%), technical staff being uncomfortable performing measurements (12/30; 40.0%), acquisition of measurements being too time consuming (7/30; 23.3%), owners declining (3/30; 10.0%) and some veterinarians felt this service was unnecessary for their patient population (3/30; 10.0%).

Veterinarians who measured blood pressure in conscious cats (n = 703) completed the remainder of the survey. Of these respondents, 435 (62%) had more than one type of NIBP device and were polled on their preference for or aversion toward each type of NIBP measuring device. Overall, Doppler was the most preferred device (300/435; 69.0%) followed by oscillometry (106/435; 24.4%); 6.7% (29/435) reported no preference for either device. Aversion to either device was explored, with 9.9% (43/435) of veterinarians averse to using a Doppler, 34.0% (148/435) averse to oscillometric devices and 56.1% (244/435) reporting no aversion toward either device. An opportunity to justify their preference for, or aversion toward, either method of measurement followed, using a question that allowed for multiple responses (Figures 1 and 2, respectively).

Figure 1

Reported justification by veterinarians for non-invasive blood pressure device preference

Figure 2

Reported justification by veterinarians for non-invasive blood pressure device aversion

Of the 703 veterinarians who measured blood pressure in conscious cats, 348 (49.5%) made a recommendation to measure blood pressure to an owner at least once weekly, 226 made recommendations of at least once a month (32.1%) and 115 (16.4%) made recommendations of every few months. Veterinarians were asked which clinical scenarios prompted the recommendation using a multiple response question (1861 responses from 703 veterinarians). Most (647/703; 92.0%) said they made the recommendation for cats with a disease that predisposes them to hypertension. Additional reasons to recommend an NIBP measurement included cats with evidence of target organ damage (TOD; 609/703; 86.6%), cats presenting for signs of illness (402/703; 57.2%), healthy older cats more than 7 years of age (190/703; 27.0%) and healthy cats between 1–7 years of age (13/703; 1.8%). Of the 647 veterinarians who recommended blood pressure measurement for cats with disease, the most common diseases that prompted the recommendation included kidney disease (638/647; 98.6%) and hyperthyroidism (597/647; 92.3%) followed by pheochromocytoma (218/647; 33.7%), hyperadrenocorticism (201/647; 31.1%), diabetes mellitus (196/647; 30.3%), hyperaldosteronism (172/647; 26.6%) and obesity (102/647; 15.8%). One hundred and six veterinarians selected ‘other’, and the most common diseases stated including heart disease (55/106; 52%), visual impairment (31/106; 28%) and neurologic signs (9/106; 8%). This question allowed multiple responses (2230 responses from 647 veterinarians).

Veterinarians most commonly preferred the forelimb to measure blood pressure (251/703; 35.7%), while fewer preferred the tail (184/703; 26.2%) and fewest preferring the hindlimb (148/703; 21.1%). Seventeen percent (120/703) of veterinarians did not indicate a preference. Most veterinarians (649/703; 92.3%) used the circumference of the extremity to determine appropriate cuff size, while few (33/733; 4.5%) used a standard cuff size or body weight (21/733; 2.9%). Tape was reportedly always used to secure the cuff by 13.9% (98/703) of veterinarians, sometimes by 45.7% (321/703) and never by 40.4% (284/703).

Veterinarians were asked how the final blood pressure values were determined. Overall, 33.7% (237/703) of veterinarians took several measurements and averaged those that were reasonably similar to each other, 27.3% (192/703) took the average of several measurements after excluding the highest and lowest values, 23.8% (167/703) took the average of several (more than two) measurements without excluding any measurements, 7.5% (53/703) took the average of several measurements after excluding the first and last measurements and 3.3% (23/703) took one or two blood pressure measurements with no repeats.

Most veterinarians (396/703; 56.3%) diagnosed hypertension at a single visit based on either a single set of measurements (100/396; 25.3%) or multiple sets of measurements (296/396; 74.7%). Conversely, 43.7% (307/703) of veterinarians diagnosed hypertension after multiple visits based on either a single set (114/307; 37.1%) or multiple sets (193/307; 62.9%) of measurements. For these veterinarians, 86.6% (266/307) said they diagnosed hypertension after two visits, 12.4% (38/307) after three visits, and 1.0% (3/307) after four or more visits. An inquiry into the blood pressure cut-off veterinarians used to diagnose feline hypertension followed (Table 2).

Table 2

Blood pressure cut-off values (mmHg) for diagnosis of hypertension in cats reported by 703 veterinarians

Blood pressure value	Number of veterinarians	Veterinarians (%)
140 mmHg	7	1.0
150 mmHg	36	5.1
160 mmHg	234	33.3
170 mmHg	98	13.9
180 mmHg	215	30.6
190 mmHg	46	6.5
200 mmHg	31	4.4

Veterinarians in this survey performed a fundic examination with blood pressure measurement always (273/703; 38.8%), sometimes (342/703; 48.6%) and never (88/703; 12.5%). Of veterinarians who performed fundic examinations (615/703; 87.5%), most preferred direct ophthalmoscopy (421/615; 68.5%), followed by indirect ophthalmoscopy (159/615; 25.9%) and few had no preference (35/615; 5.7%). Veterinarians who never performed a fundic examination (88/703; 12.5%) provided reasoning using a ‘select all that apply’ format (101 responses from 88 veterinarians). Most (56/88; 63.6%) did not trust their ability to interpret ophthalmic changes correctly, some (24/88; 27.3%) did not have the necessary equipment, others (18/88; 20.5%) did not know how to perform a fundic examination and few (3/88; 3.4%) felt this procedure was unnecessary.

Most veterinarians (633/703; 90.0%) used techniques to reduce situational hypertension. Veterinarians were asked to detail these techniques with a question that allowed for multiple responses (4650 responses from 633 veterinarians; Figure 3). Of note, only four of the 29 veterinarians (14%) that reported Doppler as distressful for cats in a previous question also reported using headphones to reduce noise during blood pressure measurement. Veterinarians who employed techniques to reduce situational hypertension were asked to choose the top three techniques that were perceived to be the most helpful. The most common techniques included the use of a quiet place (454/633; 71.7%), minimal restraint (316/633; 49.9%), performing blood pressure measurement first before other procedures (302/633; 47.7%), performing blood pressure measurement away from other animals (219/633; 34.6%) and allowing time for acclimation (167/633; 26.4%).

Figure 3

Percentage of veterinarians who reportedly used a technique to minimize situational hypertension in cats during blood pressure measurement

Most veterinarians reported either always (683/703; 97.2%) or sometimes (17/703; 2.4%) keeping a written record of blood pressure measurements and procedures; only three (3/703; 0.4%) veterinarians replied never. The information most recorded in the patient record by these 700 veterinarians included site of cuff placement (550/700; 78.6%), cuff size (521/700; 74.4%), individual measurements for systolic, diastolic and mean arterial pressure (516/700; 73.7%), average blood pressure (454/700; 64.9%) and blood pressure device used (366/700; 52.3%). Less commonly recorded information included the name of the person conducting measurements (291/700; 41.6%), position of the cat (287/700; 41.0%), a subjective assessment of stress (258/700; 36.9%), successful maneuvers to reduce stress (216/700; 30.9%) and location of blood pressure measurement (109/700; 15.6%). This question allowed for multiple responses (3568 responses from 700 veterinarians).

Discussion

This survey of practicing veterinarians sought to determine current methods of blood pressure measurement, identify obstacles to the indirect measurement of blood pressure in cats and detail techniques used to reduce situational hypertension. Our results suggest veterinarians use a large variety of approaches to obtain blood pressure measurements.

Veterinarians could most commonly access an oscillometric NIBP device in their practice. Of the veterinarians who had an oscillometric NIBP device, most used traditional oscillometry with few reporting using an HDO device. However, a third of veterinarians who reported having access to an oscillometric device did not know the type of oscillometric device they had (ie, traditional oscillometric or HDO device). Traditional oscillometric devices detect oscillations in the artery to measure the mean arterial pressure and use algorithmic calculations to estimate automated systolic and diastolic pressures. The algorithmic calculation used by a traditional oscillometric device is devised by the manufacturer, and therefore measurements are not interchangeable between devices. The HDO device for cats (S and B MedVet) measures blood pressure by means of a proprietary pressure waveform analysis. Because the HDO device directly measures systolic, mean and diastolic arterial blood pressure values, this device is, theoretically, more accurate than traditional oscillometry devices that utilize algorithms to compute systolic and diastolic blood pressure values. Few studies have evaluated the use of the HDO device in cats.^4,18 In conscious cats, the HDO device was shown to produce accurate results for systolic blood pressure when compared with the reference standard direct invasive measurement.¹⁸ As a minority of veterinarians in this survey had an HDO device (50/653; 7.7%), this survey is unlikely to be a good representation of insights into the use of this device in conscious cats.

The veterinarians with more than one type of device were asked to choose which device they preferred to use to measure blood pressure in cats and explain why. Most veterinarians preferred Doppler devices over oscillometric devices, many stating that they trusted the results more than oscillometric devices. Previous studies have suggested that some traditional oscillometric devices yield variable measurements of systolic blood pressure in cats and are less reliable than Doppler devices, especially at high systolic values.^15,16,22,23 By comparison, individuals preferring oscillometry in this survey, both traditional and high-definition, felt these devices were easier to use, had faster set-up times and decreased patient distress. Several challenges in the use of Doppler devices were also identified, with most veterinarians agreeing that this method is more difficult to use while others associated Dopplers with more patient distress and a slower set-up time. Regardless of perceptions of accuracy or precision, none of the machines meet minimum standards for validation.^6,8 Therefore, veterinarians must interpret results of indirect blood pressure measurements based on clinical context, detection of TOD and, in some cases, reproducibility of measurements.

Most veterinarians participating in this survey recommended obtaining blood pressure measurements in cats with diseases that predispose them to developing hypertension, most often kidney disease and hyperthyroidism, as well as those with evident TOD. Fewer veterinarians recommended blood pressure measurement in healthy older cats (>7 years old) or those presenting for signs of illness and rarely for healthy adult cats (1–7 years old). Systolic blood pressure has been documented to increase with age, and idiopathic hypertension most commonly occurs in older cats.^4,5,24 Though current guidelines encourage the annual acquisition of baseline blood pressure measurements in healthy older cats (⩾7 years) at least yearly, only 27% of veterinarians in this survey routinely performed blood pressure measurements in these cats.^6,11 Potential reasons for this include the concern for false diagnosis by routinely screening a cat population with low incidence of idiopathic hypertension.⁵ It could also be assumed that obstacles to blood pressure measurement play a role in deterring the average respondent from performing this diagnostic in older cats without existing disease or apparent TOD.

Only 3% of veterinarians that responded to the survey and saw cats in their practice did not have an NIBP device in their practice. Of the veterinarians that did have an NIBP device, a minority (4%) did not measure blood pressure in cats. These veterinarians who did not measure blood pressure in cats despite access to a NIBP device most commonly reported that they felt results were uninterpretable given the occurrence of situational hypertension (secondary to fear, anxiety, stress or excitement) and that measurement was too difficult to perform in cats. Some reported that their staff were unable to acquire blood pressure measurements in cats and that acquisition of measurements was too time consuming. Although not asked directly in this survey, these responses may be a reflection of why a small proportion of the veterinarians with a 25–75% cat patient population only recommended a blood pressure measurement every month to every few months, representing a potential missed opportunity for early detection of hypertension. As veterinary technicians were reported to perform most blood pressure measurements in this survey, the importance of training to inspire confidence among veterinary staff is apparent where clinically relevant and reproducible blood pressure results are desired in a timely fashion.

Current recommendations emphasize the importance of implementing a uniform protocol to measure blood pressure in conscious cats. To avoid confounding results with situational hypertension, where TOD is not evident, current guidelines support a repeat measurement at a separate visit in as soon as 14 days when blood pressure is found to be ⩾160 mmHg.^6,8 Moreover, obtaining at least five consecutive and consistent readings is recommended, discarding the first due to the potential influence of situational hypertension on this value, and taking the average of all measurements.^6,8,11 Several discrepancies were identified among surveyed veterinarians regarding how hypertension was diagnosed including the number of visits required, cut-off values, and the decision to exclude certain blood pressure measurements to diagnose hypertension in cats. More veterinarians in this survey diagnosed hypertension in one visit using multiple measurements, while fewer required at least two visits with multiple measurements per visit. A previous study showed that blood pressure decreased over time during an office visit, and therefore obtaining multiple sets of measurements at one visit may be beneficial.²¹ Approximately a third of veterinarians responded they used a cut-off of 160 mmHg and a third responded they used a cut-off of 180 mmHg for diagnosis of hypertension. We did not observe a consensus among veterinarians for the exclusion of measurements; the highest and lowest values were excluded by more clinicians, while others chose not to exclude any values, and some chose to exclude the first and last values obtained.

The ‘AAFP hypertension educational toolkit’ outlines environmental techniques to reduce fear, anxiety and stress in cats.¹¹ Many veterinarians in this survey employed techniques to reduce situational hypertension in cats. The techniques perceived to be the most helpful included seeking a quiet environment, using minimal restraint and performing blood pressure measurement before other procedures (eg, phlebotomy, cystocentesis) or away from other animals, and allowing time for acclimation. Although the authors find that these techniques are helpful for some cats in clinical practice, few studies have evaluated the efficacy of methods used to minimize situational hypertension in cats. Sparkes et al demonstrated a decrease in systolic blood pressure in some cats after a 10 min acclimatization period, supporting this as a recommendation.¹⁷ The effect of feline facial pheromone analogues on feline stress and blood pressure remains unclear, as studies have shown improvement of stress behavior that is not reflected in physiologic parameter changes, such as systolic blood pressure, with the use of these pheromones.^19,20 In our survey, two-thirds of the veterinarians who employed techniques to reduce situational hypertension reported using feline pheromones; however, only a minority (9%) perceived this technique as most helpful. A study showed that owners taking blood pressure measurements with the HDO device without a veterinarian did not impact blood pressure measurements; however, cats placed on a table rather than a carrier were shown to have higher mean arterial pressure, diastolic pressure and pulse rate.⁴

Almost all veterinarians in this survey kept a record of blood pressure measurements and useful techniques for their patients. Most veterinarians recorded the site of cuff placement, cuff size, individual blood pressure measurements, average blood pressure measurement and the NIBP device used. It was less common to note the individual obtaining measurements, patient positioning, an assessment of patient stress, successful measures to reduce stress and the location where blood pressure was measured. While it is clear veterinarians appreciate consistency in blood pressure measurement techniques, implementing a more universal form for blood pressure assessment, like the form provided in the AAFP hypertension toolkit, may further facilitate and enhance record keeping, including consideration of successful cat-specific techniques for measuring blood pressure.

Half of the veterinarians reported sometimes and about a third reported always performing a fundic examination at the time of blood pressure measurement. Few veterinarians (12.5%) reported never performing a fundic examination, with most of whom reporting that they did not trust their ability to interpret ophthalmic changes correctly, and smaller percentages reporting a lack of access to the necessary equipment or feeling uncertain of their ability to perform a fundic examination. The fundic examination represents a rapid, inexpensive way to evaluate the presence of hypertensive ocular disease, can help validate hypertension in cats with high blood pressure measurements and can help find evidence of hypertension despite an adequate blood pressure reading. A recent study found that indirect fundoscopy by non-specialty trained veterinarians was a reliable method for detection of ocular TOD in cats with hypertension.²⁵ Ocular changes detectable on fundoscopy are common in cats with hypertension, and are most often associated with blood pressure measurements over 160 mmHg.^26–28 Occasionally, cats can have ocular changes consistent with hypertensive retinopathy and an indirect blood pressure measurement less than 160 mmHg.^6,29 In this scenario, a trial with an anti-hypertensive drug is encouraged and cats should be monitored closely for clinical evidence of hypotension.⁶ Therefore, routine fundoscopy is recommended in cats with suspect hypertension (>160 mmHg) and ideally in all cats at the time of blood pressure measurement.

This study had limitations. The survey was performed and completed prior to the publication of the AAFP hypertension toolkit; therefore information from this survey may not reflect current practices. It is suspected that the number of respondents whose practices do not carry blood pressure devices or who do not measure blood pressure in conscious cats is underrepresented in this study, as these individuals might have shown no interest in taking this survey. The results of the current survey may not be applicable to other veterinary practice populations, as most respondents to the survey were from first-opinion small animal general practices in North America.

Conclusions

The most common reasons for recommending blood pressure measurements included screening for hypertension in cats with a predisposing disease, in cats with evidence of TOD and in cats presenting for signs of illness. Though most veterinarians in this survey had oscillometric devices in their practice, this survey identifies a preference among veterinarians for the use of Doppler ultrasonic flow detectors to yield more trustworthy blood pressure measurements in cats. The majority of veterinarians employed techniques to reduce situational hypertension in cats. Techniques perceived to be most helpful included using a quiet location, minimizing restraint, performing blood pressure measurement prior to other procedures, avoiding other animals and allowing time for acclimation. Our study helps clarify obstacles to routine measurement in conscious cats. Difficulty interpreting results with the occurrence of excitation, anxiety and stress appeared to be a major obstacle to blood pressure measurement. In general, the findings of the present survey suggest a need for veterinarians to implement more standardized feline-friendly techniques alongside improved guidance on best practices to generate more reliable and repeatable blood pressure measurements in at-risk cats.

Supplemental Material

sj-pdf-1-jfm-10.1177_1098612X211067015 – Supplemental material for Cross-sectional survey of non-invasive indirect blood pressure measurement practices in cats by veterinarians

Supplemental material, sj-pdf-1-jfm-10.1177_1098612X211067015 for Cross-sectional survey of non-invasive indirect blood pressure measurement practices in cats by veterinarians by Iliana Navarro, Stacie Summers, Mark Rishniw and Jessica Quimby in Journal of Feline Medicine and Surgery

Footnotes

Conflict of interest

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Stacie Summers participates as a speaker in continuing education events sponsored by Boehringer Ingelheim.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical approval

This work did not involve the use of animals and therefore ethical approval was not specifically required for publication in JFMS.

Informed consent

This work did not involve the use of animals (including cadavers) and therefore informed consent was not required. No animals or people are identifiable within this publication, and therefore additional informed consent for publication was not required.

ORCID iD

Stacie Summers

Jessica Quimby

Supplementary material

The following file is available online:Questionnaire: measuring blood pressure in awake cats.

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