Blood Pressure Monitoring¶

Overview¶

The Blood Pressure Monitoring feature enables recording of multi-reading blood pressure sessions and reviewing historical session data. A session consists of two or more individual readings taken with a rest timer between each, after which the application computes averages, classifies the result using AHA-aligned categories (Hypotension through Hypertensive Crisis), and captures the active medication status. Sessions are stored with full reading arrays as JSON and weekly aggregate averages are available for trend analysis. The feature supports offline recording and sends push notifications when a critical classification is detected.

Role Access¶

Role	Create Session	View	Delete
SuperAdmin	✓ (all CRs)	All	✓
Administrator	✓ (all CRs)	All	✓
Carer	✓ (linked CRs)	Linked CRs	✓
SupportWorker	✓ (linked CRs)	Linked CRs	—
CareRecipient	✓ (self)	Own	—
HealthCareProvider	— (read only)	Linked CRs	—

Backend¶

Controller: `BloodPressureController` — `/api/blood-pressure`¶

Method	Route	Auth	Description
POST	`/api/blood-pressure`	Authorized	Create a multi-reading BP session
GET	`/api/blood-pressure`	Authorized	List sessions (role-scoped)
GET	`/api/blood-pressure/{id}`	Authorized	Get a single session
DELETE	`/api/blood-pressure/{id}`	AdminOrHigher	Delete a session

Additional routes under BloodPressureController:

Method	Route	Auth	Description
GET	`/api/blood-pressure/weekly-averages`	Authorized	7-day rolling averages per care recipient
GET	`/api/blood-pressure/pulse-rate-ranges`	Authorized	Pulse rate classification ranges
GET	`/api/blood-pressure/bp-classification-ranges`	Authorized	BP classification ranges
POST	`/api/blood-pressure/bp-classification-ranges`	AdminOrHigher	Create a classification range
PUT	`/api/blood-pressure/bp-classification-ranges/{id}`	AdminOrHigher	Update range
DELETE	`/api/blood-pressure/bp-classification-ranges/{id}`	AdminOrHigher	Delete range (seed rows protected)

POST `/api/blood-pressure` — Session Creation Detail¶

Resolves CareRecipientId by role (same pattern as Assessment).
Validates readings: each must have Systolic and Diastolic; PulseRate is optional.
Computes averages across all readings: AverageSystolic, AverageDiastolic, AveragePulseRate?.
Calls BpClassificationService.ClassifyAsync(avgSys, avgDia) → Category + Severity.
Calls PulseRateClassificationService.ClassifyAsync(avgPulse?) → PulseRateCategory + PulseRateSeverity.
Captures active medication snapshot: queries the CR's active BpMedication record and serialises it to MedicationSnapshot JSON (name + dose + frequency at time of session).
Serialises individual readings array to ReadingsJson.
Sets TermId from the default cycle.
On Severity == Critical: sends BloodPressureAlert (type 9) push to all linked carers.
Returns full session DTO including computed averages and classifications.

Key DTOs¶

CreateBpSessionDto

readings[]           object[]   Required, min 1
  systolic           int        40–300 mmHg
  diastolic          int        20–200 mmHg
  pulseRate          int?       Optional bpm
careRecipientId      int?       Omit for self-recording CareRecipient
readingDate          DateTime?  Back-dated session datetime
clientTimestamp      string?    ISO client capture time
notes                string?    Free-text
medicationTaken      bool?      Whether medication was taken
medicationStatus     int?       0=Unknown, 1=Before, 2=After, 3=AboutTo, 4=NoMedicationConsumed

BpSessionDto (response — abbreviated)

id                   int
userId               int
userName             string
careRecipientName    string?
timestamp            DateTime
averageSystolic      decimal
averageDiastolic     decimal
averagePulseRate     decimal?
category             string     "Hypotension" | "Normal" | "Elevated" | "HypertensionStage1" | "HypertensionStage2" | "HypertensiveCrisis"
severity             string
pulseRateCategory    string?
pulseRateSeverity    string?
readingsJson         string     JSON array of individual readings
medicationSnapshot   string?    JSON object { name, dose, frequency }
medicationTaken      bool?
medicationStatus     string?
termName             string?

Model: `BloodPressureSession`¶

Field	Type	Notes
`Id`	int	PK
`UserId`	int	FK → User (recorder)
`CareRecipientId`	int?	FK → User (subject)
`TermId`	int?	FK → Cycle
`Timestamp`	DateTime	Server record time
`ClientTimestamp`	string?	ISO client capture time
`AverageSystolic`	decimal
`AverageDiastolic`	decimal
`AveragePulseRate`	decimal?
`Category`	BpCategory enum	Hypotension=1 … HypertensiveCrisis=6
`Severity`	Severity enum	Normal=1 … Critical=5
`PulseRateCategory`	string?
`PulseRateSeverity`	string?
`ReadingsJson`	string	JSON array
`Notes`	string?
`MedicationSnapshot`	string?	JSON object
`MedicationTaken`	bool?
`MedicationStatus`	MedicationStatus enum

BpClassificationService¶

File: server/src/Vitara.Api/Services/BpClassificationService.cs

Per-recipient ranges take priority over global seeds.
Ranges sorted by SortOrder ASC; first match wins.
OR logic (IsOrLogic = true): match if systolic OR diastolic meets the criterion.
AND logic (IsOrLogic = false): match only if both systolic AND diastolic are in range.
Fallback: HypertensiveCrisis / Critical.
6 global default seed ranges cannot be deleted.

PulseRateClassificationService¶

Same per-recipient/global override pattern. Range matching by MinBpm <= value < MaxBpm. 4 global defaults cannot be deleted.

Frontend¶

Routes¶

Path	Component	Notes
`/blood-pressure`	`BpHistoryComponent`	All roles
`/blood-pressure/entry`	`BpEntryComponent`	All except HealthCareProvider (route data guard)

`BpHistoryComponent` — `/blood-pressure`¶

File: client/src/app/features/blood-pressure/components/bp-history.component.ts

On init: - Calls BloodPressureService.getSessions(termId) and BloodPressureService.getWeeklyAverages().

Expandable row: Renders individual readings from readingsJson (supports both PascalCase and camelCase keys for backward compatibility), shows medication snapshot (name + dose + frequency), and medication timing status (Before/After/About To/No Medication etc.)

Delete: Available for Administrator, SuperAdmin, and Carer roles. Uses DialogService.confirmDelete() before calling BloodPressureService.deleteSession(id).

HealthCareProvider: "Add Reading" button is hidden; read-only view only.

Colour-coded categories: Each category string maps to a CSS class for visual severity indication.

`BpEntryComponent` — `/blood-pressure/entry`¶

File: client/src/app/features/blood-pressure/components/bp-entry.component.ts

This component implements a multi-step wizard.

Configuration Loading¶

On init: - Loads BpReadingCount from AppConfigService.getByKey('BpReadingCount') — determines how many readings to collect (default 2). - Loads pulse rate ranges via BloodPressureService.getPulseRateRanges().

Step Sequence¶

[care-recipient] → reading-1 → timer-1 → reading-2 → [timer-2 → reading-3 → …] → summary → complete

The care-recipient step is skipped if the user has only one linked CR or is a CareRecipient self-recording.

Reading Step¶

FormArray with one entry per configured reading count.
Each entry: systolic (40–300, required), diastolic (20–200, required), pulseRate (optional, 20–300).
AHA category preview: Computed client-side after each keypress using the classification ranges loaded from BloodPressureService.getBpClassificationRanges(). Displays e.g. "Stage 2 Hypertension" in real time below the inputs.

Timer Step (2-minute rest)¶

2-minute countdown (120 seconds) between consecutive readings.
Page Visibility API correction: On visibilitychange, recalculates elapsed seconds from a stored timerStartTime to correct for browser throttling.
User can click "Skip Timer" — the reading is flagged timerSkipped: true in the readings array.
sessionDateUserEdited flag: if the user has manually changed the back-date field, the timer completion callback does not overwrite it.

Summary Step¶

Computes and displays averages: avgSystolic, avgDiastolic, avgPulseRate?.
Resolves the overall AHA category + severity for the averaged values.
Loads the CR's active BP medication via UserConditionsService.getActiveBpMedication(careRecipientId?).
Medication status selector: Unknown / Before / After / AboutTo / NoMedicationConsumed.
"Session date" datetime-local input for back-dating.

Offline Fallback¶

BloodPressureService.createSession() catches network/5xx errors and enqueues the payload to OfflineQueueService with type 'blood-pressure'.

Submission¶

Calls BloodPressureService.createSession(dto) → POST /blood-pressure with the full CreateBpSessionDto including the readings array, medication status, and optional back-dated timestamp.

Feature Service: `BloodPressureService`¶

File: client/src/app/features/blood-pressure/services/blood-pressure.service.ts

Method	HTTP	Endpoint	Notes
`createSession(dto)`	POST	`/blood-pressure`	Offline fallback
`getSessions(termId?)`	GET	`/blood-pressure?termId=N`
`deleteSession(id)`	DELETE	`/blood-pressure/{id}`
`getWeeklyAverages()`	GET	`/blood-pressure/weekly-averages`
`getPulseRateRanges(careRecipientId?)`	GET	`/blood-pressure/pulse-rate-ranges`
`getBpClassificationRanges(careRecipientId?)`	GET	`/blood-pressure/bp-classification-ranges`
`createBpClassificationRange(dto)`	POST	`/blood-pressure/bp-classification-ranges`
`updateBpClassificationRange(id, dto)`	PUT	`/blood-pressure/bp-classification-ranges/{id}`
`deleteBpClassificationRange(id)`	DELETE	`/blood-pressure/bp-classification-ranges/{id}`

AppConfig Keys Relevant to This Feature¶

Key	Default	Description
`BpReadingCount`	2	Number of readings per session
`HighBpRecheckWaitMinutes`	2	Rest timer duration between readings (minutes)
`HighBpRequiredChecks`	2	Minimum readings before summary is shown

Push Notifications Sent¶

Trigger	Notification Type	Recipients
Session severity = Critical	`BloodPressureAlert` (9)	All linked carers of the care recipient

BP Categories (AHA-aligned)¶

Category	Systolic	Diastolic
Hypotension	< 90	OR < 60
Normal	90–119	AND 60–79
Elevated	120–129	AND < 80
Hypertension Stage 1	130–139	OR 80–89
Hypertension Stage 2	140–179	OR 90–119
Hypertensive Crisis	≥ 180	OR ≥ 120

Classification ranges are configurable per care recipient or globally via Management → BP Classification.

End-to-End Data Flow¶

Carer/CareRecipient            Angular                      API                   DB
  |                            |                             |                     |
  | Select care recipient      |                             |                     |
  |                            |-- GET /bp-classification-ranges? -->               |
  |                            |-- GET /pulse-rate-ranges? --|                     |
  |                            |<-- ranges loaded -----------|                     |
  |                            |                             |                     |
  | Enter reading 1 (e.g. 138/90)|                           |                     |
  | Preview: Stage 1 shown     |                             |                     |
  | Wait 2-min timer           | (timer, may skip)           |                     |
  | Enter reading 2 (e.g. 142/92)|                           |                     |
  |                            |                             |                     |
  | Summary: avg=140/91, Stage 2|                            |                     |
  | Load active medication      |-- GET active BP med ------->|                    |
  | Select: "Taken Before"     |                             |                     |
  |                            |                             |                     |
  | Submit                     |-- POST /blood-pressure ---->|                     |
  |                            |                             |-- classify averages  |
  |                            |                             |-- INSERT session --->|
  |                            |                             | if Critical: push    |
  |                            |<-- BpSessionDto ------------|                     |
  |<-- navigate /blood-pressure|                             |                     |