By: Dr. Erin Marcus
New America Media
There’s really no excuse for people not to check their blood
pressure right at home — where the readings tend to be more accurate
than in a doctor’s office.
Sometimes, the simplest tools in medicine are the ones that give us the most useful information.
Take the humble blood pressure machine, for example. It’s been around
for years, and it’s cheap, compared to a lot of other medical devices.
It’s simple to use and doesn’t require a medical or a nursing degree to
operate, but the numbers it reports are valuable in helping predict a
person’s risk of a host of medical problems, including heart failure,
stroke, and kidney failure. It can also help doctors determine whether a
person really needs to take medicine to control his or her high blood
pressure.
In recent years, many physicians have concluded that just checking
blood pressure in the doctor’s office or clinic isn’t sufficient.
A “Call to Action” from the American Heart Association (AHA), the
American Society of Hypertension (ASH), and the Preventive
Cardiovascular Nurses Association (PCNA) recommends that most people who
have been diagnosed with high blood pressure, as well as people whose
blood pressure is slightly elevated but not yet in the “high blood
pressure” range, get a monitor and check their blood pressure regularly
at home.
Because they’re taken in a familiar environment, home blood pressure
readings tend to be lower than the measurements taken in a doctor’s
office or clinic, and better reflect a person’s true blood pressure.
They give doctors and nurses a better sense of how well a person’s
treatment is working, compared to sporadic readings taken in the office,
and may enable some people to avoid medication entirely.
In a few cases, they also help detect the opposite: blood pressure
that’s in an abnormally high range at home, even though it seems normal
during visits to the office. Home blood pressure monitoring can also
help people save money and avoid missing work time, by reducing the
number of visits they have to make to the doctor’s office or clinic.
“There’s emerging evidence that home blood pressure readings are good
predictors of cardiovascular outcomes for most people,” said Dr.
Mahboob Rahman, an associate professor and hypertension researcher at
Case Western Reserve University and University Hospitals Case Medical
Center in Cleveland. “Patients are probably further along [in the habit
of checking home blood pressure] than physicians, but we need to provide
them with guidance.”
Don Wiggins, a 60 year old radio host and sales manager, uses a $50,
battery-powered machine to check his blood pressure, and says it’s an
important part of his daily routine.
He began recording his blood
pressure three years ago, after he underwent emergency heart bypass
surgery.
A home nurse showed him how to use his blood pressure monitor. “At
that point, I was ready to listen to anybody,” he recalled recently.
“But the machines are so easy. There’s really no excuse for anyone not
to check his or her blood pressure,” he added.
“High blood pressure is very prevalent, especially among
African-American men,” he said. “It’s a silent killer, and it’s
important to keep it under check.”
How to take your own blood pressure
Below are some suggestions from Dr. Rahman, as well as from the
AHA/ASH/PCNA “Call to Action” statement, regarding the best way to check
your blood pressure accurately:
1. Pick a blood pressure machine that gives automatic readings and
that’s been “validated,” meaning it’s been tested for accuracy according
to a widely accepted set of standards.
Dr. Rahman recommends a nonprofit website, Dableducational.org, which
lists monitors that have been tested according to the standards of the
European Society of Hypertension. It’s also helpful to get a machine
that will keep a log of your readings so that you’ll have something to
show your doctor or nurse practitioner.
2. Use arm monitors rather than wrist monitors.
Arm monitors, meaning machines with a “cuff,” or sleeve that fits on
the upper arm – tend to be more accurate than wrist monitors, according
to the “call to action” statement, and finger monitors should generally
be avoided. Wrist monitor readings can change with the position of the
wrist. The wrist needs to be held at the level of the heart to get the
most accurate reading.
3. Make sure the cuff is the correct size.
The cuff, or sleeve of the machine that fits around your arm needs to
be the correct size for your arm. The inflatable part of the sleeve
should fit around 80 percent of your upper arm. If your arms are large,
you may need to buy a separate large cuff.
4. Follow the basic rules.
The basic rules, whether in the clinic or the home, start with
sitting in a chair that supports the back, with both feet in a
comfortable position on the ground, for five minutes before taking the
measurement.
Smoking, exercising, and drinking coffee should be avoided for half
an hour prior to the reading, since these can make blood pressure levels
rise transiently. If you need to use the toilet, do so before you check
your blood pressure – don’t take a reading when your bladder is full.
Try to relax.
5. Check your blood pressure two to three times a week, at times when you are relatively calm.
The “Call to Action” statement recommends that doctors review at
least 12 recordings prior to making any decisions about beginning,
stopping, or adjusting medication. The statement also says that a home
value of 135/85 or above is high, as opposed to the 140/90 level that’s
usually considered elevated. For people with diabetes and other
conditions that increase their risk of heart disease, the goal blood
pressure is 130/80 or lower.
6. The goal is keeping an overall record.
Remember, the goal of checking your blood pressure at home is to keep
an overall record that will help your doctor or nurse decide on what
treatment to recommend.
Home monitoring is not meant to figure out why you might feel ill at
any one particular moment. “Some people get in the habit of ‘I’m not
feeling well, so I’ll check to see if my blood pressure is high or low,”
Dr. Rahman said. “That’s not the best use of the blood pressure
machine.” If you’re not feeling well, call your doctor or nurse so that
they can diagnose the reason why.
7. Don’t panic if the levels fluctuate.
In most people, blood pressure tends to be a bit higher in the
morning and at work, and it’s normal for it to ebb and flow. “The
variability of readings is high,” the joint statement explains.
“Individual high or low readings have little, if any, significance.”
8. Get your machine regularly checked.
Remember to bring your machine back to your doctor’s office every
year, so that the staff can make sure it’s still working accurately.
Before using the machine, bring it to your clinic or doctor’s office
so that the staff can check its accuracy and make sure you know how to
operate it correctly. The American Academy of Family Physicians and
British Hypertension Society also post online instructions that can help
orient you when you begin using your machine.
9. Pharmacy and grocery store monitors aren’t best.
Don’t rely on the blood pressure monitors available at the grocery
store or pharmacy, as they aren’t always accurate. If you can’t afford
to buy your own machine, check with your local fire department to see if
they offer “drop-in” times when you can get your blood pressure
checked.
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