Welcome, I'm Dr. Keith Moran. You're watching Medicine with Dr. Moran. Today's
video is on how to prepare for your doctor's appointment with a special
emphasis on your blood pressure. Today I'm going to talk about how to get your
blood pressure taken properly at home, how to record it, and how to present the
figures to your physician. This goes a long way in helping your doctor and also
involving you in your healthcare. My patients often ask me about how to make
a diagnosis of high blood pressure or how to monitor it if they have it. They
ask me how to best present the data that they acquire at home. They do understand
the importance of high blood pressure this of course can lead to stroke, heart
attacks, kidney disease, and other medical problems. Blood pressure readings in a
doctor's office can be much higher than at home and they do not correlate
particularly well with our gold standard test. The gold standard test is
ambulatory 24-hour blood pressure monitoring. This gold standard I'm going
to make a separate video on but essentially it's a technique where one
wears a blood pressure monitor for 24 hours and the blood pressure is checked
on a regular basis about every 20 minutes during the day and 45 minutes
during the night. We typically get 50 or 60 readings of the blood pressure during
a 24 hour span and it gives us a good idea of blood pressure control
throughout the day. Home blood pressure readings correlate much better
with the ambulatory monitor than readings from your doctor's office. In general
readings in the doctor's office tend to be 5 or 10 points higher than home
readings. About 20 to 30 percent of patients will in fact have high blood
pressure in the doctor's office but when they're home all of their home readings
are actually completely normal. This phenomena is well known to patients it's
called white coat hypertention or isolated office
hypertension. Home blood pressure monitoring though can be very helpful in
the diagnosis of high blood pressure. It's also helpful in patients who have
established high blood pressure. Numerous trials have shown that home monitoring
can improve compliance with medications as well as blood pressure control. Home
blood pressure monitors should be checked initially when bought and then
at least annually for accuracy. There's a couple of ways you can do that one is to
take your monitor to a pharmacy or to your family doctor's office and check
the reading that you get with your machine up against their reading. They
should be within 5 to 10 points of each other. The best machines are the ones
that inflate themselves automatically as opposed to ones that
have to be self inflated. Studies have shown that the blood pressure may go up
even ten millimeters of mercury if you have a machine that you have to self
inflate. Make sure when you buy a machine you get an appropriate size cuff. If
someone is very obese a wrist cuff can be used instead. Before taking your blood
pressure a number of things should occur 30 minutes beforehand
do not eat, consume alcohol, consume caffeine, use tobacco, or exercise. All of
those things will increase your blood pressure. You need to find a comfortable
chair with a back. When you sit down to measure your blood pressure make sure
you're sitting upright with uncrossed legs and your feet are flat on the ground. The
arm that you're taking your blood pressure with should be well supported
on a table with the palm up just like I'm doing. The cuff. When you put it
on your arm should be right at the level of your heart. Sit quietly for five
minutes before you take your blood pressure. This is a picture of how you
should be positioned to take blood pressure.
Notice the posture this is important.
Attach the blood-pressure cuff to your arm one inch above your elbow crease
which is one inch from your funny bone your funny bone being here.
So the cuff should sit right here. When you put the cuff on your arm make sure
that this is where it overlaps within the acceptable range based on the
markings of the cuff. Every blood pressure cuff has markings on it where
the overlap point should be to ensure that you have the correct size cuff. Make
sure if there is a marking for the brachial artery which is here where I
have my finger that that marking is in that spot. Once you're ready turn the
power button on and then press start. During the reading make sure you sit
quietly without distractions and please do not talk. It is important that you
record the readings properly. There are two blood pressure numbers to record. One
is the systolic reading which is the higher of the two. This is the pressure
when the heart is contracting. The other blood pressure reading is called the
diastolic which is the pressure in the artery when the heart is not contracting.
There is a third number which you'll see on your machine which is the pulse. Write
down each of these three numbers. If your blood pressure seems high when you take
it compared to what it is usually it's always wise to take a second reading
three to five minutes later. If this is much lower and more in line with your
typical readings then I generally recommend that you take a third reading
and simply average the second and third readings and discard the first one. This
is typically how we take blood pressure in our medical blood pressure studies.
Patients actually take three readings we discard the first and average the second
two. An important point is to make sure that your machine is reading correctly.
Any time you're not sure about it you should always test the machine against
the reading that you might get when your doctor takes it
or at the pharmacy. As I mentioned previously the reading should be within
five to ten millimeters of mercury. You should know that home blood pressure
readings can vary during the day. Often they can vary 10 to 20 points. Some
patients will have a much higher variation. Remember that the blood
pressure typically is highest in the mornings.
Also note that anxiety, illness, or pain are reasons why blood pressure will
go up. It's a good idea at one point to actually check the blood pressure
reading in the opposite arm. It should be within 10 millimeters of the arm that
you usually take it on. Some patients can have an arterial blockage in one arm and
so that one arms blood pressure reading can be less than the other. So if I have
a blockage in my left arm the number I get here might be 20 or 30 points lower
than what I would get in my right arm. You always take the readings from the
arm with the higher pressure this will be more representative. Next is the blood
pressure log. When you record your readings this can be done on your blood
pressure monitor, or on an app in your phone, or a spreadsheet as I will show in
a minute, or simply the usual way most patients do it when they become in to
see me is simply a hand written sheet of paper. It is so helpful to have one
column for morning readings, one column for afternoon readings, and one column
for the evening readings. This allows us to see whether there's variation in the
blood pressure throughout the day and allows us to adjust the medications to
provide much smoother blood pressure control. There's no point in having good
blood pressure readings for half of the day and the other half of the day
they're elevated. Remember that early morning readings tend to be the highest
for most people because a number of hormones get released in the 4 a.m. to 7
a.m. time frame to get one's body ready for
day such as epinephrine and cortisol. This is the time where we see the most
heart attacks and the highest blood pressure readings. Smoothing out any peak
in the blood pressure reading at this time can be helpful. It is one of the
reasons why I always recommend that if patients are taking two or more blood
pressure pills that you take one pill at night to prevent the early morning rise
in blood pressure. It's always helpful when you're at home to take a number of
readings ideally twenty when one is trying to see
whether you have high blood pressure or not. Alternatively the ambulatory blood
pressure monitor can be done which again is our gold standard. It's also helpful
to take home readings when there's a change in blood pressure, medication, or
if the blood pressure has been found to be either too high or too low. Once the
blood pressure comes under better control less frequent readings are
appropriate. Another key point to know is that if patients have dizziness when
they stand up it can be secondary to a drop in blood pressure with standing. I do
have some of my patients document their blood pressure sitting and then again
standing. Typically we will take it two minutes after standing and five minutes
after standing. The blood pressure should not drop more than ten millimeters of
mercury with standing. A significant drop with standing would prompt us to adjust
your blood pressure medication. When looking at your readings it's important
to average the readings in each column morning, afternoon and evening as well as
to take an overall average. This is where a spreadsheet can be helpful so you do
not have to do the math. As I mentioned there are different ways to show the
data. Your blood pressure monitor may be able to give you a 7 day 14 day or
28 day average. It may transfer the data to an app on your cell phone or you may
manually enter the blood pressure in a cellphone app. You can use a spreadsheet
as I'm about to show or what most of my patients do is the old-school method
where you simply create a chart with a pencil and a piece of paper and bring it
in to the doctor. Here is an example of a spreadsheet. This contains a number of
readings over a one week period broken down into the time of day morning
afternoon and evening. You can see the average for the systolic, diastolic, and
pulse readings along the bottom. The pulse readings can be very important as
I will explain on the next slide.
Optimal readings. Home reading should be less than 130 over 80 on average. Ideally
it's nice to see readings in the 110 to 120 over 60 to 70 range. There's nothing
wrong with readings of 100 over 60 as long as patients are not symptomatic
with dizziness. Most premenopausal females will have readings of 85 or 90
systolic and 50 to 60 diastolic. Pulse rate should be above 55 beats per minute.
Some blood pressure medications will reduce the pulse and
sometimes the pulse gets too slow and in fact can lead to dizziness. When the
pulse gets too slow the systolic blood pressure often goes up because the heart
is simply running too slow. Medication adjustment in this case would be needed.
If there is a significant discrepancy between your readings at home and your
doctor's readings an ambulatory blood pressure monitor is worthwhile. That way
this would be able to decide which of the two readings are in fact correct. If
you have high blood pressure there are many options for treatment. The most
important ones and the ones that we always do first are lifestyle
modifications. Many patients have lifestyle problems that lead to their
blood pressure. There are many lifestyle things that
people can do, but in general a reduction in salt, an increase in exercise,
weight loss, reduction in alcohol consumption, as well as reducing
stimulant consumption like caffeine. Improving sleep and treatment of sleep
apnea will also help improve blood pressure. There are some secondary
medical problems which could cause high blood pressure including thyroid disease
and a number of others. These ultimately need to be ruled out by
your doctor. Ultimately if all of the above is not healthful patients are
started on blood pressure medications. If you are started on blood pressure
medications it's important that you know the name of the medicine, the dose, and
the dose frequency. These are things that need to be written down on a piece of
paper that goes in your wallet or purse. I hope you found the above healthful and
educational. I try very hard to make my medical videos the most comprehensive
based on best available medical evidence. This is Jag here. He has been wanting to
hop up on the table the whole video. You've been watching Medicine with Dr.
Moran. I'm doctor Keith Moran. Get healthy, what do you say Jag? Stay
healthy.