Friday, May 11, 2018

Checking Your Blood Pressure the RIGHT WAY

Well, I went from not having hypertension, to suddenly having hypertension recently. I did not physiologically change but the parameters of what is considered to be healthy for the long-haul of life changed. Hypertension is no joke though. It is death by a thousand cuts, not something that will  kill you in the short term (usually, anyway--although is a common cause of hemorrhagic strokes and delirium-related seizure/injury for instance), but it is THE LEADING CAUSE OF DEATH AND DISABILITY OVER TIME by leading to stroke, heart disease, kidney disease, other vascular disease. That is beyond the scope of what I want to talk about here, but this below is the change:           

New guidelines 
(Essentially, they lower/shift the ranges of concern to emphasize earlier treatment for better long-term health outcomes and get rid of prehypertension, which semantically minimized something that should be addressed)

Normal: Less than 120/80 mmHg
Elevated: 120-129 systolic AND less than 80 diastolic 
Stage 1: 130-139 systolic OR 80-89 diastolic 
Stage 2: 140+ systolic OR 90+ diastolic
Hypertensive crisis: 180+ systolic AND/OR 120+ diastolic

What I want to discuss here briefly, are common mistakes I come across in actually checking blood pressure which can add to erroneous treatment. I strongly believe patients should be their own advocates and at least in part responsible for keeping track of their own health, and checking blood pressure should be a part of that.

Blood pressure monitoring devices are easy to come by these days and most people can save a little for 1 to 2 months (drop a soda/coffee habit for a month, for example), to pay for a quite reasonably-accurate $60 device.

Common mistakes I see:

Not calibrating: Ask your doctor if you can bring your home blood pressure monitoring device by the office to calibrate against theirs. I recommend an independent visit for this, so you aren't "rushed" like you might be during a routine visit where they are trying to keep the doctor on schedule as well, bending you into their day, and you might feel less anxious since you aren't having to see a doctor that day.

Not accounting for "white-coat hypertension" by the nurse who checks blood pressure at the primary care doctor, which may make the blood pressure seem higher than it is.

Not checking throughout the day for a realistic average. Checking first thing in the morning, before lunch, and before bed, can help identify sources of provocation, provide a more realistic blood pressure average, and help guide timing and dose of potential blood pressure medications (for instance, what if you are always high just before bed, but normal in the morning?). Doing this (slightly tedious) assessment three times a day for a week or 2 can be quite helpful in guiding your primary care doctor in creating a custom treatment plan.

Cuff over clothing: This can add up to 50 mmHg to the reading. If you roll up your sleeve but the roll is tight, this can also alter the reading. So wear a loose long-sleeve & roll it up, or just where a loose short sleeved shirt if you can.

Not resting a bit. I see this happen at my local pharmacy; a person is walking by with a bag of groceries and then just drops down, pushes the button, and then frowns at the results. You are supposed to rest quietly for 3-5 minutes before blood pressure assessment. Checking blood pressure in the middle of traffic... or 30 seconds after you walked down a long hallway from the waiting room, got off a scale, and hopped up on an exam table is not the standard by which blood pressure should be measured.

Cuff size: If you use a cuff too big, it will make your blood pressure seem artificially lower. Conversely if you use a cuff too small, it will make your blood pressure seem artificially high. Use the right size.

Talking: Answering your nurses questions or talking in general because you can't handle "uncomfortable silence" can increase your blood pressure up to 10mmHg. Be still and quiet.

Poor body position: Crossing your legs can raise systolic. An unsupported back can raise your diastolic. A generally tense/uncomfortable position can raise both. You aren't supposed to check blood pressure perched up on an examination table or slumped over in your armchair at home.

Timing of smoking: Don't smoke. But if you must, or you vape/chew nicotine gum, don't do it 30 minutes before you check your blood pressure. Nicotine temporarily raises blood pressure.

Pee: If you have a feeling of a need to urinate, that can artificially raise your blood pressure, just like general anxiety or a specific stress in your day/life.