Because uncontrolled high blood pressure (hypertension) is a well documented risk factor for stroke, heart attack and heart failure I discuss it a lot on this site and with my patients.
What To Monitor and How To Measure
I primarily makes decisions on blood pressure treatment these days based on patient self-monitoring. I discuss this in detail in a post entitled (Why I Encourage Self-Monitoring Of Blood Pressure In My Patients With High Blood Pressure.)
I have found self-monitoring of patient’s BP to substantially enhance patient engagement in the process. Self-monitoring patients are more empowered to understand the lifestyle factors which influence their BP and make positive changes.
Blood pressures are amazingly dynamic and as patient’s gain understanding of what influences their BP they are going to be able to take control of it.
If high readings are obtained in the office I instruct patients to use an automatic BP cuff at home and make a measurement when they first get up and again 12 hours later. After two weeks they report the values to me (preferably through the electronic patient portal or by Kardia Pro.)
I discuss in detail the recommended technique for BP measurementin my 2018 post entitled “Optimal Home Blood Pressure Monitoring: Must The Legs Be Uncrossed and The Feet Flat?”
The 2018 ACC/AHA guidelines on hypertension specify in detail how to optimally make home BP measurements as follows:
• Remain still:
• Avoid smoking, caffeinated beverages, or exercise within 30 min before BP measurements.
• Ensure ≥5 min of quiet rest before BP measurements.
• Sit with back straight and supported (on a straight-backed dining chair, for example, rather than a sofa).
• Sit with feet flat on the floor and legs uncrossed.
• Keep arm supported on a flat surface (such as a table), with the upper arm at heart level.
• Bottom of the cuff should be placed directly above the antecubital fossa (bend of the elbow).
• Take at least 2 readings 1 min apart in morning before taking medications and in evening before supper. Optimally, measure and record BP daily. Ideally, obtain weekly BP readings beginning 2 weeks after a change in the treatment regimen and during the week before a clinic visit.
• Record all readings accurately:
• Monitors with built-in memory should be brought to all clinic appointments.
And, spoiler alert, it does matter if you cross or uncross your legs.
What Should The BP Goal Be?
For many patients with hypertension, SPRINT trial data published in 2015 suggest that a systolic blood pressure target of <120 mm Hg (intensive therapy) is preferable to a target of <140 mm Hg.
The SPRINT trial found that cardiovascular events like stroke and heart attack and death from these cardiovascular causes was lower by 25% in those patients treated intensively. Overall death was lower by 27%
Read my post on SPRINT here and have a discussion with your physician about whether these more stringent BP goals are right for you. Keep in mind that the technique used in SPRINT likely gives us lower BP than home self-monitoring.
I discuss recent European and American BP guidelines which came to different BP goals after SPRINT in a post entitled “Becoming Enlightened About More Stringent Blood Pressure Goals: Sapere Aude”.
“As a 64 year old who has emerged from his nonage with hypertension, I have carefully examined the latest American hypertension guidelines especially in light of the SPRINT study and elected to add a third anti-hypertensive agent to get my average BP below 130/80. It’s worked for me with minimal side effects but I carefully monitor my BP.
If I notice any symptoms (light-headed, fatigued) suggesting hypotension associated with systolic BP <120 mm Hg I tweak my medical regimen to allow a higher BP.
Like all of my patients I would prefer to be on less medications, not more but when it comes to enlightenment about the effects of hypertension, it is now clear that lower is better for most of us in our sixties down to at least 130/80*
Home Blood Pressure Monitoring Devices
You can get a good validated automatic BP monitor at Walgreens or CVS for around 35-40$.
But if you want to spend a little more you can get BP devices which have added features such as style, portability, BlueTooth communication with smartphone apps and perhaps most importantly connection through the cloud with your physician.
My favorite BP cuff used to be the QardioArm (QardioArm: Stylish, Accurate and Portable. Is It the iPhone of Home Blood Pressure Monitors?)
I still love the QardioArm but lately I’ve been recommending the Omron Evolv for my patients who need monitoring as their recordings can be connected with me through Omron/Alivecor’s smartphone app:
The Omron Evolv One-Piece Blood Pressure Monitor: Accurate, Quick And Connected
Finally, be aware that are scam methods of BP measurement are being promoted to the public.
I wrote about one such smartphone app called “Instant blood pressure”
Sphygmomanometrically Yours,
-ACP
