High blood pressure is a major risk factor for all the common cardiovascular diseases including heart attack, stroke and peripheral vascular disease. It also contributes to a loss of kidney function, especially in those who already have damaged kidneys and are excreting excessive protein in the urine. Therefore, a well-controlled blood pressure is a major goal of therapy for many patients.
About I in 3 subjects have an artificially high level of blood pressure when it is taken by a doctor in the office. This is called "white coat" or "office" hypertension. An elevated "white coat" blood pressure can lead to false assumptions that more aggressive treatment for blood pressure is required. Moreover, blood pressure varies from minute to minute during the day and from day to day, often without any obvious cause. Finally, coming to the appointment in the clinic can be a stressful event and lead to an artifactual rise in blood pressure. For these reasons, blood pressure records in the clinic are inadequate to judge the true level of a person's blood pressure. One good solution to this is for the patient to purchase an automated home blood pressure recording device and to record their own blood pressure in their own home on a regular basis. The ideal procedure for this is described below.
The best method for recording home blood pressure is with an instrument that automatically inflates the cuff around your arm and records the result on a digital readout of blood pressure and heart rate. One recommended manufacturer is Omron. These automated devices cost $50 to $80.
The most accurate record of blood pressure is with an upper arm cuff. For patients with a large arm, whether due to muscle or fat, it is important to buy a large cuff, since small cuffs lead to artifactually high levels of blood pressure. Measurements of blood pressure at the wrist and especially the finger are generally less accurate and are not recommended.
Blood pressure should be recorded when you have been sitting quietly for 2 minutes. Place the cuff around your arm and put your arm out on a table next to the chair where you are sitting. This should be a calm time of the day. For example, in the early morning when you get up or the evening as you get ready to go to bed. After waiting 2 minutes, press the button and record the result.
For some patients, a single daily record of blood pressure is all that is required. Initially, it is helpful to record the blood pressure every morning and every evening to determine if there are significant differences between the two. If the blood pressure often varies by more than 10% between morning and evening, then it is advisable to record the blood pressure at both times.
If you have feelings of faintness or dizziness while standing or feel excessively tired and weak, it is possible that your blood pressure falls excessively on standing or during exercise. In this case, please record your blood pressure after 2 minutes of sitting and again, after 2 minutes of quiet standing or after exercise. Again, the arm in which your blood pressure is being measured should be supported on a piece of furniture at about the level of your heart.
Once you have recorded the blood pressure and heart rate, write these down on a piece of paper with the date and bring them to your clinic visit. Note the medications that you are taking and, on any particular date, any changes in medications or symptoms. It is helpful to have a duplicate copy of the record that you bring to the clinic so that we may keep it in the chart and you may take your own record home with you.
The ideal level of blood pressure varies according to circumstance. However, for patients with established high blood pressure, especially with their other risks to the cardiovascular system such as high cholesterol levels, overweight/under activity, smoking, diabetes, or prior cardiovascular or kidney disease, the target level of blood pressure is a systolic blood pressure of 125 to 130 mmHg. Currently, we emphasize the systolic (upper) level of blood pressure and normally pay less attention
to the diastolic (lower) level of blood pressure.
If you have questions concerning this information, please discuss it with your physician at the next clinic visit.
Normally, blood pressure will change from day to day. Therefore, the most important blood pressure is the average value from week to week. Spikes and dips from day to day are a part of normal life. They usually should not lead to anxiety unless they are very severe and are accompanied by symptoms. If so, please call your doctor.