I’m going to practice these checkboxes to keep my BP lower, whether in the process of measurement or not. The full bladder / sympathetic nervous system activation really “feels” true. Probably important to urinate when nature calls for several good reasons - BP, UTI prevention, continence preservation, etc.
Grace - such a fun idea for a post! A little racy, a little gross, and very useful. After writing this I made sure to empty my bladder before driving home through heavy rain, which was stressful enough. Thanks for stopping by :)
I used to teach taking blood pressure to first year medical students and it taught me how much I didn't know. Thank you for this--as always! I bought a decent home cuff and retake it after sitting quietly, with my arm supported--vs running in to an exam room and holding out my arm.
Jan, this is really great. Thank you for teaching the first years back in the day. Of all my teachers in medical school, the two that stand out the most in my memory are a gross anatomy professor and the doctor who taught us physical diagnosis (a pulmonologist). Wizards and magicians! I wish I had time to teach again... maybe someday again when I am not hustling.
Supporting the arm is so important... the ACC article did not mention this specifically, but I added it under the one checkbox because elsewhere I read that taking the BP with arm tilted downwards can increase # by about 5 points, and arm held too high decrease # by 3-5 I think.
Here’s a CDC article and image that includes supporting the arm-- I always thought it was both position and muscle contraction that made the difference. https://www.cdc.gov/bloodpressure/measure.htm
And I think you’d be ( already are) a fantastic teacher.
Very interesting. I have always found it curious when I am told that it’s OK not to roll up my sleeve and the cuff is placed over my clothes. It seems that health care workers should be better educated on this matter. Fortunately, I have never had a high reading, and tend to actually run low.
Hi Patricia - I agree. I almost want to print this out and give it to our office staff. Hopefully they would not find it annoying and self righteous! I'll confess to you that I often check BPs with sleeves down, especially since the pandemic started and the cuff became a more potentially dangerous fomite. I'll commit to doing a better job, and wiping down the cuff in between uses.
I'm careful with feet on the floor and relaxing/supporting my arm, but I didn't know about many of these, or how wide the variation could be.
I've started to ask for a seated reading followed by a standing reading (the way I monitor at home), because I have orthostatic issues. I understand they're screening for hypertension, but I don't want to miss a data opportunity.
(The guides fail to recognize that low BP is a thing. One has to be tenacious to find info that isn't about extremes, like shock.)
Thank you for engaging pts to monitor at home! That trust and encouragement likely has myriad good results. Thanks.
Hi Dar :) Great points here, and measuring BP sitting vs standing to gauge orthostasis is so important. It's another vital sign sacrificed on the altar of getting through complex visits in short time frames.
You are absolutely correct that low BP is a thing, and is often caused by other medications we prescribe like prostate meds, diuretics, too many BP meds, cardiac meds, etc not to mention dehydration, arrhythmias...
Thanks for engaging at home; I really think this is more valuable than a one time number in the office... and other studies increasingly back this up. Strong work advocating for yourself and the "extra" vital sign.
Thanks, Ryan, for explaining why BPs can be so variable. A few years ago, when my PCP’s clinic got a fancy new BP monitor, I began getting alarmingly high readings. The cuff was (in my opinion) too big for my arm and the inflated cuff was painful. The nurse (that’s who used the fancy new monitor) would shrug when I complained about it. My PCP always did a recheck with a traditional BP monitor, and my BP would be normal. So I came to expect high readings from the fancy monitor and not freak out about them.
I see this a lot, too Liz, thanks for bringing it up. I personally have a reflexive "trust" of machines as impersonal arbiters of data, but they are only as good as they have been designed and tested to be. It sounds like the old fashioned human PCP was getting the right numbers, especially if things shot up with the new tech. A great reminder to rage against the machines as we are increasingly being replaced by them ;)
Great information! I have, as of late, noticed my primary care physician’s staff using a manual bp cuff vs the machine. I mentioned that to the med tech and was informed that my doctor herself made that change due to inaccurate readings. In my bedside nursing days, I’ve always preferred to recheck BPs manually.
I worked a short stint in a “BP check clinic” years ago and learned to make sure my patients always kept feet flat, stop talking, correct cuff size, take a few deep breaths and arm chest high.
As always, thanks for the good work and information!
Hi Sue, and happy New Year to you as well! Working in a BP check clinic honed your skills well I can see, and the several basics you mentioned are the really critical ones. I don't think most of us check off all these boxes every time, but glad you found this review useful, too.
"Cheers for 2024, and better BP readings for all!" Makes for a nerdy toast.
Definitely a good point, and this was not listed by the ACC article. I'm sure there is literature out there to support higher BP readings during AM visits, or maybe they are better because by the time people get to the office they are fresh off taking their AM meds... will check this!
I know that surgical outcomes worsen as the OR day grinds on unfortunately... unrelated to BP (I think?), more related to staff fatigue, but indicative that so many healthcare factors have circadian rhythms.
I had a doctor who would double check my BP after the assistant did. He also spent time talking with me before retaking the BP. What I found interesting is that he is the only doctor I had that would take my BP with my arm elevated to mid chest as you commented. Correct me if I'm wrong but wasn't normal BP 130/80?
Many of my patients are also surprised when I insist on holding their arms up to chest level (right atrium) as the standard way. I guess I learned that somewhere along the way and it stuck. And BP targets and definitions have definitely changed over the years, you are correct:
"High blood pressure is now defined as readings of 130 mm Hg and higher for the systolic blood pressure measurement, or readings of 80 and higher for the diastolic measurement. That is a change from the old definition of 140/90 and higher, reflecting complications that can occur at those lower numbers.
In the first update to comprehensive U.S. guidelines on blood pressure detection and treatment since 2003, the category of prehypertension is eliminated.
While about 14 percent more people will be diagnosed with high blood pressure and counseled about lifestyle changes, there will only be a small increase in those who will be prescribed medication.
By lowering the definition of high blood pressure, the guidelines recommend earlier intervention to prevent further increases in blood pressure and the complications of hypertension."
Great post! I have a couple of MA that I like to show this. Had a few experience with taking BP with sleeve on and arm not supported. Good thing I have a reliable monitor at home. When I first got my Omron wrist cuff, went to the Nurse's station and compared readings. It was spot on. It also has sensors to tell if you have the arm in right position. In addition to memory, I can upload through bluetooth to my app on the phone. Great way to track and let your PC know. Sample: OmDate Time Systolic (mmHg) Diastolic (mmHg) Pulse (bpm) Symptoms Consumed Notes
Sep 14 2023 02:09 pm 129 80 77 - - -
Sep 13 2023 10:01 am 150 90 73 - - Amp
Sep 12 2023 08:40 pm 121 69 65 - - -
Sep 12 2023 01:36 pm 116 55 71 - - -
You can notes like "family gathering" ;-)
I will have a new substack today or tomorrow and part will be the new CVD risk assessment. Stay tuned!
Omron does seem like a good reliable brand I agree from anecdotal cross checks in the office. You have some fancy data tracking going on there, much respect and approval from primary care docs! One outlier there (amp) outweighed by the rest it seems.
Omg this is so interesting and helpful!
I’m going to practice these checkboxes to keep my BP lower, whether in the process of measurement or not. The full bladder / sympathetic nervous system activation really “feels” true. Probably important to urinate when nature calls for several good reasons - BP, UTI prevention, continence preservation, etc.
There you go, an idea for a future post ✌️
Grace - such a fun idea for a post! A little racy, a little gross, and very useful. After writing this I made sure to empty my bladder before driving home through heavy rain, which was stressful enough. Thanks for stopping by :)
I used to teach taking blood pressure to first year medical students and it taught me how much I didn't know. Thank you for this--as always! I bought a decent home cuff and retake it after sitting quietly, with my arm supported--vs running in to an exam room and holding out my arm.
Jan, this is really great. Thank you for teaching the first years back in the day. Of all my teachers in medical school, the two that stand out the most in my memory are a gross anatomy professor and the doctor who taught us physical diagnosis (a pulmonologist). Wizards and magicians! I wish I had time to teach again... maybe someday again when I am not hustling.
Supporting the arm is so important... the ACC article did not mention this specifically, but I added it under the one checkbox because elsewhere I read that taking the BP with arm tilted downwards can increase # by about 5 points, and arm held too high decrease # by 3-5 I think.
You would be an excellent teacher!
Thanks Sue! My mother, a teacher, would be happy to hear that ;)
Here’s a CDC article and image that includes supporting the arm-- I always thought it was both position and muscle contraction that made the difference. https://www.cdc.gov/bloodpressure/measure.htm
And I think you’d be ( already are) a fantastic teacher.
Very interesting. I have always found it curious when I am told that it’s OK not to roll up my sleeve and the cuff is placed over my clothes. It seems that health care workers should be better educated on this matter. Fortunately, I have never had a high reading, and tend to actually run low.
Thanks for this article.
Hi Patricia - I agree. I almost want to print this out and give it to our office staff. Hopefully they would not find it annoying and self righteous! I'll confess to you that I often check BPs with sleeves down, especially since the pandemic started and the cuff became a more potentially dangerous fomite. I'll commit to doing a better job, and wiping down the cuff in between uses.
Cheers and thanks for stopping by :)
Thank you! This is great info.
I'm careful with feet on the floor and relaxing/supporting my arm, but I didn't know about many of these, or how wide the variation could be.
I've started to ask for a seated reading followed by a standing reading (the way I monitor at home), because I have orthostatic issues. I understand they're screening for hypertension, but I don't want to miss a data opportunity.
(The guides fail to recognize that low BP is a thing. One has to be tenacious to find info that isn't about extremes, like shock.)
Thank you for engaging pts to monitor at home! That trust and encouragement likely has myriad good results. Thanks.
Hi Dar :) Great points here, and measuring BP sitting vs standing to gauge orthostasis is so important. It's another vital sign sacrificed on the altar of getting through complex visits in short time frames.
You are absolutely correct that low BP is a thing, and is often caused by other medications we prescribe like prostate meds, diuretics, too many BP meds, cardiac meds, etc not to mention dehydration, arrhythmias...
Thanks for engaging at home; I really think this is more valuable than a one time number in the office... and other studies increasingly back this up. Strong work advocating for yourself and the "extra" vital sign.
Thanks, Ryan, for explaining why BPs can be so variable. A few years ago, when my PCP’s clinic got a fancy new BP monitor, I began getting alarmingly high readings. The cuff was (in my opinion) too big for my arm and the inflated cuff was painful. The nurse (that’s who used the fancy new monitor) would shrug when I complained about it. My PCP always did a recheck with a traditional BP monitor, and my BP would be normal. So I came to expect high readings from the fancy monitor and not freak out about them.
I see this a lot, too Liz, thanks for bringing it up. I personally have a reflexive "trust" of machines as impersonal arbiters of data, but they are only as good as they have been designed and tested to be. It sounds like the old fashioned human PCP was getting the right numbers, especially if things shot up with the new tech. A great reminder to rage against the machines as we are increasingly being replaced by them ;)
Thanks for the “rage” reminder!
Great information! I have, as of late, noticed my primary care physician’s staff using a manual bp cuff vs the machine. I mentioned that to the med tech and was informed that my doctor herself made that change due to inaccurate readings. In my bedside nursing days, I’ve always preferred to recheck BPs manually.
I worked a short stint in a “BP check clinic” years ago and learned to make sure my patients always kept feet flat, stop talking, correct cuff size, take a few deep breaths and arm chest high.
As always, thanks for the good work and information!
Happy New Year!
Hi Sue, and happy New Year to you as well! Working in a BP check clinic honed your skills well I can see, and the several basics you mentioned are the really critical ones. I don't think most of us check off all these boxes every time, but glad you found this review useful, too.
"Cheers for 2024, and better BP readings for all!" Makes for a nerdy toast.
Such great info Ryan. I have also heard that time of day affects BP, with readings being higher in the AM vs PM. Is this a factor?
Definitely a good point, and this was not listed by the ACC article. I'm sure there is literature out there to support higher BP readings during AM visits, or maybe they are better because by the time people get to the office they are fresh off taking their AM meds... will check this!
I know that surgical outcomes worsen as the OR day grinds on unfortunately... unrelated to BP (I think?), more related to staff fatigue, but indicative that so many healthcare factors have circadian rhythms.
I had a doctor who would double check my BP after the assistant did. He also spent time talking with me before retaking the BP. What I found interesting is that he is the only doctor I had that would take my BP with my arm elevated to mid chest as you commented. Correct me if I'm wrong but wasn't normal BP 130/80?
Many of my patients are also surprised when I insist on holding their arms up to chest level (right atrium) as the standard way. I guess I learned that somewhere along the way and it stuck. And BP targets and definitions have definitely changed over the years, you are correct:
"High blood pressure is now defined as readings of 130 mm Hg and higher for the systolic blood pressure measurement, or readings of 80 and higher for the diastolic measurement. That is a change from the old definition of 140/90 and higher, reflecting complications that can occur at those lower numbers.
In the first update to comprehensive U.S. guidelines on blood pressure detection and treatment since 2003, the category of prehypertension is eliminated.
While about 14 percent more people will be diagnosed with high blood pressure and counseled about lifestyle changes, there will only be a small increase in those who will be prescribed medication.
By lowering the definition of high blood pressure, the guidelines recommend earlier intervention to prevent further increases in blood pressure and the complications of hypertension."
https://newsroom.heart.org/news/high-blood-pressure-redefined-for-first-time-in-14-years-130-is-the-new-high
Great post! I have a couple of MA that I like to show this. Had a few experience with taking BP with sleeve on and arm not supported. Good thing I have a reliable monitor at home. When I first got my Omron wrist cuff, went to the Nurse's station and compared readings. It was spot on. It also has sensors to tell if you have the arm in right position. In addition to memory, I can upload through bluetooth to my app on the phone. Great way to track and let your PC know. Sample: OmDate Time Systolic (mmHg) Diastolic (mmHg) Pulse (bpm) Symptoms Consumed Notes
Sep 14 2023 02:09 pm 129 80 77 - - -
Sep 13 2023 10:01 am 150 90 73 - - Amp
Sep 12 2023 08:40 pm 121 69 65 - - -
Sep 12 2023 01:36 pm 116 55 71 - - -
You can notes like "family gathering" ;-)
I will have a new substack today or tomorrow and part will be the new CVD risk assessment. Stay tuned!
Ok I will look forward to reading!
Omron does seem like a good reliable brand I agree from anecdotal cross checks in the office. You have some fancy data tracking going on there, much respect and approval from primary care docs! One outlier there (amp) outweighed by the rest it seems.
Short for amlodipine, though one might think amphetamine. My doctor asked about that one. :-)