Home blood pressure monitoring |
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Here at the Brook Health Centre we’re keen to involve our patients as much as possible in decisions regarding their own health. High blood pressure (hypertension) is a common problem, and there is overwhelming evidence to support the benefit of reducing high blood pressure in reducing your risk of stroke, heart disease and death.
Traditionally, blood pressure measurement has been done at the doctors’ office, but recently electronic blood pressure (BP) recording machines have become widely available in the shops. We’re delighted that you can now measure your blood pressure at home should you wish, as this has the following benefits;
· A greater number of recordings gives a more accurate average ‘true’ blood pressure, to determine if treatment is needed or needs adjusting. · The patient feels more empowered and informed about their healthcare. · Everyone’s blood pressure is bit higher in the doctor’s office than at home, home recordings remove the element of ‘white coat hypertension’ that affects some more than others.
Are there any disadvantages? There may be -
· The evidence doctors use to determine the thresholds for defining high blood pressure is based on office measurements—researchers and experts haven’t agreed exactly what to make of home recordings yet. · There is a risk of over-medicalising the issue and causing some people too much anxiety about their blood pressure. Everyone’s blood pressure varies during the day.
Some people don’t want or are unable to perform home blood pressure readings—that’s fine, this is purely optional.
You will need to buy a machine. Some machines are more accurate than others, and we recommend that you buy one from the list of validated machines by the British Hypertension Society. You will see that only machines with a cuff that goes around the upper arm are advised, and you will need a large cuff if you have a large arm.
What to do
1. Obtain a validated machine as advised above. 2. You can record your readings on either of the charts below. The Excel spreadsheet will calculate your average blood pressure for you, or you can print out the Word document and write in the recordings by hand. 3. Please bring a copy of one or other record to your consultation.
Frequently Asked Questions
What should my blood pressure be?
This is not as straightforward as it seems—blood pressure varies naturally during the day, so one should not be alarmed by an occasional raised reading during a time of stress such as a bad day work, nor falsely reassured by a normal reading on a relaxing Sunday afternoon! That’s why an average of many readings can be useful. The National Institute for Health and Clinical Excellence (NICE) defines raised blood pressure as either systolic (top number) or diastolic (bottom number), or both, persistently raised above 140/90mmHg. They recommend offering drug treatment to those with blood pressure over 160/100mmHg (even if just the systolic is raised) who are generally healthy. For those with who are at higher risk of heart attack or stroke (such as older patients, those with raised cholesterol, smokers etc), or who are known to have heart, brain or kidney blood vessel damage, the high blood pressure requiring treatment is over 140/90mmHg . For those with diabetes, the threshold is lower again, at 140/80 or 130/80 depending on the stage of the diabetes.
The NICE recommendations are based on blood pressure recordings made in the doctors’ office. We simply aren’t sure yet what threshold to use for home readings, which are naturally a bit lower. At this time, NICE don’t recommend taking home readings because there isn’t enough evidence for them to draw a conclusion on, but there is an emerging consensus in the US and Europe to use a threshold of 135/85mmHg for diagnosis of uncomplicated hypertension based on home readings, with a treatment target of <135/85 mmHg.
Of course all of these guidelines need to be put in the context of the individual patient. People vary in their attitude to risk, teir attitude to taking medication and in their tolerance of side effects of medication. We always try to involve the patient in decisions about treatment.
How do I take my blood pressure?
Please follow the instructions with the machine. Note the instructions regarding cuff size (you may need to buy a large cuff), positioning (seated, legs uncrossed, back and arm supported) and getting used to the machine with several measurements before recording them.
I have mildly raised blood pressure, do I have to take medication?
This depends on the level of blood pressure and other risk factors for heart disease and stroke such as whether you smoke, have raise cholesterol, diabetes or a worrying family history. We will discuss these during your consultation before we agree on the best course of action for you.
Lifestyle measures that have been shown to reduce blood pressure include;
· Regular exercise · Not drinking alcohol excessively · Reduction in caffeine intake · Reduction in salt intake · Stopping smoking · Relaxation
What do I do now?
The information on this website is for education only. Please make an appointment for a face-to-face or telephone consultation with one of the doctors or nurses to make a formal assessment.
If you start medication for blood pressure, or after an increase in medication, we suggest repeating the self-monitoring protocol after 4-6 weeks. Once your blood pressure is at target, we suggest repeating the self-monitoring protocol every 12 months, as blood pressure does creep up with age.
Where can I find more information?
The Blood Pressure Association has further information about home monitoring. The website www.patient.co.uk is a trusted source of information for patients in general. They do a good information sheet on high blood pressure and the different treatments for it.
References Blood Pressure self-monitoring: questions and answers from a national conference; BMJ 2008; 337: p38-42; 3rd January, 2009 NICE Clinical Guideline 34, Hypertension |
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The Brook Health Centre Swinneyford Road Towcester NN12 6HD Telephone: 01327 323900 |
