Tag: blood pressure measurement

Does Getting Hypertension Earlier in Life Carry More Health Risk?

 

Has your doctor told you that you have high blood pressure? Take it seriously! Hypertension is a leading cause of cardiovascular disease. Uncontrolled high blood pressure can also damage blood vessels and many organs in the body, including the heart, kidneys, brain, and retinas in the back of the eyes. In 2018, around 500,000 deaths in the U.S.A. were directly or indirectly due to hypertension.

Here’s the surprising part; you can have high blood pressure and not know you have it. That’s because hypertension often causes no symptoms. The guidelines for diagnosing high blood pressure have gotten stricter after research showed that following more rigorous guidelines can lower the rate of death. These days, doctors diagnose hypertension if you consistently have a blood pressure of 130 mm Hg or greater for the systolic, or top number, and 80 mm Hg or greater, for the diastolic, or bottom number.

Why the change in guidelines? Research now suggests that the risk of developing cardiovascular disease in those who have hypertension goes up even before a person meets the threshold for hypertension of 130/80 or greater. In fact, the risk of cardiovascular disease starts to rise at a systolic blood pressure of as low as 115 mg Hg, a blood pressure level that’s considered normal. So, lower blood pressure is better up to a point.

How When You Get High Blood Pressure Affects the Risk of Complications

 

Untreated high blood pressure is harmful at any age, but does it matter when you get it? Hypertension becomes more common with age, but high blood pressure is also becoming more common in younger age groups due to growing rates of obesity.

Does developing high blood pressure earlier in life, as a young adult, increase the risk of health problems and death more than getting it later?

According to a large study carried out by Chinese researchers, developing hypertension earlier in life carries a greater risk of cardiovascular disease and death than receiving the diagnosis later in life. The study showed people who developed high blood pressure before the age of 45 had double the risk of developing cardiovascular disease compared to those diagnosed after this age. The study also found that for each decade that passed before subjects developed high blood pressure, the lower their risk of cardiovascular disease was.


You might think you can’t control when you get high blood pressure. But even if you have a strong family history of hypertension, research shows that lifestyle changes can delay its onset. The obvious factors that slow the onset of hypertension and help with blood pressure control are aerobic exercise and eating a healthy, unprocessed diet. However, a 2015 study also found that staying a healthy body weight and getting adequate sleep helps slow the onset of hypertension in people with borderline high blood pressure readings. Therefore, it’s important to adopt a heart-healthy lifestyle as early as possible, especially if you’re at high risk of hypertension due to family history.

The Bottom Line

Developing hypertension earlier, before age 45, increases the likelihood of developing cardiovascular disease more than getting it later in life. However, the most important factor is to diagnose and treat it as soon as possible to reduce damage to blood vessels, the heart, and other organs. Also, this study suggests that it’s important to teach healthy lifestyle habits that reduce the risk of hypertension.

Regardless of when you develop hypertension, keep close tabs on your pressures and make the lifestyle changes necessary to keep it under control. If your physician prescribes blood pressure medications, take them too. Even if you need medications, lifestyle factors are important for preventing the complications of high blood pressure such as cardiovascular disease and stroke.

Consider checking your blood pressure at home and keep an accurate record. It’s hard to maintain good control when you only get a reading a few times per year when you see your doctor. Check it several times per day to see how it varies. When you have this information, your doctor can better adjust your medications to keep your pressure under control throughout the day.

Low Blood Pressure Diet Plan: DASH Diet Explain

The Right Fit: 7 Factors That Affects Accurate Blood Pressure Measurement

 

References:

MayoClinic.org. 2018 Jul 1;107:108-115. doi: 10.1016/j.exger.2018.02.016. Epub 2018 Feb 19.

Int J Med Sci. 2015; 12(7): 605-612.Published online 2015 Jul 16. doi: 10.7150/ijms.12446.

CDC.gov. “Facts About Hypertension”

Medscape.com. “Excess Risks of Hypertension Greatest With Younger Age at Onset”

 

 

The Right Fit: 7 Factors That Affects Accurate Blood Pressure Measurement

Young man measuring blood pressure at home

Factors that impact the accuracy of blood pressure readings

The only way to know if you have high blood pressure (BP)  is to have your blood pressure checked. Even if you have your own blood pressure monitor and your BP readings are high,  your healthcare provider will be the one to confirm that you are hypertensive.  They make this diagnosis based on your BP measurement on more than one visit.

However, if you end up in the Emergency Room with an extremely high blood pressure, you most likely will be told that you had high blood that you were not aware of.

Unfortunately, some individuals find about their high blood pressure during an emergency situation such as a stroke.

Uncontrolled high BP problems can lead to serious health complications such as heart attack, kidney disease, stroke, or even death and disability. If you’ve experienced (or been diagnosed with) BP spikes or drops, it should be beneficial to have your BP regularly monitored. Lifestyle changes are also essential to manage blood pressure disorders.

What do the figures in a blood pressure reading mean?

Your BP is typically shown as two numbers displayed one over the other. The one on top is your systolic blood pressure or SBP, which is the measurement of the pressure in the blood vessels (the arteries) when the heart muscle contracts.

The bottom figure is the diastolic blood pressure which is a measure of the pressure in the blood vessels (arteries) when the heart muscle relaxes, refilling with blood.

When considered separately, a higher SBP and DBP are linked with an increased risk for heart-related medical problems.

If your BP result shows 120 for systolic BP and 80 for diastolic BP, it would be read as “120 over 80” or written as “120/80 mm Hg.”

Evidence has shown that the precise measurement of BP is crucial to ascertain the risk or guide management for high blood pressure and related heart issues. In support of this obtaining the correct measurement, the American Heart Association (AHA) has formulated recommendations for accurate BP measurements.

If you are checking your own  blood pressure, it is essential to know the common factors that cause your reading to be not so accurate.  An inaccurate reading can lead to an inaccurate treatment.

  1. The location of measurement

The standard location for BP measurement is the upper arm. A healthcare provider or someone trained to take your reading at home can use a stethoscope and place it at the elbow crease. This is the location of a major blood vessel of the upper arm, called the brachial artery.

In general, the systolic BP (blood pressure when the heart beats) increases when a reading is taken from blood vessels that are farther from the center of the body. Examples are BP readings taken using the wrist or fingers.

On the other hand, diastolic BP generally decreases when taken from the wrist or finger, in comparison with an upper arm reading.

Accurate measurements at the wrist require that the wrist be kept at the level of the heart – this avoids the effects of hydrostatic pressure (pressure of fluids inside the body).

Finger monitors may have lost their popularity due to inconsistent and inaccurate BP readings.

Regardless of where you take your blood pressure, make notes and also share the location of the cuff during measurement with your healthcare provider.

  1. Body position

A BP reading taken while sitting, lying, and standing will yield different results.

Generally, taking a BP measurement while an individual is in a sitting position is preferred.

Regardless of whether the BP reading is taken in a sitting or lying position, the blood pressure cuff should be at the level of the patient’s heart

When the BP is taken while lying down (with the face upward), the arm should be supported with a pillow. If not, the BP reading may show higher results than when a reading is taken in an upright position.

The back should be supported during BP taking. If the person is made to sit in an examination table with no back support, the SBP may be increased by 5-15, and the DBP elevated by roughly 6 mm Hg according to studies.

It is not advised to be in a cross-legged position as well. Crossing the legs during BP determination elevates the SBP by approximately 5-8 mm Hg and the DBP by 3-5mm Hg.

  1. Arm position

Changes in the position of the arms while taking a reading can significantly cause differences in results. For instance, when the upper arm is hanging down while in a sitting position (i.e., the upper arm is below the heart level) when measuring BP, the readings will be falsely high.

Consequently, if the arm is placed above the heart level, the reading will be too low.

In general, research evidence shows that a 2 mm Hg difference is seen with every inch deviation that the arm is placed below or above the heart level.

  1. Cuff size

Another typical error during BP taking is “miscuffing.” This happens when the size of the cuff (the inflatable part of a BP equipment that’s typically made of rubber) is too large or small relative to an individual’s arm circumference.

According to the Hypertension Clinical Practice Guidelines, using a BP cuff that is too large results in a falsely low BP. On the other hand, using a cuff that’s too small results in a falsely high BP reading.

The ideal cuff should have a length that is 80%, and a width that is at least 40% of the arm circumference of the user or patient. Hence, the length-to-width ratio should be at 2:1.

According to the AHA, the recommended cuff size when taking BP measurements are as follows:

  • Small adult cuff size (12×22 cm)- for individuals with an arm circumference of 22-26 cm
  • Adult cuff size (16×30 cm)- for individuals with an arm circumference of 27-34 cm
  • Large adult cuff size (16×36 cm)- for individuals with an arm circumference of 35-44 cm
  • Adult thigh cuff size (16×42 cm)- for individuals with an arm circumference of 45-52 cm
  1. Patient/user and related factors

Recent food consumption- after taking a meal, your body directs extra blood to the stomach and small intestines. Blood vessels distant from your digestive tract can narrow, making your heart beat faster and harder. This can result in postprandial hypotension(low blood pressure after meals). It is best to take a BP reading in the morning before eating. If you must eat first, wait for about 30 minutes before taking a measurement.

Exercise or movement during BP measurement– take your blood pressure before an activity, or you might get a high result. Also, refrain from moving about during BP measurement to obtain accurate results.

Temperature– if you are cold, you might get a falsely higher reading than expected. Low temperatures cause the blood vessels to narrow, which elevates BP because more pressure is needed to force blood through narrowed blood vessels.

 

Full bladder– A full bladder will give you a high reading. Empty your bladder before taking a measurement.

 

Tobacco, alcohol, and caffeine– It is best not to consume these before taking a reading. But if you have taken these, wait for at least 30 minutes before having your BP taken.

 

Clothing– Don’t put the cuff over clothing. Place it over bare skin. It will significantly affect your BP if roll-up your sleeve to the point that it gets tight on your upper arm. Take your arm out of the sleeve if possible, making sure it does not get tight; or take off your shirt.

 

Stress- Avoid stressful thoughts, and be in a comfortable position for at least 5 minutes before taking a measurement. Stress can alter your blood pressure.

  1. Device-related factors

Use of a non-calibrated device- if your equipment has not been correctly calibrated, it may not give you accurate results. Ensure a certificate is attached to your device, or have it calibrated with your physician.

Use of a non-validated device- similarly, if the accuracy of the equipment has not been validated, you may become over or under-diagnosed with a condition.

  1. Procedure-related factors

The user or patient talks during the procedure- 25-40% of individuals who initiated speech or talked during the measurement of BP lead to elevated readings according to several studies.

The use of inaccurate measurement techniques such as miscuffing

Best Practice For Accurate BP Measurement

  1. The patient or individual should be relaxed, sitting on a chair with the feet kept flat on the floor and the back supported. He or she should be seated for 3-5 minutes without talking or moving about before measuring BP.

 

  1. The individual should avoid smoking, exercise, or caffeine intake for at least 30 minutes before taking a BP reading.

 

  1. Voiding or emptying the bladder should be done before BP taking.

 

  1. Neither the patient nor the one taking the measurement should talk during the rest period, and especially while measuring the BP.

 

  1. Clothing that is covering the upper arm where the cuff is placed should be removed.

 

  1. It is recommended to use an upper arm BP device that has been validated and also calibrated periodically.

 

  1. The patient or user’s arm should be supported (e.g., resting on a table). The individual should not be holding his/her arm since isometric exercises (the contraction of a muscle without visible movement) can affect BP results.

 

  1. You need to position the middle of the cuff (typically marked on the BP cuff by the manufacturer) over the artery that pulsates on the patient’s bare upper arm. During measurement, the cuff should be at the level of the heart (the midpoint of the sternum).

 

  1. The correct cuff size should be used, such that it encircles 75 to 100% of the upper arm. Moreover, the cuff should be pulled taut, with proper tightness for both the top and bottom edges of the cuff, encircling the individual’s upper arm.

 

10.Take your BP in both arms, and record the arm that gives the higher result for subsequent BP readings.

 

  1. If you need to repeat measurements, give at least 1-2 minute intervals in between measurements.

 

  1. For BP readings using a stethoscope, the cuff should be inflated 20-30 mm Hg above the SBP, which has been estimated through the palpation method.

 

  1. The trained person taking your BP should deflate the cuff (release its pressure) slowly at about 2 mm Hg/secondwhile listening to the tapping–called the Korotkoff sounds.
  2. Commonly, the SBP and DBP are recorded at the nearest even number.

 

  1. If you take medications to manage your BP, note the time that the most recent medication was taken before the measurement.

 

  1. For home-use devices, upper arm cuff models, which work via oscillometric means, and have passed clinical validations are preferred.
  2. Also, it is advised for home users to use a device that automatically stores all readings, or can send readings electronically to the healthcare provider.

Final Note

Regular monitoring of your BP can assist the doctor in determining issues and  risks for other health problems. Coupled with lifestyle changes, the right diet, exercise, and regular consultation, you will be able to achieve optimal health and wellness and avoid medical conditions that are the result of high blood pressure.

 

References

Muntner et al. (2019). Measurement of Blood Pressure in Humans: A Scientific Statement from the​​American Heart Association. Retrieved fromhttps://www.ahajournals.org/doi/full/10.1161/HYP.0000000000000087

Pickering et al. (2005). Recommendations for blood pressure measurement in humans and experimental​​ animals: part 1: blood pressure measurement in humans: a statement for professionals from​​ the Subcommittee of Professional and Public Education of the American Heart Association​​ Council on High Blood Pressure Research. Retrieved from  https://www.ncbi.nlm.nih.gov/pubmed/15699287

 

 

 

 

When Should I Check My Blood Pressure at Home?

Way too many billions of people worldwide suffer from high blood pressure, also known as hypertension (HTN) and they don’t know it. Some never check their blood pressure while others don’t check it enough. They only have it checked when they go to the doctor’s office.

Furthermore, 45% of individuals with known high blood pressure do not have it within an acceptable range even though they go to the doctor. They are taking prescription  blood pressure medication that is failing to control their blood pressure. This might be you.

Elevated or not, you should get into the habit of checking your blood pressure especially if you are overweight, diabetic, drink alcohol, eat a high sodium diet, inactive, smoke, snore, abuse drugs or if you have a family history of high blood pressure or have kidney disease.

A question frequently asked by individual that are ready to take steps to lower their blood pressure is when should I take my blood pressure at home? And its good question. Plan to check your blood pressure when you wake up and before bedtime. Also plan to take it if you had a stressful day or feel symptoms of high or low blood pressure such as head ache or dizziness.

Facts about High Blood Pressure

  •  75 million people in the US have high blood pressure
  • 81% are unaware that they have it
  •  75% are treated and only 51% is adequately controlled
  • Occurs more often in blacks at a rate of 41%
  • Morbidity and mortality are greater in blacks
  • 2/3 of people over 65 have high blood pressure
  • High blood pressure increases with age

Statistics show that the most common reason why we visit the doctor is for blood pressure management. Yet still our blood pressure is poorly managed and out of control leaving us at risk for complications.

I Got 99 Problems and Getting a Doctor’s Appointment is One

When you first found out that you were hypertensive with a BP of 150/95, you refused to take the prescription. If being more active can help, then you are on it like white on rice.  However, 6 months later your blood pressure did not budge, so you decided to take the blood pressure pill prescribed by your doctor, continue walking and ditched the  french fries and hamburgers.

Fast forward now.  You feel the same. Well you did not have any symptoms of high blood pressure to begin with. So how do you know if any of this is working?  According to the chart in the doctor’s office, by now you should see a decrease in your systolic blood pressure by approximately 15- 20 points. But you have not followed up with your doctor. Now what?

There is no denying that we sometimes have too much on our plate like career and family, but sometimes it also very difficult to get a doctor’s appointment. After waiting two months for your visit, you had to wait 2 more hours to be seen by the doctors.

I appreciate and respect doctors and their expertise, but they are also a part of the problem. Have you ever tried to call your doctor after hours or on the weekend? What kind of help do you get? None!!

Doctors play a role in this problem too because once the office closes for the day, holidays and weekends, they are impossible to reach and sometimes they  take days to return a phone call or call in a prescription to the pharmacy. Forget about the physician on call. They never want to make changes to your medication because they don’t know who you are. You are told to wait for the office to reopen and go the emergency room in the case of an emergency.

Self Management of Blood Pressure

Did you know that studies have shown that if you check your blood pressure on a regular basis, you will have better control over it? However, you cannot rely only on your visit to the doctor to have your blood pressure check. Fortunately, you have options including checking it yourself. But don’t be misled. You will still need support and guidance from your physician.

Hopefully, you have a physician that understands the role you will now play to help control your own high blood pressure. He/She will guide you on how to take, track and report your blood pressure readings. You might even receive instructions on how to adjust your medication base on the readings.

The only way to know if your lifestyle changes and blood pressure medication is working is to take your blood pressure regularly. Depending on where you live, you can also have your blood pressure taken at the pharmacy. Some churches and community centers offer blood pressure screening. Look for one in your area.

If your blood pressure is elevated only when checked in the doctor’s office, then you might have a condition called white coat hypertension. Being able to check your blood pressure outside of the doctor office will help the doctor decide if you have true hypertension. If it is still then your are most  like hypertensive.

However, the reverse can also be true, your blood pressure can be normal at the doctor’s office but high at home. Therefore, having the right tools and resources to check your blood pressure regularly is crucial for you over all health and well-being.

Tricks of the Trade from a Nurse

Experts recommend that you check your blood pressure two times per day. Take your blood pressure 2-3 times, one minute a part as follows:

  • Relax for 5 mins before checking
  • Sit in a chair with your back  supported
  •  Uncross legs
  •  Feet flat on the ground or supported by a foot stool
  • Relax Arm at the level of the heart on a hard surface
  •  No talking, text, watching TV or activity
  •  No caffeine, exercise, or smoking 30mins before checking.
  •  Empty bladder
  • Take your blood pressure at the same time everyday

BP Devices

  •  Automated (recommended]
  • Manual

Select the right site

  • Upper arm (recommended)
  • Wrist
  • Thigh
  • Lower Leg

Select the Right Arm Circumference Cuff Size

  • 22-26cm Small Adult
  • 27-34cm Adult
  • 35—44cm Large Adult
  • 45-52cm Adult Thigh

Select a device that is Validated and Certified by one of the following;

  • Association for the Advancement of Medical Instruments
  • British Hypertension Society
  • European Society of Hypertension

Somebody Please Call 911 or Your Doctor or Go to the Emergency Room

Now that you understand the importance of taking your blood pressure and you learned the skills of proper blood pressure measurement the next step is to know when to call 911.


If you experience any of the below symptoms, seek medical attention immediately.

  • Difficulty breathing
  • Nosebleed
  • Sudden difficulty speaking and understanding
  • Sudden loss of vision or vision problems
  • Sudden weakness in one arm, one leg or one side of the face
  • Sudden spinning sensation in head
  • Sudden severe headache
  • Sudden chest or arm pain
  • Sudden Confusion
  • Several high blood pressure reading
  • SBP greater than 180 or DBP greater than 110

Because I don’t know your circumstances, I cannot advice you  on which action to take if you are experiencing any of the above symptoms. I am very aware that we don’t all have access to the same healthcare. But you should know that something serious might be happening to you and you need to seek help.

If you are diagnosed with hypertension but despite taking medications, your blood pressure is still high then start to monitor your blood pressure.  You will increase your chances of getting it within normal range.

If you are overweight, diabetic, smoke , stressed, eat and drink too much of the wrong things then you will develop high blood pressure. No questions ask. You should also start checking your blood pressure too and get a head of it.

The most effective way for you to be successful with checking your blood pressure often  is to have your own equipment at home. Select a  machine that is easy to use. Preferably one that stores your information . This way you can  keep track and report your measurements to your doctor. Taking your blood pressure is a quick and painless process. With the right mindset, support and tools you will be on  your way towards good health.