High Blood Pressure

Control of high blood pressure (BP) decreases the risk of stroke, heart attack, sudden death, heart failure, kidney failure and dementia.

Home blood pressure monitors are used to diagnose high blood pressure and to evaluate treatment and control of high blood pressure (BP). They can be used to confirm “white coat” (BP high only in the doctor’s office) and “masked” hypertension (BP normal in doctor’s office/high outside). BP that is higher outside the office is particularly risky. BP measurements performed at home with a validated electronic blood pressure cuff (Omron™ and others) predict heart attacks and strokes better than office BP readings, and home measurement improves blood pressure control in people on blood pressure pills, because it gives patients and their families a sense of more control over their care.

It is easy to perform and most patients with high blood pressure should perform HBPM.

Use a validated oscillometric, automatic devices such as an Omron™ upper arm device. If your upper arm is more than 12 inches around you need a large adult cuff, (noted on box). A complete list of approved, validated monitors is available online at dableducational.org. Costco and Sam’s Club sell validated Omron BP monitors for $66.00. The monitors usually last about 5 years unless dropped.

If you have a very large upper arm, your doctor may recommend a wrist blood pressure monitor again, Omron, or other validated devices.

After you get your device, bring it to the office to use to check against your doctor’s device and make sure you know how to take your own BP. When measuring your BP measure each arm and from then on use the arm with the higher BP reading.

Technique: rest for 4 minutes, sit with your back supported, arm at the level of the heart, feet on the floor (a kitchen chair at a kitchen table works well). Measure BP twice in the morning (just let the cuff deflate and count to 10 in between readings), before pills and breakfast, and twice in the evening, after dinner or before bedtime for 7 days in a row. WRITE DOWN OR GRAPH ALL YOUR READINGS. Your doctor will then have about 30 readings to look at, instead of one or two from the office, and he/she will review them with you.

Goal blood pressure at home should be a bit lower than in the office-

If you have hypertension without kidney disease or diabetes, 2010 data suggest a reading less than 135/85 both morning and evening is optimal. If you have kidney disease it probably should be should be less than 130/80 both times.

We are not sure about people with diabetes without kidney disease; for now we recommend less than 130/80.
Check with your doctor- if you are over age 80, your blood pressure may need to be a bit higher. If you have orthostatic hypotension (BP lower in the standing position) your doctor may have you measure your blood pressure standing rather than sitting. If your doctor is trying to exclude white coat hypertension the blood pressure level to exclude it is lower. Blood pressure at home should be less than 125/76 morning and evening. (Most people without high blood pressure have readings less than that at home).

Report any blood pressures more than 160 systolic or less than 110 systolic immediately to your doctor.

If you have any questions or concerns please contact your Providence Medical Group Family Medicine or Internal Medicine Primary Care Physician.

Submitted by:
Susan Steigerwalt MD
Providence Heart Institute