Tracking your own blood pressure may be useful

You probably get your blood pressure taken at the doctor's office, but did you know that checking it at home could be just as important — if not more so — for some people?

"Home monitoring keeps a more day-to-day log of what is happening with the blood pressure and also allows one to realize that what they're doing could be affecting the blood pressure," said Dr. Atul Chugh, director of preventive cardiology and hypertension at University of Louisville Physicians.

For example, the blood pressure reading might be higher than usual a day or so after eating a takeout meal, Chugh said. That "should be a signal to the patient to say, 'Well, probably having that Chinese with that much sodium was probably not a good idea and my body was affected adversely because of it, so it's really important that I not do that as often.' "

Blood pressures taken at home also can affect doctors' decisions about medications. "The number that they bring in to me from their record is more important in adjusting their medicines than the number I get in the office," said Dr. Thomas Tu, an interventional cardiologist with Baptist Medical Associates. "A sheet of paper with lots of blood pressure readings over the last month will be a much more thorough reflection of what their blood pressure is doing."

High blood pressure is a stealthy condition that can threaten your health without causing overt symptoms and possibly lead to strokes, kidney failure and heart attacks. "There'll be some of my patients who have a little bit of a headache, ill-defined malaise — just not feeling right — but the vast majority will not have anything that really tells them that their blood pressure is high," Chugh said.

Blood pressure guidelines are controversial, and what is considered normal or high can vary from physician to physician and patient to patient, depending on their circumstances. "I would be cautious to recommend a number that's correct for everybody," Tu said.

Recently published guidelines recommend that people aged 60 and older be started on medication if their blood pressure is 150/90 millimeters of mercury or higher. For people younger than 60, drugs are recommended when their blood pressure is 140/90 millimeters of mercury or higher, and the same goes for adults of any age who have chronic kidney disease or diabetes, according to the guidelines published in JAMA in February.

"If someone always has normal blood pressure, they probably don't need to be checking at home," Tu said. "But there are people with chronic conditions like high blood pressure and blocked arteries and things like that who need to know their blood pressure on a regular basis, and those people I would recommend that they really do obtain a cuff and keep track."

Chugh said people should consider checking their blood pressure regularly at home if they are on blood pressure medication, have a strong family history of high blood pressure or have recently had preeclampsia, a condition that can develop during pregnancy. African Americans and people with autoimmune disorders, such as rheumatoid arthritis, are some others who might benefit.

Dr. James Jennings, a family physician with Norton Community Medical Associates-Brownsboro, said monitoring can be helpful for people whose hypertension is poorly controlled or who have a lot of variability in their readings or who get anxious when they go to the doctor.

Some people have white coat hypertension, meaning that their blood pressure is artificially elevated in the doctor's office but not elsewhere, or masked hypertension, meaning their pressure is normal during doctor's visits but high at other times. "That's where things like home monitoring and 24-hour blood pressure cuffs could be very important," Chugh said.

The latter, which are sometimes used by hypertension clinics, can take readings several times a day to help sort out whether a person truly has high blood pressure and whether the blood pressure dips appropriately at night, he said.

Choosing a monitor

Blood pressure monitors can be purchased from a variety of sources, including drugstores, discount stores and online, for less than $100, or higher. Some have fancier features than others, such as being able to communicate with apps to help with tracking.

For accuracy, Tu suggests using blood pressure monitors that have a well-fitted arm cuff instead of a wrist cuff. Also, "I would recommend that patients use cuffs that are automatic, so that they don't have to pump anything up, that they don't have to listen to anything themselves. They just have to hit the button and let the machine do the work," he said.

The cuff size is important because "if it's too small for your arm, you're going to get a falsely elevated blood pressure. If it's too big for your arm, it's going to be falsely reading low," Jennings said.

There are markers on each blood pressure cuff that will show you whether it's well-fitted for your arm or not, Tu said.

Ask your health-care provider how often to measure your blood pressure at home, such as daily or weekly. Chugh said he usually suggests that people on blood pressure medicine check their blood pressure two or three times a week.

"For all my patients I advocate that they take their blood pressures within 30 minutes of waking up," Chugh said. They should be "sitting on a chair with both feet on the ground, with back supported, so no core muscles are being used, an arm that is at the heart level. I usually tell them left (arm), but it could be either/or, but just as long as we know that one arm is being used."

Be careful about the activities you engage in before you take your blood pressure. "If you're really checking for hypertension, it's imperative that the patient be at rest for five minutes and not have smoked or had caffeine 30 minutes prior to" taking the measurement, Chugh said. "These things will artificially increase the blood pressure."

Also, keep in mind that exercise can impact readings. "If you've just gotten off the treadmill, that's not a time to get an accurate blood pressure," Jennings said. "It's not going to be your resting pulse, and it's not going to be your resting blood pressure."

Tu noted that there can be fluctuations in pressure at various times of day. There's an "early morning spike in blood pressure, and then the blood pressure will fall down a little bit later on in the day, and then oftentimes, there's a secondary rise in the afternoon," he said. "It's important to get a sense of what that variation is for you, so that you know what's typical."

If you're going to try to compare apples to apples, measure your blood pressure at the same time each day, Jennings said. If you get a high reading, it can be helpful to wait 15 to 30 minutes and check it again, he said.

Before doing a home check, get your blood pressure taken on both arms at a doctor's office to make sure there are no major differences from arm to arm, Chugh said.

Be sure to jot down your blood pressures so your doctor can review them. "I know that there's lots of electronic devices now that will record your blood pressure," but it sometimes can be troublesome for the doctor to cycle through that information, Tu said. "What I would do is simply just write it down on an old-fashioned piece of paper," making note of the systolic blood pressure (top number), the diastolic blood pressure (bottom number) and the pulse or heart rate.

Reporter Darla Carter can be reached at (502) 582-7068 or on Twitter @PrimeDarla.

LEARN MORE

• Choosing a monitor: http://bit.ly/1fi1jhH

• How to monitor and record blood

pressure: http://bit.ly/1gH9l7l

• Should insurers reimburse? http://bit.ly/1ptCgk7

• New guidelines for treating blood

pressure in adults: http://bit.ly/1nKtM90

• Guidelines controversy: http://bit.ly/1oNnoxT

LOCAL ADVICE

See a video of Dr. Atul Chugh of University of Louisville Physicians discussing home blood pressure monitoring at www.courier-journal.com/health.

TIPS

• If you're tracking blood pressures at home, be sure to record them, or get a machine that does so.

• Take your monitor to your doctor to make sure that it's accurate.

• Check Consumer Reports or other reliable sources before you buy a monitor. Arm monitors recommended by the magazine include the Omron 10 Series BP785 for about $100. It's "excellent for accuracy" and "very good for comfort."

• Tell your doctor if your blood pressure is too high or too low.

• Don't stop or adjust your blood pressure medicine without consulting your doctor.

• Be aware that doctors may prescribe drugs or suggest exercise or dietary changes to improve your blood pressure.