Can you handle the pressure?
“I went to my doctor’s office and when they checked my blood pressure, it was high. Now they want to put me on medication.”
Research has shown that blood pressure readings taken in a physician’s office can fluctuate from visit to visit, depending on many variables:
What size of blood pressure cuff did they use?
Did I rush to the appointment because I was running late?
Was I upset that the doctor was late?
Did I eat a salty meal the previous evening?
Was the reading taken as soon as I sat down in the examination room?
So if it is high at one visit, does it really mean that you have high blood pressure? You may just have highly variable blood pressure. Or you could have White Coat Syndrome. Neither of these are “normal”, but they aren’t as bad as having true high blood pressure. Or you could simply have the normal degree of variability in blood pressure that human beings are supposed to have.
Last year, a research study of more than half a million adults with more than 7.7 million systolic blood pressure measurements looked at the problem of variable office blood pressures. This study was a “retrospective cohort” study, meaning that the researchers looked at the results for a group of people after the fact. They found that the average absolute change in blood pressure between 2 consecutive doctor visits was about 12 mmHg (which is also approximately the amount of change that we see when starting a blood pressure medication).
So even though the patients weren’t necessarily placed on medication, their blood pressure measurements were different.
The implications of this study are that visit-to-visit blood pressure variability could be leading physicians to unnecessarily prescribe or increase doses of blood pressure medication as a “knee-jerk” response to a single high blood pressure reading.
Other research has shown that many doctors are still relying on office blood pressure measurements as the main determinant of someone’s “real” blood pressure, even though the US Preventive Services Task Force and American College of Cardiology/American Heart Association guidelines recommend against this approach.
At Wisconsin Cardiology Associates, we recommend checking (and documenting) your blood pressure daily for the week before a doctor’s appointment, and bringing that diary of your results to the doctor. This will be more representative of your true blood pressure than the single value in the doctor’s office.
And even if you don’t have a doctor’s visit coming up, it is reasonable to check your blood pressure for the first week of every other month, as blood pressure can change over time.
How to do it:
When you check your blood pressure at home, you should:
- Sit quietly for 5 minutes before you measure
- Legs uncrossed, feet on ground
- Place your arm at your chest or heart level
- Stay still and do not talk as the machine operates
- Check it three times: throw out the first value, and average the second two
When you check your blood pressure at home, you are taking an active role in managing this important risk factor, empowering yourself to take control of your health.
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