High Blood Pressure: Why you should monitor it at home

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If you have been diagnosed with high blood pressure, it would be a good idea for you to start monitoring your blood pressure at home, says a recent joint statement from the American Heart Association, American Society of Hypertension and the Preventive Cardiovascular Nurses Association. The statement was published May 24 online in Hypertension: Journal of the American Heart Association; the Journal of the American Society of Hypertension; and the Journal of Clinical Hypertension.

“Blood-pressure measurement and tracking could be improved with home monitoring by the patients themselves, in much the way people with diabetes monitor their blood- sugar levels with home glucose monitors,” says Thomas G Pickering, M.D., chairman of the statement-writing group. Pickering cites reliable evidence that the time-honored means of measuring blood pressure in adults can be misleading. Scientific evidence shows that between 10 percent and 20 percent of patients diagnosed with high blood pressure are exhibiting the “white coat effect,” meaning that their pressures are normal under other conditions, but rise in the medical setting.

“It is also believed that some people with normal blood pressures in their doctors’ offices have pressures that spike to potentially dangerous levels in other situations,” says Pickering, director of the Center for Behavioral Cardiovascular Health and Hypertension Program at Columbia Presbyterian Medical Center in New York. According to the statement, home monitoring is particularly useful in the elderly, in whom both blood-pressure variability and the “white coat effect” are increased, as well as in patients with diabetes, patients with kidney disease and in pregnant women. Pickering notes that because blood pressure is highly variable during the day, taking one reading at a doctor’s office every few months fails to provide a complete assessment of a person’s condition. Home monitors can take multiple measurements and can be used at different times of day. Many monitors also store and average blood-pressure readings over time, providing crucial data for patients to take to their physicians so they can work as a team to diagnose and treat the condition.
The joint statement emphasized the following points in selecting and using a home blood-pressure monitor.

• Patients should purchase oscillometric monitors with cuffs that fit on the upper arm. They should use a proper fitting cuff, and ask a health-care provider the proper way to use the monitors. Wrist monitors are NOT recommended.
• Patients should take two or three readings at a time, one minute apart, while resting in a seated position. The arm should be supported, with the upper arm at heart level, and feet on the floor, back supported, legs uncrossed.
• It’s important to take the readings at the same time each day, or as a health-care professional recommends.
• Use of a home monitor can confirm suspected or newly diagnosed hypertension and rule out diagnosis for patients whose readings at the doctor’s office don’t reflect their actual pressures over time.
• Home monitoring can be used to evaluate the response to any type of antihypertensive treatment and to motivate patients to take their medications regularly.
• The target goal for treatment with a home monitor is less than 135/85 millimeters of mercury (mmHg), or less than 130/80 in high-risk patients.