Is Your Blood Pressure Really High?

There are close to a billion people in the world with high blood pressure, and almost half of them do not have it under control.

Full pay, half the job

Imagine hiring a painter who paints only half your house, but charges you the full amount. This is what the healthcare system is doing to patients with high blood pressure (also called hypertension).

Not acceptable!

It would be bad enough if only money were involved. Here, however, we are talking about disastrous consequences of poor blood pressure control.

Heart disease, including heart attacks, strokes, kidney failure, vascular disease … the list goes on. Uncontrolled hypertension takes a very heavy toll.

Deaths rise

In the last ten years, according to the CDC, the number of people dying from illnesses related to high blood pressure has increased by 66% in the US (compared to a 3.5% increase in the number of deaths from all other causes combined in the same time frame).

And with all the high-tech and fancy gadgetry available to us, we cannot control high blood pressure.

Where to start?

First things first.

Are we really measuring BP correctly?

Just do it?

It should be pretty simple, right, to measure someone’s blood pressure?

Every adult who goes to see a doctor, or enters a hospital, has his or her BP checked. They slap a cuff on you, and boom! It is done!

Not so fast!

Incorrect technique leads to inaccurate and unreliable results.

It sounds obvious, but needs to be restated.

Correct methods of checking blood pressure need to be revisited and re-emphasized.

One high reading= hypertension?

Before we go any further, it is important to emphasize that the diagnosis of high blood pressure, or hypertension, should only be applied after obtaining at least 3 readings of the person’s blood pressure over the course of at least 2 visits to the doctor’s office.

ACC advice

This is how the American College of Cardiology recommends obtaining a blood pressure reading, whenever possible:

1. The patient should be settled and comfortable for at least 5 minutes before checking the blood pressure.
2. The patient should be sitting down with the back supported, with his or her feet well supported on the floor.
3. The arm should be supported in the horizontal position, with the blood pressure cuff at the level of the heart.
4. At least 2 measurements should be obtained.
5. The blood pressure should also be measured with the patient standing up for 1-3 minutes, because posture can affect the blood pressure.
6. An appropriate sized blood pressure cuff should be used. The bladder of the cuff should go around at least 80% of the circumference of the upper arm.
7. When evaluating a new patient, blood pressure should be checked in both arms, and the arm with the higher reading should be used for BP checks at subsequent visits.

AMA advice

The American Medical Association has some additional pointers:

1. The patient should empty his or her bladder before getting a blood pressure check. A full bladder can raise the systolic BP (top number) by 10-15 millimeters of mercury (mm Hg).
2. The legs should be uncrossed. Crossing the legs can raise the systolic BP by 2-8 mm Hg.
3. The BP cuff should be placed over the bare arm; putting it over clothing can artificially raise the systolic BP by 10-40 mm Hg.
4. No talking! A patient having a conversation with the person checking his or her blood pressure can experience a rise in systolic BP of 10-15 mm Hg.

What else?

The patient should preferably avoid tobacco, alcohol and caffeine use for at least 30 minutes before having a BP measurement.

It is also important to have the doctor’s office temperature in a comfortable range.  The blood pressure is likely to rise if the patient is feeling cold.

Proper calibration

Blood pressure measuring instruments should be regularly calibrated in accordance with the instructions of the manufacturer. Machines can malfunction!

SPRINT trial

It is interesting to note how blood pressure was measured by the investigators in this recent scientific study, which was stopped a year early by the National Heart, Lung and Blood Institute because of potentially life-saving information which had already been gathered. Although a detailed report of the study has not yet been released, they did announce significant benefits from lowering blood pressure beyond current recommendations.

However, one should not jump to conclusions till we receive more information about the risks and benefits of treatment, and which groups of patients were included and excluded from the study.

SPRINT BP details

• BP was measured in an office setting.
• An automated machine was used (an Omron machine). This is not an endorsement by me of a specific company, but just a statement of fact.
• The machine waited for 5 minutes, and then took 3 BP measurements, and averaged them.
• The BP was measured while the staff were out of the room.

According to Dr William C. Cushman, a network principal investigator in the SPRINT study, “With the way it’s (BP check) done in office practices today, even if it’s done with a good machine and by somebody who knows how to take blood pressure, it is often 5 or 10 mm Hg higher than that.

CONCLUSIONS

• Checking blood pressure sounds simple, and can be simple.
• However, several important precautions need to be taken.
• Ignoring these steps can lead to inaccuracy and inconsistency when serial blood pressure readings are followed, and the patient can at times receive an inaccurate diagnosis.

Want to read more?

For a more detailed analysis of BP control, and reasons for lack of control, you can refer to my eBook: “High Blood Pressure: 10 Reasons Your Blood Pressure Is NOT Under Control,” available at http://goo.gl/t3h2zs.