DECATUR — Patients often have this problem: They run into the doctor’s office late for an appointment because of a red light, slow train, talkative boss or some other distraction.
They are also nervous or annoyed by the appointment in the first place, and one of the first exams a nurse may perform is the blood pressure test.
To their surprise, the numbers are high, but healthcare professionals often find patients’ blood pressure numbers are elevated during a visit to the doector.
Many cardiologists, including Jyothinagaram, recommend their patients use home blood pressure monitors.
“It is a feedback on how well they are doing,” he said. “And they feel involved in their care.”
In November 2017, the American College of Cardiology and the American Heart Association published the new blood pressure guidelines.
The categories are:
- Normal with a blood pressure systolic reading of 120 and diastolic 80 or lower
- Elevated with a systolic reading between 120 and 129 and diastolic less than 80;
- Stage 1 with a systolic between 130 and 139 or diastolic between 80-89;
- Stage 2 with a systolic at least 140 or diastolic at least 90;
- Hypertensive crisis Systolic reading over 180 or diastolic reading over 120.
The top number is the maximum pressure your heart exerts while beating (systolic pressure), and the bottom number is the amount of pressure in your arteries between beats (diastolic pressure). The numeric difference between your systolic and diastolic blood pressure is calledur pulse pressure, according to the Mayo Clinic website.
Patients who might benefit from a home blood pressure monitoring device include those diagnosed with high blood pressure or on blood pressure medication, patients with high risk of heart disease or women who are pregnant.
Prices range from $15 to more than $100. Many factors determine the price.
“They have fancy ones,” Jyothinagaram said. “Some have a two-person reading, some are wireless, some have apps. But the brand names and store brands all work about the same.”
Healthcare professionals do agree on a certain style of monitors.
According to Yvonne Carry, a registered nurse navigator with HSHS St. Mary’s Hospital, monitors placed around the wrist are usually the least effective.
“They read 10 to 20 points lower,” she said. “Taking the measurement above the elbow is the most accurate.”
The portable monitors come in various sizes, depending on the circumference of the upper arm.
“Get the right size,” Jyothinagaram said. “It should cover 80 percent of the arm above the elbow.”
Healthcare professionals stress the importance of preparation as well. Perform the test 30 minutes after exercising. Sit with back support and feet on ground, then put the cuff above the elbow. The middle of the cuff should be above the elbow. Patients should be in relaxed with the arm supported on the desk, table or flat surface above the heart.
Before attempting another test, make sure the cuff is completely deflated.
“In the hospital, we hold it out for the patient, trying to keep it at heart level,” Carry said. “You may need to find someone who does it the old-fashioned way to show you how it is done.”
Healthcare providers suggest if a patient believes the home monitor is incorrect to take it to the office. The difference could be caused by various factors, including a low battery, for example. Afterward, a patient will need to remember the difference between the doctor’s readings and the home monitor.
“And do the math when determining the accurate results,” Carry said.
A patient’s blood pressure can rise during the day after eating, stress or exercise. However, if the monitor has large fluctuations of readings throughout the day, doctors can schedule 24-hour monitor ambulatory heart monitor.
“You will need to keep track with a diary while you are taking the reading,” Carry said.