Don’t just get your BP taken; make sure it’s taken the right way

By American Heart Association News

Attention passengers, this is your pilot speaking.

I’m kind of in a hurry to get to our destination and you probably are, too.

Since I know what I’m doing, I’m going to cut some time by zipping through all those boring safety checks that usually take us so long, and get us in the air right away.

Such a scenario is comical. No pilot would be so reckless. No passenger, crew or flight controller would allow it.

Yet a similar hurry-up-and-get-it-done approach happens far too often when it comes to getting our blood pressure taken. That’s unfortunate because a blood pressure reading should be handled as meticulously as a pre-flight safety checklist.

Seriously, it’s that important.

High blood pressure makes you twice as likely to suffer a heart attack or stroke. It can affect you in other ways, including your ability in the bedroom, guys. And the only way to know whether you have high blood pressure is by getting it taken – and taken correctly.

Now here’s the new wrinkle: On Monday, the rules changed about what classifies as high blood pressure, also known as hypertension. Experts looking at all the newest data have now defined hypertension as a reading of 130 on top or 80 on the bottom. In the past, the standard used to be 140/90.

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The change comes from an update to the guidelines followed by doctors across the country. A major difference is eliminating the category called “prehypertensive” or “high normal.” That warning zone is now part of the danger zone. The new guidelines are designed to help people get their blood pressure under control earlier – which has been shown to prevent organ damage.

Getting blood pressure under control doesn’t necessarily require medication. In many cases, people can lower their numbers through lifestyle changes such as eating healthier, being more active and drinking less alcohol.

In releasing the guidelines, the experts who spent three years putting it together drew attention to one more thing: The steps involved in taking a textbook blood pressure reading.

“It is incumbent on those of us who are physicians to measure it properly and to train people to do it properly at home,” said Paul Whelton, M.D., chairman of the writing committee that updated the guidelines and an epidemiology professor at Tulane University School of Public Health and Tropical Medicine in New Orleans. “You can’t be too busy to do it right.”

While this story has focused on giving a quality blood pressure reading, there’s another way of looking at it. Consider this a primer in how to get your blood pressure taken.

The following graphic is meant to be printed or saved on your phone. While you’re at it, consider sharing it on social media and emailing it to friends and family.

Text version of infographic.

Here are more details about what to do after the first reading:

-- Take at least two readings one minute apart and average them. This reduces variability. If you think the range is too wide, take a third and then calculate the average. (If you’re doing this at home, it’s best to do these in the morning before taking any medications and again in the evening before dinner.)

-- Remember that your blood pressure can vary as much as 5-10 millimeters of mercury (how BP is measured) just during a cycle of breathing. So don’t expect all the readings to be exactly the same.

-- The log of your readings should include the averages, as well as the individual readings. You should bring the log to a medical appointment so your healthcare provider can see the trends and, while you’re there, it’ll be easier to add the latest readings.

-- If you use a home monitor, bring it to all clinic appointments. This is especially important if your device has a built-in memory that records your results. It’s also a good idea to have your healthcare provider check your device about once a year to make sure it is accurate.

If you’re still not convinced the extra effort is warranted, Whelton frames it this way: Surely you’d want the lab that handles your blood test to follow strict quality control standards; why not demand the same when it comes to blood pressure readings, an area with a lot of chance for error?

About that chance for error …

At a 2015 American Medical Association meeting, 159 medical students were given a blood pressure check challenge with a simulated patient. Only one – one! – performed all 11 elements they’re trained to do. The average number of steps performed correctly was 4.1.

One of the biggest mistakes: Failing to have a patient rest for five minutes in a chair before the measurement. Only 11 of these doctors-in-training did that.

The study was published this summer in JAMA, a leading medical journal. An article(link opens in new window) about the study(link opens in new window) includes a sobering message from Raymond R. Townsend, M.D., a study co-author and director of the hypertension program at the Hospital of The University of Pennsylvania. Townsend was named the AHA’s Physician of the Year in 2016.

“I used to have a standing challenge on rounds at Penn: ‘If you can do a blood pressure correctly in my presence, I will buy you a dinner [at a] restaurant of your choice in Philadelphia,’” Townsend said. “After 10 years, not a single person – resident, fellow or student – ever could do it.”

For patients, there’s a lot more than a free meal riding on an accurate reading. So the next time you strap on a blood pressure cuff, make sure as much time and effort is invested into an accurate reading as you’d like your pilots to do before takeoff.

Editor's note: This article was revised on Dec. 2, 2019, to correct a typo.

If you have questions or comments about this story, please email [email protected].

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