Measuring Your Blood Pressure at Home Using a Manual Monitor

Introduction
Its become routine to you: you arrive at the doctors office and , prior to seeing the doctor, the nurse wraps that cuff around your arm to check your blood pressure. You may be wondering, however, what exactly is blood pressure that makes monitoring it so important? Blood pressure refers to the force of blood against the walls of the arteries, which are the blood vessels that carry oxygen-rich blood to the heart and other parts of the body. Whether you have high, low, or normal blood pressure can have significant health outcomes. Approximately 77.9 million, or one out of every three, adults living in the United States have high blood pressure, also known as hypertension. On the other hand, low blood pressure, also called hypotension, is not nearly as prevalent as hypertension, however, it also can lead to health complications. Furthermore, severely low blood pressure can potentially deprive your body of enough oxygen to carry out its normal functions, leading to damage to your heart and brain. Refer to Table 1 for some of the common health complications caused by uncontrolled blood pressure. Table 1. Health Effects of Uncontrolled Blood Pressure Hypertension Heart attack Stroke Aneurysm Heart failure Weakened and narrowed blood vessels in the kidneys Thickened, narrowed, or torn blood vessels in the eyes Metabolic syndrome Trouble with memory and understanding Hypotension Dizziness Weakness Fainting Risk of injury from falls

An important part of managing your blood pressure is checking your blood pressure at home. Home monitoring can help you keep track of your blood pressure in a familiar setting, make sure that your medication is working properly, and alert your physician to potential health concerns. Furthermore, home monitoring is an easy step you can take to improve your health because blood pressure monitors are widely available and do not require a prescription.

What are the Benefits of Monitoring Your Blood Pressure at Home?

Help make an early diagnosis. If you have a condition that could contribute to hypertension, such as diabetes or kidney problems, monitoring your blood pressure at home could help your physician diagnose hypertension earlier than if you have only infrequent blood pressure readings in the doctors office.

 Help track your treatment. Blood pressure monitoring at home can help people of all ages, including children and teenagers, keep track of their condition. The recordings you take and present to your doctor provides your doctor with important information between visits. Moreover, checking your blood pressure regularly is the only way to know whether your lifestyle changes or your medications are working effectively. By keeping track of changes at home, you can help your health care team make decisions about your ongoing treatment plan, such as adjusting dosages or switching medications. Encourage better control. Taking your own blood pressure measurements at home can lead to better blood pressure control. Moreover, you can develop a stronger sense of responsibility for your health, and it may motivate you to further control your blood pressure with an improved diet, physical activity, and proper medication use. Cut your health care costs. Monitoring your blood pressure at home may reduce the number of visits you need to make to your doctor. As a result, this can decrease your overall health care costs and your travel expenses. Check if your blood pressure is different outside the doctors office. Your physician could suspect that your blood pressure reading increases due to the anxiety associated with visiting the doctors office, but that otherwise it is normala condition known as white coat hypertension. Home blood pressure monitoring can help determine if you have true hypertension or simply white coat hypertension. Monitoring your blood pressure at home may also help when the opposite occurs (i.e. your blood pressure appears normal at the doctors office, but is raised elsewhere). This type of hypertension, sometimes referred to as masked hypertension, is more common in females and individuals who have cardiovascular risk factors, such as obesity, high blood cholesterol, and high blood sugar.

Systolic vs. Diastolic Blood Pressure

When your heart beats, it contracts and pushes blood through your arteries to the rest of your body. This force creates pressure on the arteries, which is called your systolic blood pressure. The diastolic blood pressure indicates the pressure in the arteries when the heart relaxes between beats. Refer to Table 2 for the blood pressure categories defined by the American Heart Association (AHA).

Systolic Blood Pressure Diastolic Blood Pressure

118 76
Read as 118 over 76

Table 2. American Heart Association (AHA) Blood Pressure Categories Blood Pressure Category Normal Prehypertension High Blood Pressure (Hypertension) Stage 1 High Blood Pressure (Hypertension) Stage 2 Hypertensive Crisis (Emergency care needed) Systolic (mm Hg) (upper number) Less than 120 120-139 and or Diastolic (mm Hg) (lower number) Less than 180 80-89

140-159

or

90-99

160 or higher

or

100 or higher

Higher than 180

or

Higher than 110

NOTE: Your doctor should evaluate unusually low blood pressure readings. NOTE: A single high reading does not necessarily mean that you have high blood pressure.

Materials Needed:

Stethoscope

Blood Pressure Cuff

Before You Check Your Blood Pressure

Meet with your doctor to establish your systolic baseline and ask what reading should prompt an immediate call to the doctors office. Find a quiet place to check your blood pressure. This is important because you will need to listen for your heartbeat. Make sure that you are comfortable and relaxed. Make sure you have recently emptied your bladder (a full bladder may affect your reading). Roll up the sleeve on your arm. Sit and rest in a chair next to a table for 5 to 10 minutes. Rest your arm comfortably at heart level and sit up straight with your back against the chair. Keep your legs uncrossed. Rest your forearm on the table with the palm of your hand facing up.

Steps to Taking Your Blood Pressure at Home

Step 1: Slide the cuff onto your bare upper arm (right or left) The lower edge of the cuff should be approximately 1 inch above the bend of your elbow Pull the end of the cuff so it is evenly tight around your arm. You should place it tight enough so you can slip two fingertips under the top edge of the cuff

~1 inch

Step 2: Place the disk of the stethoscope face down under the cuff, just to the inner side of your upper arm

Step 3: Place the stethoscope ear pieces in your ears Make sure the ear pieces are facing forward (pointing toward the tip of your nose) to get the best sound

Step 4: Rest the pressure gauge in the open palm of the hand of your cuffed arm, so that you can clearly see it

Step 5: Make sure that the airflow valve on the bulb is closed by turning the screw clockwise

Step 6: Inflate the cuff by squeezing the pump rapidly with your opposite hand (you may hear your pulse in the stethoscope)

Step 7: Watch the gauge and keep inflating the cuff until the gauge reads about 30 points above your usual systolic blood pressure (at this point, you should not hear your pulse in the stethoscope)

Step 8: Keeping your eyes on the gauge, stop squeezing and slowly release the pressure in the cuff by opening the airflow valve counterclockwise (turn knob counterclockwise) WARNING: Do NOT turn the knob too quickly. It will give you an inaccurate reading.

Step 9: Let the pressure fall 2-3 millimeters or lines on the dial per second while listening for your heart sounds WARNING: Do NOT turn the airflow valve knob too quickly. It will give you an inaccurate reading.

Step 10: Listen carefully for the first pulse beat. As soon as you hear it, note the reading on the gauge. This reading is your systolic pressure.

Step 11: Listen carefully until the sound disappears. As soon as you can no longer hear your pulse, note the reading on the gauge. This reading is your diastolic pressure.

Step 12: Allow the cuff to completely deflate

Step 13: Record your measurements

WARNING: If your measurements show that your blood pressure is higher than normal and you experience symptoms such as severe headache, chest pain, numbness, or tingling in the face or limbs, contact your doctors office immediately or seek emergency assistance. WARNING: Contact your doctor if you have any unusual or persistent increases in your blood pressure readings. NOTE: Your blood pressure will vary throughout the day, and readings are often slightly higher in the morning.

Tips for Accurate Use

Check your monitors accuracy. o Prior to using a monitor for the first time, ask your doctor or nurse to check its accuracy against the office model. In addition, have your doctor or nurse watch you use your monitor in order to see if you are doing it properly. If you happen

to drop the device or damage it, bring it in to be checked before you use it again to make sure that it still works properly. Measure your blood pressure twice daily. o You should measure your blood pressure once in the morning prior to taking any medications and once in the evening. In addition, you should take two or three readings each time you measure your blood pressure to ensure that your results are accurate. You can wait as little as one minute in between your readings.Your doctor may recommend that you try to take your blood pressure at the same time each day. Dont measure your blood pressure right after you wake up. o Dont eat breakfast or take medications before measuring your blood pressure. If you exercise after you wake up, take your blood pressure before exercising. Avoid food, caffeine, tobacco, and alcohol for 30 minutes before taking your measurements. Dont talk while taking your blood pressure.

Helpful Resources:
American Heart Association (AHA): http://www.heart.org/HEARTORG/ Mayo Clinic (all visuals were courtesy of the Mayo Foundation for Medical Education and Research): http://www.mayoclinic.org WebMD: http://www.webmd.com