ORAL SESSION 12C: BLOOD PRESSURE VARIABILITY Ma, Zhiyi1; Zhao, Yixin2; Lu, Xining1; Yang, Fan1; Chen, Yuanyuan1; Sun,
Ningling1 1Beijing Tsinghua Changgung Hospital, BEIJING, CHINA 2New Reach Technologies, Beijing, CHINA doi: 10.1097/01.hjh.0000745164.52814.b4A NOVEL DEFINITION, EARLY EVENING ELEVATED BLOOD PRESSURE, HAS A HIGH PREVALENCE RATE ACCORDING TO AMBULATORY BLOOD PRESSURE MONITORING
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Q. I am a 50-year-old woman with newly diagnosed high blood pressure. As diets go, mine is definitely on the healthy side. I do not exercise at a health club, but I do a lot of housecleaning and gardening, and I do walk a fair amount, which I feel is equal to what I would accomplish at a health club. I weigh 150 pounds and my height is 5 feet, 6 inches. I take Toprol-XL. My blood pressure seems to be normal in the morning, averaging 121/74, but in the afternoon the upper number is often in the 140s to 150s. Is it normal for blood pressure to rise like this as the day goes on, especially while on a medication?
A. It's great that you are paying close attention to your blood pressure readings. Beta blockers like metoprolol (Lopressor, Toprol-XL) are not great medications for lowering blood pressure when used all by themselves. So, as the day goes on, and you eat and exert yourself physically, my guess is that the metoprolol is just not strong enough to control your blood pressure. One option is to switch to another medication, such as a diuretic or an ACE inhibitor. If your doctor thinks you need the beta blocker for some other cardiac condition, adding a diuretic or ACE inhibitor to the beta blocker makes sense. In fact, combining low doses of medications that fight high blood pressure in different ways is probably a more effective way to do it than with a high dose of a single medication.
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What is the best time to take blood pressure?
Your blood pressure follows a pattern, rising a while before you wake up. It is the highest at midday and tends to drop in the evening or late afternoon.
Your blood pressure follows a pattern, rising a while before you wake up. It is the highest at midday and tends to drop in the evening or late afternoon. Your nighttime blood pressure is typically lower than in the morning or the afternoon.
The blood pressure reading you get at night is your nocturnal blood pressure.
If your blood pressure is consistently too high or too low, it can be a sign of kidney disease, diabetes, thyroid diseases, or obstructive sleep apnea.
However, irregular blood pressure is not always associated with diseases. Your blood pressure may be higher or lower than it should be due to lifestyle factors, such as smoking, stress, anxiety, night-shift work, and obesity.
If you get a consistent abnormal blood pressure reading, speak to your doctor.
The recommendations are to take your blood pressure twice a day, in the evening and the morning. Take two readings each time, a minute apart.
If there's too big a difference between the readings, space them apart even more. It's best to create a routine and stick to it daily. It will help you see a pattern in your results.
Keep a record of your blood pressure readings in a notebook. Record the reading time, day, blood pressure reading, and heart rate every day.
It would be best to write which arm you put the cuff on. Over time, you will see a pattern.
What do the readings mean?
When you take your blood pressure, you will see readings. The top number is systolic pressure. It refers to the blood's force against your artery walls when the heart pumps, pushing blood out. The bottom figure is the diastolic pressure, which is the pressure between heartbeats when the heart is at rest.
If your systolic pressure is consistently above 130 and your diastolic pressure is consistently below 80, you should speak to a doctor. They will help you determine the lifestyle and dietary changes you need to stay healthy.
Uncontrolled high blood pressure can cause many health complications over time. These conditions include heart diseases, eye problems, stroke, and kidney diseases.
However, simple lifestyle changes, such as quitting smoking and working out daily, can help lower your blood pressure. You should also reduce your salt and sodium intake.
Tips for taking blood pressure at home
It's easy to measure your blood pressure at home. You can keep track of your daily blood pressure readings and show them to a doctor when you go for a routine checkup.
When taking your blood pressure at home, you should follow some tips to get the correct readings:
Relax
First and foremost, relax when you're taking your blood pressure. Don't take a reading right after exercising or doing any strenuous activity. Instead, sit down, relax, and take a reading.
You should sit comfortably and quietly for at least five minutes before measuring your blood pressure. Do not think about things that stress you out. Also, do not talk while you're measuring your blood pressure.
Be consistent
Measure your blood pressure at the same time every day. It will help you create a routine. Talk to your doctor to determine the right time to take your blood pressure based on your current health conditions.
Know your recommendations
Ask your doctor about your target blood pressure. They will give you a range based on your medical history and current health condition.
Average your readings
Instead of just taking one reading, take two or three. Then, you can take the average of these readings to be the most accurate reading.
Position your arm properly
Use the same arm to take your blood pressure every day. Rest your arm on a table or a flat surface. Or, you can raise it to your heart's level when taking your blood pressure. If you need to elevate your arm, keep a cushion or pillow under it.
Avoid alcohol, tobacco, caffeine, and food before a reading
Do not drink coffee or eat anything for 30 minutes before you take a reading. Also, avoid tobacco or alcohol for half an hour or more before blood pressure measurement.
If you need to go to the bathroom, do it before taking a reading. A full bladder changes the blood pressure reading, showing you a higher figure as it raises blood pressure.
Don't place the cuff on clothing
When using a blood pressure monitor cuff, do not apply the cuff over your clothing. Instead, put the cuff around your bare skin.
However, don't roll your sleeves up to expose your skin since the sleeve might tighten around the arm, disrupting the reading. Instead, take your arm out of the sleeve when measuring your blood pressure.
SLIDESHOW
How to Lower Blood Pressure: Exercise and Tips See SlideshowWhy should you measure your blood pressure at home?
If you monitor your blood pressure using an at-home device, it can help with the early diagnosis of diseases. For example, if you notice a pattern of consistently high blood pressure, you can speak to your doctor.
Using the information you provide, the doctor may be able to diagnose your condition before the disease progresses any further. Self-monitoring becomes even more critical if you already have a medical condition, such as kidney problems or diabetes.
It also helps track your treatment. For example, if you have made a lifestyle change or started a new medication, monitoring your blood pressure will help you determine if this intervention is working.
It will also give your doctor information to decide if they need to change your medication or adjust dosages.
Some people experience a rise in blood pressure when they go to the doctor's office. The condition is called white coat hypertension. One way to avoid this is to check your blood pressure at home.
Likewise, some people may have blood pressure in the normal range at a doctor's office, but their blood pressure spikes when they're elsewhere. It is called masked hypertension.
In both cases, taking your blood pressure at home can help give an accurate measurement.
Plus, it can reduce your healthcare costs since you won't have to go to the clinic as often. If you notice irregularities in your blood pressure readings, consult a healthcare provider.
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Medically Reviewed on 7/14/2022
References
SOURCES:
Cleveland Clinic: "Why You Should Take Your Blood Pressure at Home, and How To Do It."
Mayo Clinic: "Blood pressure: Does it have a daily pattern?", "Get the most out of home blood pressure monitoring"
UTSouthwestern Medical Center: "5 tips for taking your blood pressure at home."