Monitors give voice to silent disease
November 5, 2007
Craig — Monitoring your blood pressure is kind of like watching the temperature and oil pressure gauges on your automobile. If your car is relatively new and has been well maintained, those gauges are going to be sitting right on normal nearly all of the time. But, it’s still important to keep your eye on them – just in case.
The same goes for monitoring your blood pressure. The nurse or your doctor probably puts the cuff on your arm every time you go to the doctor’s office, even for a routine matter. And, if your BP is more than 120/80 on those occasions, it’s usually not a big concern since some individuals feel stress having blood pressure taken in a medical setting.
If your blood pressure is consistently higher than that number, however, your doctor will monitor it more closely and ask you to make lifestyle changes – get more exercise, lose weight, eat more fruits and vegetables, reduce the salt and saturated fats in your diet. If those measures don’t get your blood pressure down, you may eventually get a diagnosis of hypertension and a prescription for medication.
Hypertension is one of the most common chronic medical conditions – affecting about 60 million Americans or about 25 percent of adults. It’s called a silent disease because it rarely gives out symptoms.
If detected early, high blood pressure is relatively easy to manage with lifestyle, diet, medications and careful monitoring. Without treatment, hypertension can lead to severe life-threatening problems such as stroke, heart disease and kidney failure.
Approaches to monitoring
The most important and reliable blood pressure readings take place in the doctor’s office, but in order to make sure treatment is working, doctors often ask their patients to keep track of their blood pressure in between office visits – either by coming into the office for blood pressure readings or by using a home monitor.
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Because they are expensive, readily available and easy to use, home monitors are becoming increasingly useful as a way of managing the disease. While doctors initially had some concerns about the accuracy of home monitors, studies generally show that the accuracy of machines is getting better and that their use improves blood pressure control and the patient’s adherence to therapy.
A review of 18 studies involving nearly three thousand subjects presented at the annual meeting of the European Society of Hypertension (Paris, 2004) found that people who monitored their BP at home had lower blood pressure and better control of their hypertension than those who were monitored in a doctor’s office.
The Treatment of Hypertension Based on Home or Office Blood Pressure trial concluded that home monitoring “led to less-intensive drug treatment and marginally lower costs : with no differences in general well-being or left ventricular mass.”
The Association for the Advancement of Medical Instrumentation is the U.S. group responsible for testing and setting standards for home blood pressure monitors. Devices without the AAMI seal may be sold, but are prohibited from making claims about accuracy.
The gold standard for reliability is the mercury sphygmomanometer used in nearly every medical facility, but for home use these devices are cumbersome.
Similar devices with a self-inflatable cuff and an aneroid (spring operated) or electronic gauge can be purchased for $10 to $20. These come with a stethoscope to listen for the Korotkoff sounds that represent systolic and diastolic pressure and require some instruction and dexterity to use.
For about $100, you can buy a machine with a cuff that will inflate automatically and give a digital readout. Some models print out results with date and time in a handy form that you can mail to your doctor’s office or take on your next appointment.
Monitors that measure blood pressure at the wrist or finger are generally not as reliable. False readings can occur because of constriction of peripheral blood vessels or merely positioning of the limb.
Whatever machine you use, it’s important to take it with you to the doctor’s office from time-to-time to make sure that it’s calibrated to give an accurate measurement.
Your doctor or nurse can show you the proper way of taking blood pressure. You must be seated and relaxed for at least two minutes before inflating the cuff, and the arm from which you are taking the reading should be resting at a level with your heart. Even a slight change from those practices can mean several points up or down in blood pressure.
While determining proper treatment and dose, a doctor may ask a newly diagnosed patient to take numerous readings at several times of the day and while performing various activities.
Once the medication has been established and blood pressure is fairly stable, fewer measurements may be necessary, but it’s still important to monitor the difference between morning, afternoon and evening blood pressure. Since work stress can affect blood pressure, it’s also a good idea to include both work days and weekends.
About half of Americans with high blood pressure don’t know they have it. And about half of those who do eventually quit following their treatment plan, at least in part because they have no symptoms to spur them on.
Home blood pressure monitoring several times a day is like stepping on the scales when you’re trying to lose weight; it helps you stay focused on your goal. An extra five or 10 points on the blood pressure gauge may reflect only some temporary stress in your environment.
But, if an upward trend becomes apparent, you may want to think about how you might be deviating form your treatment plan. Have you been lax about exercise? How about the salty olive dip you had at the party last night? Have you been getting five servings of both fruits and vegetables every day?
Studies show that treatment of even mildly elevated blood pressure can make an enormous difference in reducing a person’s risk of death from stroke, heart attack, kidney failure and other causes.
A small investment in a home blood pressure monitor can be an important adjunct to successful treatment.