High blood pressure is the main risk factor in arterial disease (diseases of the coronary arteries, arteries of the brain, and of peripheral arteries.)

Blood pressure can be affected by different stimuli (such as stress, illness, lack of sleep, etc.) and because of this, one measurement may not be enough to determine a person’s true blood pressure, and can leave him vulnerable to the risks associated with high blood pressure.  In the past few years techniques have been developed to gain a much more accurate sense of the accurate blood pressure than can be had in the clinic:

1.     Supervised monitoring of blood pressure over 24 hours,

2.     Self measurement blood pressure at home.

The choice between the two options depends on the temperament of the patient, and the proportion of risk for the more serious conditions that can result from high blood pressure, such as heart attack, congestive heart failure, stroke, and kidney failure, etc.  According to some studies treatment of high blood pressure is more effective when the patient feels "in control" and takes more responsibility for his own treatment.

The advantages of supervised monitoring over 24 hours are:

1.     Patient comfort

2.     Test results are immediate and accurate

3.     The patient's ability to administer the test can be monitored.

Self testing at home is another option for some patients.  In this case, 2 sets of measurements are taken, at the same times each day (for example, first thing in the morning before taking medications and in the evening) and recorded, for 4 days.  The measurements are then averaged together to get the "balanced" measurement.  The doctor then double-checks all of the test results and the average.  The goal is to stabilize the blood pressure at or near 135/85, except in diabetic patients whose readings should be even lower.

In home testing it is possible to increase or decrease the frequency of measurements based on how well the blood pressure is balanced, measuring more for people whose pressure is not balanced in 3 weeks, and less often for people whose pressure has been stable for 1 to 3 months.

Patients who are easily alarmed are not encouraged to self test, nor should patients use self testing to try to change their drug protocols.  Patients self testing at home should be sure to use a recommended digital testing device that fits around the wrist.

You should not measure every day (or draw conclusions from the measurement) when you are not feeling well (for example when you have a headache) since whatever is making you feel bad can raise blood pressure above normal measurements.

This tip was provided through the kindness of Prof. Michael Bursztyn

Department of Internal Medicine

Center for Blood Pressure Treatment