monitoring your blood pressure at home

monitoring your blood pressure at home
MONITORING YOUR BLOOD PRESSURE AT HOME WHY SHOULD YOU MEASURE AND MONITOR BLOOD PRESSURE AT HOME?  To find out if your blood pressure is elevated all the time, or just when you visit the clinic. o If blood pressure is elevated only when you visit the clinic, you may not need to take medication for high blood pressure.  To find out if your blood pressure is always elevated at home but not in the clinic. o If this is your pattern, you may need to take blood pressure medication.  To help you and your clinician to better control your blood pressure to help prevent stroke, heart attack, and kidney failure. WHAT SHOULD YOUR BLOOD PRESSURE BE?  Blood pressure consists of 2 numbers, for example, 124/84. o The first number is called the systolic pressure. o The second number is the diastolic pressure. o Both the systolic and diastolic blood pressures should be controlled to goal.  For most people, the goal blood pressure at home is lower than the goal blood pressure in the clinic. Goal Clinic Goal Home Blood Pressure Blood Pressure Most People Below 140/90 Below 135/85 People with diabetes or Below 130/80 Below 130/80 kidney disease WHAT HOME BLOOD PRESSURE CUFF SHOULD YOU PURCHASE?  Purchase an arm cuff, not a wrist or finger cuff o Wrist and finger cuffs are less accurate.  Ask your clinician if you need a regular size arm cuff, or a large adult arm cuff if your mid‐
upper arm is greater than 13 inches around. o A cuff too small for your arm falsely elevates blood pressure. o Some specially designed cuffs can self‐adjust to your arm size. o A few persons with very large arms may have to use a wrist cuff – discuss with your clinician.  Purchase only cuffs that have been validated for accuracy by one or more of three organizations: AAMI (Association for Advancement of Medical Instrumentation), BHS (British Hypertension Society), IP (International Protocol) o Most cuffs made by Omron, A&D/LifeSource, MicroLife, and a few other companies have been validated for accuracy.  A list of validated cuffs is available at www.hypertension.ca/devices‐endorsed‐
by‐hypertension‐canada o Validated cuffs can be purchased in many drug stores or on‐line:  www.omronhealthcare.com 
 www.andmedical.com  www.microlife.com Arm cuffs cost from $50 to $110 depending on “extras”: o Although not necessary, some very useful monitors check blood pressure automatically three times at one minute intervals and average the three readings. HOW CAN YOU BE SURE YOUR CUFF IS ACCURATE?  Even validated cuffs may be inaccurate in some persons.  Bring your cuff to clinic to confirm its accuracy every 6 to 12 months. o Your clinician will take 5 readings in a row at 30‐60 second intervals: the first, second, and fourth readings will be with your cuff, and the third and fifth readings with their cuff. The last reading from your cuff should be within a few points of the last two clinic cuff readings. HOW SHOULD YOU ACCURATELY MEASURE YOUR BP?  Do not use pharmacy or grocery store equipment which is frequently inaccurate.  Home blood pressure may be extremely inaccurate if you do not measure it with correct technique!  Do NOT measure your blood pressure if: o You “feel” that it might be high – this is likely due to stress. o You have exercised, smoked, eaten, or drunk any fluids within 30 minutes. o Your are watching television, reading, or talking on the phone. o You need to empty your bladder or bowel.  You can watch correct home blood pressure technique on this on‐line computer video: www.hypertension.ca‐video  To correctly measure your blood pressure: o Rest quietly for 5 minutes o Sit in a chair with your feet flat on the floor, back and arm supported, arm level at the mid‐point of your sternum (“breast bone”). o Use the same arm each time (the arm with the higher blood pressure if your clinician found a difference). o The arm should be bare (or with a thin sleeve only). o Wrap the cuff snugly around your bare upper arm.  The lower edge of the cuff should be 1 inch above your elbow crease.  The tubing on the cuff that connects to the device should be on the inside of your arm. o Trigger your monitor to measure the blood pressure. o Repeat a second blood pressure measurement one minute later.  Some cuffs measure the blood pressure automatically 3 times at 1 minute intervals and then average them. o Average (add and divide by 2) the two blood pressure readings together and record the result immediately onto the attached blood pressure log. o Do not leave out high or low readings. HOW MANY TIMES DO YOU NEED TO MEASURE BLOOD PRESSURE TO ACCOUNT FOR ITS VARIABILITY?  Blood pressure changes up and down quite a bit, and so a single set of readings has little, if any, importance.  To be meaningful, you must measure your blood pressure twice in the morning and twice in the evening for at least 3 days and preferably for 7 days. Then, average together all of the measurements from the last 2 days, or the last 6 days, depending on whether you measured over 3 or over 7 days. Omit readings from the first day. o Measure morning blood pressure after you have been up for 30 minutes and before you take medications or eat breakfast. o Measure evening blood pressure before you take medications. HOW SHOULD YOU INTERPRET YOUR AVERAGE HOME BLOOD PRESSURE?  Bring your average blood pressure over the 3 to 7 days before a clinic visit and your blood pressure log to your clinic appointments.  You may be asked to call your average blood pressure to your clinician.  Always note to your clinician if you have missed medication doses.  The table below is a guide to interpret home blood pressure results with regular communication of these results to your clinician: Average BP over 3‐7 days Recommendation Below 135/85 (or below 130/80 BP at goal. if diabetes or kidney disease) In 3 months, repeat twice daily BP for 3‐7 days. 135‐180/85‐110 BP elevated. Repeat twice daily BP for 3 days. Call clinician if average BP is 135/85 or higher. Above 180/110 BP elevated. Call your clinician to discuss. Below 100/60 BP low. Call your clinician to discuss. Home Blood Pressure Monitoring Data Sheet
Name: ____________________________________________________
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Date This Sheet Started: ________/________/________
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 2
Day 3
Day 4
AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM PM
210
205
200
195
190
185
180
175
170
165 x
160
155
x
150
145
140
135
130
125
120
115
110
105
100 x
95
x
90
85
80
75
70
95
60
55
50
Average BP last 6 days = ______/______
• Take your AM (average last 2 of 3 readings) and PM (average last 2 of 3 readings) BP for 7 days as recommended in "Monitoring Your Blood Pressure
(BP) At Home" instruction sheet.
• On the chart above, record the average AM and PM BP reading for the last six of the seven days. In each column, make an "x" as close as you can to
your average systolic (top number) and a diastolic (bottom number) BP, as in the example on the far left side of the chart
• For patients with diabetes, kidney disease, or heart disease, your goal home BP is generally below 130/80 mm Hg (dotted lines). For all other patients,
your goal home BP is below 135/85 mm Hg (solid lines).
Modified from University of Michigan Hypertension Center
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