< BACK

Blood pressure readings taken outside a clinic setting by a patient or someone else or by ambulatory monitoring devices have become increasingly prominent in the management of patients with hypertension.

Self-monitoring can be an accurate method to evaluate a patient's usual blood pressure and to evaluate the effect of antihypertensive medication. Self-measured blood pressure readings may be more reliable because of the greater number of readings that can be obtained during a certain period.

It gives a precise measure of the blood pressure, for two reasons: first, a large number of readings are taken, and second, they are taken outside the environment of the doctor's office. Thus it gives a better prediction of the risk associated with high blood pressure than the doctor's readings. In addition, it is the only way of assessing the diurnal rhythm of blood pressure, which is characterized by higher pressures during the day and lower pressure at night.

The circumstances at the time of measurement may influence the height of the blood pressure. If readings are taken too soon after a meal or exercise, they may be lower than at other times, while if they are taken after smoking a cigarette or drinking coffee, they may be increased.

The use of self-monitoring is recommended for the majority of patients with hypertension. Exceptions would include persons who are markedly obese or those with irregular heart rhythms. Four potential benefits of home monitoring are:

• Distinguishing sustained hypertension from white coat hypertension
• Assessment of the response to antihypertensive medications
• Improved patient compliance
• A possible reduction in costs

Patients should check their new blood pressure monitoring devices in their physician's office before home use and then once a year thereafter to ensure accuracy.

Patients should be instructed to take readings both in the morning and the evening, on work and nonwork days. The frequency of readings should be determined by the patient's clinical situation. The frequency of readings depends on the situation: for initial evaluation it may be appropriate to take them several days per week, but when the patient's condition is diagnosed and stable readings can be taken less frequently.

There is no universally agreed on upper limit of normal home blood pressure level, but a reasonable figure would be 135/85 mm Hg. Blood pressure recorded at work may be somewhat higher.

AMBULATORY BLOOD PRESSURE MONITORING (ABPM)

Ambulatory blood pressure monitoring (ABPM) is a technique for measuring blood pressure over a period of 24 hours while people go about their normal daily activities. The patient wears a small monitor, which takes readings automatically every 15 to 30 minutes, and stores them in its memory. It provides accurate and reliable information and can give your doctor a more accurate picture of your blood pressure than occasional visits and readings taken at his or her office.

Will I be able to lead a normal life?

Wearing a monitor doesn't interfere with daily activities. The monitors are lightweight, comfortable to wear and quiet. A trained professional in your physician's office will program the device to automatically measure your blood pressure throughout the day and night. You will have an inflatable cuff worn on one arm and a recording device about the size of a Walkman worn at the waist. Most people find them very comfortable to wear.

OTHER MONITORING DEVICES

There is a nice selection of digital blood pressure monitors that are available to you as well that do not require 24 hour monitoring. These devices are used at the patient's discretion when convenient. Omron makes top quality blood pressure monitors. There is the wrist blood pressure monitor and other digital read out blood pressure monitoring machines such as a manual inflation monitor and an automatic inflation monitor.

What else do I have to do? Your doctor may ask you to keep a record of things like: what time you wake up or go to sleep, when you eat, experience strong emotions or stress, take medication, exercise or have other experiences that can affect your blood pressure. This information will help him or her with the monitoring process.

< BACK