Who's Taking Your Blood Pressure -- Seriously?
So I'm going to the doctor's for a routine visit. I'm a bit late
and had to park a block or so away, I practically run the
distance to the office. I check in at the front desk, turn to
take my place behind a 1999 copy of Sunset magazine, when the
doctor's assistant calls my name. She leads me into a small room
and takes my blood pressure (BP). She gets a reading of 196 over
95. " A bit high", she says. A bit high? I had taken it at home
only an hour ago with a reading of 119 over 72: I'll say it's a
bit high. During an insurance exam only a month ago, the nurse
took a reading of 121 over 70. A bit high?
I mentioned the high BP reading to the doctor when he came in. "
Oh that thing," pointing to a little electronic device,
"everybody tells us it reads high. Just forget about it and use
your home reading..."
Uh huh. I'm a bit confused. Haven't we all been inundated with
public service announcements about high blood pressure
(hypertension) for many, many years? "Have your blood pressure
checked regularly," the radio announcer would say. High blood
pressure is indeed dangerous. According to the American Heart
Association, about 65 million Americans have hypertension. From
1992 to 2002, the death rate from high blood pressure increased
by 26.8 percent, and the actual number of deaths rose by 56.6
per cent. Now, thanks to recently revised high blood pressure
classifications, one study from the University of Illinois says
that maybe 60% of all American adults may have high blood
pressure. Yikes!
Hypertension is associated with increased risk of heart failure,
stroke, heart attack, kidney failure and liver problems. There
is no question that keeping an eye on blood pressure should be
an important part of any healthy life style.
Yet, who would have thought that performing a seemingly simple
blood pressure test, could be so fraught with potential mistakes
and even lead to misdiagnosis and improper treatment? Three
things have an effect on your blood pressure reading. The
patient, the test administrator, and the equipment.
Some people simply get nervous whenever they go to the doctor's
office, this phenomena is sometimes called 'white coat
syndrome.' Other factors that the patient brings to the test
might include whether or not the patient was exercising, or
maybe 'ran up the stairs' to make the appointment on time.
Drinking, coffee, and taking certain medications just prior to
the test may affect results.
As for the test administrator, try to remember the last time you
had your blood pressure taken. Did the nurse:
* Ask if you were on medication, had been exercising in the
last hour or two. Ask if you had been smoking or drinking
caffeine prior to the test? * Did the nurse have you wait
quietly in a chair for several minutes before starting the test?
* Did the nurse check for proper positioning of the cuff (check
for a pulse)? * If you are a larger person, or smaller person,
did they use the appropriate size cuff. * Did they raise your
arm and support it 'above' your heart while taking the
measurement? * If your result was unusually high or low, did
they repeat the test, waiting at least two minutes.
Any deviation from the list above could result in an inaccurate
reading. Now think about the consequences. With an artificially
high reading, you'll be going home thinking you have high blood
pressure when in fact, you may not, and conversely, with an
inaccurate low reading, you'll be going home thinking you don't
have it, when you may.
One other factor that can give the wrong result is a poorly
calibrated instrument. Blood pressure is taken with a
sphygmomanometer (BP cuff) . There are three different types,
mercury, aneroid and digital. All three have advantages and
disadvantages. The mercury sphygmomanometer, is the most
accurate, but all three require routine calibration. The real
question is; does that ever happen? Ask your doctor when was the
last time his or her BP cuff was checked for accuracy. The
American heart Association recommends BP equipment be checked at
least every year.
What about checking your blood pressure at home? Not a bad idea.
A recent report printed in the March 17th issue of the American
Medical Association, says "Home blood pressure monitoring may
have better prognostic accuracy than office blood pressure
measurements for patients treated for high blood pressure."
Hypertension is a real killer. Keeping tabs on your own blood
pressure only makes sense. Whether you do it at the doctor's
office, the drug store, or at home, learn more about how its
done, and what is required to obtain an accurate result. Blood
pressure testing may not be rocket science, but it IS science,
and the patient and the medical professional should regard the
test as seriously as the disease itself.