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Experts call for home blood pressure monitoring

About 73 million Americans — nearly half of them women — have hypertension (high blood pressure), a condition that propels blood too forcefully through blood vessels, increasing the risk of heart attack, heart failure, stroke, and kidney damage. If you have hypertension or borderline hypertension, you should be checking your blood pressure at home on a regular basis. That’s the major recommendation in a joint statement from the American Heart Association (AHA), the American Society of Hypertension (ASH), and the Preventive Cardiovascular Nurses Association (PCNA). Although other guidelines on managing hypertension have endorsed home blood pressure monitoring, this is the first time experts have given detailed advice about its use.

The statement, which also urges that the cost of home monitors be reimbursed, marshals evidence that regular home monitoring gives a more accurate picture of an individual’s blood pressure than readings in a health care setting or merely occasional, casual monitoring (at home or in drugstores, for example). Regular, daily home blood pressure checks are also better than office-based readings alone for identifying the risk of a heart attack or other cardiovascular event, and for judging the effectiveness of a medication or other pressure-lowering strategy. Also, home blood pressure monitoring involves people more in their care, which can bolster their efforts to make behavior changes and take their medications.

Readings taken in health care settings don’t always reflect “true” blood pressure, that is, the average over an extended period of time. For one thing, blood pressure fluctuates over the 24-hour cycle, depending on a person’s activities. Also, some people have what’s known as white-coat hypertension — their blood pressure spikes upward in a physician’s office or other health care setting. Others have “masked hypertension” — normal in a health care setting but high at home. Home monitoring can also provide a better sense of how well a medication or other blood pressure–lowering strategy is working.

In adults, hypertension is defined as a systolic pressure (the upper number) of 140 or greater or a diastolic pressure (the lower number) of 90 or greater (see box below). Another 60 million American adults have prehypertension (a range of 120 to 139 for systolic pressure or 80 to 89 for diastolic pressure). Home blood pressure monitoring could help clarify their situation and establish the need for treatment, according to the new advisory statement.

Blood pressure category

Systolic (mm Hg)

 

Diastolic (mm Hg)

Normal

<120

(and)

<80

Prehypertension

120–139

(or)

80–89

Hypertension stage 1

140–159

(or)

90–99

Hypertension stage 2

≥160

(or)

≥100

Source: American Heart Association

There’s no cure for hypertension, but it can be managed with lifestyle changes and often with medications. Blood pressure is a key consideration in making such treatment decisions. Defining the goal as blood pressure below 135/85 — or below 130/80 for people with diabetes or kidney disease — the AHA/ASH/PCNA made the following recommendations:

Buy an oscillometric monitor (one that doesn’t require the use of a stethoscope). It should work with a cuff that fits on the upper arm; wrist and finger models are not recommended. Home monitoring devices are available at drugstores and medical specialty shops, as well as through catalogs and on the Internet. They range in price, from around $50 to $100.

After you buy the blood pressure monitor, take it to your clinician’s office to check its accuracy and your technique. Discuss with your clinician how she or he would like to incorporate home blood pressure readings into your care.

To determine your starting blood pressure values, use the monitor for a week, first thing in the morning and before going to bed at night. Each time, rest for five minutes in a seated position and then take two or three readings at least one minute apart. Keep track of all your readings. At the end of the week, discard the first day’s readings: an average of 12 morning and evening measurements should give your clinician an idea of your true blood pressure and provide a solid basis for treatment decisions.

How to measure your blood pressure correctly

If you choose to measure your blood pressure at home, technique matters. Click here to watch a video from Harvard Health Publications that shows Harvard Heart Letter editor Patrick J. Skerrett demonstrating the right way to take a blood pressure reading at home. This instructional video also offers tips for choosing a home blood pressure monitor.

Work with your clinician to determine how often to conduct home blood pressure monitoring. Keep in mind that blood pressure readings are highly variable, so an individual spike or dip should not be a cause for concern.

September 2008 update

Hypertension Health Report
Click to enlarge

Hypertension: Controlling the 'Silent Killer'

Stop the silent killer! Hypertension: Controlling the 'Silent Killer' lays out a step-by-step lifestyle program you can use to lower your blood pressure. It also covers blood pressure monitoring and medications. With the information we have today, there is no need for hypertension to be a killer any longer. Read more

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