Transcription:
Monitoring Your Blood Pressure at Home

Monitoring blood pressure at home can help people with high blood pressure to keep their condition under control. There are important things to keep in mind. As you monitor your blood pressure at home today, we are talking to Lance merits, an exercise physiologist at Upland Hills health, heart long and sleep center.

He has information that may help us keep track of our blood pressure better.

This is the inspire health podcast from Upland Hills health. I'm your host, Caitlin white. Well, Lance, thank you so much for being with us today. Can you start us off by telling us a bit about your role as an exercise physiologist at Upland Hills health, heart long and sleep center. Yeah, thanks for having me on here today.

At Upland Hills, I get the opportunity to work with many individuals to get their heart back on track. As they recover from a heart long or cancer event on a day to day basis. I more spend time evaluating participants of our programs, exercise ability, and developing a safe and manageable exercise program for them to help kind of build up their strength in stamina.

Typically, this is a pretty exciting role as no two days are alike. No two patients are alike. Uh, and many times after a heart event, a person has started on many new medications or they have ongoing challenges from the procedure or surgery being a clinical exercise physiologist. I. Get to observe and then respond to a really large variety of day to day changes.

Often I'm telling people that I'm very similar to a clinical kind of like personal trainer, but we, we address lifestyle factors as well, such as nutrition, sleep, diabetes, stress, anxiety, depression, tobacco usage, and more. So it's kind of like a personal trainer on steroids. And getting that ability to work with somebody right after they had a major life changing event is, is pretty rewarding.

Cuz a lot of folks are very receptive and, and wanting to do something about their health so that this big scary thing never happens again. Absolutely. So today's episode is all about monitoring your blood pressure at home. So who is a good candidate for keeping track of this at. That's a good question.

Not everybody needs to monitor their blood pressure at home. A lot of people get nervous when they go into the doctor's office, because at every office visit, they always measure your blood pressure. So a lot of people think that they need to have their, their blood pressure checked more routinely or, or more often at home.

But in fact, most people do not need to have a blood pressure cuff even at home. However about 45% of adults. That's, you know, kinda like one outta two people has high blood pressure and of those people that have high blood pressure only about 25% actually have that under control. So the people that would benefit from having a blood pressure cuff at home would be those that have been told you have high blood pressure or what we call in the medical world.

Hypertension hyper meaning high intention is related to the. Folks that have hypertension or high blood pressure or have been told that should probably have a blood pressure monitor at home. And then maybe some other specific groups that should have a cuff at home would be anybody that's starting or changing a blood pressure medication to make sure that really they're on the right dose or people that have conditions like diabetes or kidney disease or not your typical thought pattern.

A woman developing signs of pregnancy related high blood pressure or preeclampsia should also have a monitor at home. And lastly, if, if somebody's had high blood pressure readings at the doctor's office, we, a lot of people know the phrase, white coat hypertension, which is kind of a, a. Medical phrase or thought process of folks that maybe get a little bit nervous coming into the doctor's office or they're they get a little anxious and their blood pressure goes up.

A home blood pressure cuff can really help to give your doctor a better understanding of what your blood pressure is actually doing. If you're on the fence about whether or not you need a blood pressure cuff, I think of it the same way as a diabetic needing a blood sugar meter, you're able to get readings at home and at your doctor's office, but yet home readings can be a lot more valuable information to guide you and your doctor's decision because they give a little bit more frame of reference of what's going on.

Interestingly, as I was kind of thinking about this talk today, I was looking up some different research and articles. And back in 2017, a study was done looking at the benefits of using these home blood pressure, monitors and doctors gave away some 3000 monitors to people that had uncontrolled high blood pressure by the third follow up visit with their doctor, more than two thirds of the people had their blood pressure under control.

Even compared to the control people that were, were sitting and receiving typical therapy without getting any blood pressure monitor. And by the end of the study, nearly everyone had their blood pressure under control. I think the takeaway here is that doctors were able to adjust blood pressure. Because they can reliably monitor blood pressures.

Now at home home blood pressure monitoring can be really effective and really helpful tools to be managing someone's health. Well, what are some tips you might have for people getting the most reliable and accurate readings at home? I mean, should I be taking my own blood pressure or have someone else do it for me?

How does this work at. It's a good question. Not everybody has luxury of having somebody else there and learning to take blood pressures manually. It's a skill and something that you need to be pretty competent in how to do. But the main point of the, the question here is that absolutely, you can take your blood pressure at home.

I'll talk in a little bit about how to do this, but most blood pressure monitors that you buy for at home use are designed to be used by the person themselves or the person measuring their own blood pressure. If you have a blood pressure monitory, you purchase. Simply follow the instructions on how to check it.

And I'll talk about that in a little bit more in, in, in some more detail, but then once you feel comfortable with your technique, I usually suggest to a lot of our, our program participants to bring the monitor into your doctor appointment for the staff, to verify your technique and the accuracy of your monitor.

A lot of times following these simple steps, you can typically expect to receive blood pressure results that are as accurate or even more accurate than the readings at your doctor's. Because a lot of these home blood pressure cuffs are actually calibrated really, really well. And they're calibrated for all sorts of different levels of pressure.

So when somebody's, pressure's at 80, when it's at a hundred, when it's at one 20, those computers and those home blood pressure monitors now are self testing that, and so these units, when they start to go bad, they really go bad because they're no longer calibrating themselves. So somebody can get a really good unit.

And get really accurate blood pressure numbers because these things are calibrating themselves. It's the technology has really come a long way with these. Yeah. That is incredible that we have that technology in our homes these days now with so many on the market. How can I be sure if I have a good BP monitor, what are some of your recommendations?

This is a really common question. We get all the time. There are a lot of different monitors. There's a lot of different brands. There's features of blood pressure monitors out there. I typed into Amazon this morning and I saw over a thousand different options and that that's can be really overwhelming.

You know, when I talk about this to some of our patients, I, I start to break down some of the basics. For starters, there's really two different types of blood pressure monitors. There's an arm monitor where the cuff is placed kind of above the elbow. Most folks are familiar with that. That's the type of blood pressure you get checked when you go into the doctor's office for the most part and there's wrist monitors.

One's where the cuff is placed just above your wrist joint. Both of these have their own pros and cons as most things do our monitors, the one where the cuff is above the elbow typically are more accurate than wrist monitors. They often have a lot of bells and whistles with them that most people do not need.

Quite honestly like the ability to connect to a smartphone or have multiple users. However, as they may be the most accurate type of monitor, a lot of it's dependent on the correct fit and placement of the cuff. So just because it's an accurate monitor isn't guarantee, you're gonna get perfect results with it.

Also, our monitors are typically more bulky compared to wrist units. So if somebody is always taking their blood pressure at home, you know, at the kitchen counter and they wanna leave their cuff always there, that might be a great fit for them. But somebody that travels a lot or wants to take their cuff with them to work, these are big units to be transporting back and forth.

and so that's kind of where wrist monitors can be a little bit more beneficial. They're often lightweight, very portable. Like I said, most folks find them to be very comfortable and more comfortable than the arm monitor because they're only clamping down on, on your wrist instead of your whole upper arm.

And for some people with really large arms circumference, whether that be really muscular or really. Kind of large fat deposits on your arm. The risk cuffs might be the only option because the arm cuff might not be large enough to go around your arms. However for wrist cuffs to be accurate, the measurement needs to be taken at heart level.

And a lot of people, they put the wrist cuff on and they kind of hold it down by their side and their blood pressure numbers are all over the place with accuracy. So it gets really challenging, uh, to say, well, I'm sorry, you bought a really nice monitor, really expensive, but these numbers don't seem to paint the whole picture.

Let's look at your technique. When we look at somebody's technique, then we can tell a little bit more detail about what it is that's contributing or failing. As far as their, their management of their home blood. Pressure's going. and then I think a lot of people end up asking us, you know, so there's the basics, there's the nuts and bolts of the different types of monitors.

People then say, okay, when it comes down to it, well, what's your brand, you know, what's the model I should go look for at, at Walgreens or Walmart, whatever. And with all of those different types of monitors out there, you know, I just talked about the basics. You also wanna make sure that you're buying one, that's gonna best meet your needs.

I recommend to every one of our patients to go to the website, validate bp.org. That's not my website. It's not any website of our hospital or anything. That's, uh, American medical association put together this website called validate. And that's just like the word V a L I D a. T E B P B as in boy, P as in paul.org and this website, American medical association put together for monitors that have been authenticated and validated for clinical accuracy as they go through a whole independent review process.

That list is super beneficial because though. You might have bad technique problems. If you buy a cuff off of that list, you at least know for the most part, if you're monitoring your blood pressure and using the correct technique, that thing is gonna give you about as accurate a blood pressure as, as you possibly can get.

And you can even filter on that website saying, I want a home unit. I want a wrist unit. I want a cuff unit. If a monitor's on that list, you can be sure it's gonna read accurately too often. People come into our cardiac rehab program and describe the numbers that they've been seeing. And it's like, gosh, those are not the numbers that we've been seeing on you though.

We have 'em bring in their unit. And when they do the monitor that they bring in often is this old monitor, you know, that they had from when their, their mom was having heart problems or a sibling or a neighbor or a friend. Or it's a unit that they just went off and looked on Amazon and they found one that, you know, had 4,005 star reviews or whatever.

And unfortunately, a lot of those end up not working so great or they're not calibrating well anymore. And so. People are relying on these, these monitors and it's not giving 'em great information. And it ultimately isn't helping really anybody at that point. So I really recommend everybody before I give any sort of brand recommendation or anything like that.

Go to validate bp.org, to look, to make sure that whatever you're gonna spend your hard earned money on has been shown to be value like validated and a. after you review that list, you want to consider the cost. A lot of these units can go from $30, which can be affordable for a lot of people all the way over to a hundred dollars, which can be quite pricey.

And some insurance companies can reimburse you for buying one. You'd have to check with your insurance carrier on that, but some of our participants in our program have had success with that. But then you wanna look at what features you need. Some of these models sync to your phone or your computer.

Some models can detect you your regular heart rhythm. So it can say, Hey, you're experiencing irregular rhythm like atrial fibrillation or your heart rate seems to be higher than what it typically is, or it's lower than what it typically is. Some models are capable of logging two different users, you know, on a personal level.

My folks have, have one of these type units because they switch a little button on there and it's person one and person two. And so they don't need to have two different units. They both can use the same cuff and it keeps track of person, one being my dad and person two being my mom, the. You really wanna consider what features are worth paying for?

You know, if you're a single person, you probably don't need this capability of having two people on there. If you're not a tech savvy person, you probably don't need the capability of having it synced to a smartphone. And lastly, you wanna check the fit and the accuracy of the monitor. You wanna make sure that the monitor you choose fits your upper arm or your wrist.

A lot of these units come with more than one cuff. I often encourage a lot of our participants. You know, I I'm picturing some right now you get some of these senior female quilters that have, you know, quilted for years and they have these cloth tape measures at home. Take a tape cloth measure. Go around your arm.

See what your, your arm circumference is. If it's, you know, 35 centimeters for your arm circumference, make sure when you go to Walmart to buy a unit, you look on the box and you say, Hey, the cuff on this unit says it's appropriate for somebody with an arm circumference 30 to 40 centimeters. Well, you know, then you're gonna, uh, probably be appropriate for that unit.

When it comes down to it, the brand I most commonly see on validate BP and I, I don't have any sort of commission or anything from this company, but the company is Aron O M R O N Aron models. Not all of Aron's models are validated, so they aren't the world's picture most company, but most of their models are the other thing I like, at least with where I work, a lot of their models are available at Walgreens or, um, at Walmart.

So somebody can buy those things locally. Or a lot of pharmacies have those. You can also buy 'em on websites like Amazon, other brands that I see folks bring in that are on that validate BP list would be Walgreens has a couple of models on there. And then another brand called with things that I've seen at target.

My go to recommendation for a lot of people is the Amron three series or the Amran bronze series as these are. High quality validated units, but typically start about $35 at place like Walmart, Walgreens, Amazon. So they can be very attainable for a lot of people. Well, Lance, we touched on this earlier, but how do I know I am using my BP monitor correctly?

That's a good question. You could have the most accurate monitor in the world, but it's only as accurate as proper technique is used for folks that I, you know, can't be right in front of and, and sit and observe and talk through the technique. I often suggest searching on YouTube million hearts campaign out of American heart association, put together a YouTube video called how to use your home blood pressure monitor.

And it's a really basic, it's like a five minute video and it talks exactly through the process. I'll talk through it with you now. It's pretty simple. First, you don't wanna smoke, drink or consume any caffeine or alcohol or exercise for at least 30 minutes before taking your blood pressure. Those type things can really affect the rating that you're gonna get.

Ideally, you should also wait 30 minutes after having a meal. Before checking your blood pressure, you should try to use the bathroom and empty your bladder and then sit quietly for five minutes. Sometimes folks come in and their blood pressure has always been great. They come in and see us, their blood pressure's high.

We say, all right. Did you have any caffeine today? Yeah, I just had three cups of coffee. Do you typically have caffeine? No, I don't. Well, right. There is part of why their blood pressure's high or it's, you know, your blood pressure's kind of high. Uh, why do you think that is? Well, I don't know. Have you gone to the bathroom late?

No, I haven't gone to the bathroom. You know, holding your bladder can really cause your blood pressure to. When you're sitting quietly before taking your blood pressure for five minutes, you don't want to talk during that time or while you're measuring your blood pressure. Cuz again, that could raise it.

So now that you've done that you're ready to measure your blood pressure. You wanna wrap the cuff around your bare arm without any clothes between your skin and the cuff. You know, a lot of people say, well, it's a thin cotton shirt. Uh, you know, or it's a big, it's a long sleeve button up shirt. It's kind of cumbersome to take off.

Well, You wanna take it off because you really wanna make sure that you're not restricting your arm at all, is that could affect the accuracy of your reading. You wanna sit on a sturdy chair with a supportive back with your feet flat on the ground. People usually. Know, this one, they say, that's right. You know, I can't cross my legs when I'm getting my blood pressure checked.

They, a lot of folks know that. Yeah, that's right. You know, the doctor always tells me I can't cross my blood pressure and they're right. Crossing your legs can raise your blood pressure by about five points. So you wanna make sure your feet are flat on the ground. Rest your arm on a flat surface with the cuff of the monitor, being at about the same height or level as your.

A lot of people ask the question, you know, does that little tube need to be a certain direction? Does it need to be coming down? My, the length of my arm, does it need to be going out by my elbow? Does it need to face up towards my, my chin? No, nothing to do with the tube coming off of the cuff, but now you're ready to, you know, hit the start button on the, the blood pressure machine or, or whatever they call the, the button, the start button or the take blood pressure button, whatever it is.

You wanna be sure you take your blood pressure at about the same time, every. And when you do measure it, you want to take two or three readings with about a minute apart between those readings, they used to say, take your blood pressure, wait five minutes, check it again. Now they're more saying, Hey, take, take two readings or three readings.

And when I say they am meaning like the American heart association. Take these two or three readings with about a minute apart, and most doctors will recommend that you take your blood pressure right away in the morning before you take any medications. And again, between kind of noon and four, the thing I tell my patients about that is that if you check it right away in the morning, before you take anything else, it kind of tells us, Hey, what's the picture looking like when you know, Jim is off of his blood pressure medications, and then you check it again between noon and four, we can kind of see, well, now that Jim.

Has had his medications. What are these medications doing to affect his blood pressure? Recording the measurements will really help to give your doctor a better picture of what your blood pressure is doing throughout the entire day. Not just, you know, one snippet here at seven in the morning and another time at five at night.

Some common technique, errors that have drastic effects on your, on your blood pressure measurements. One was our, I already mentioned about like crossing your legs, but other things can really affect the reading. Like placing the cuff over the closing can increase your blood pressure by like an impressive 10 to 40 points.

So it. Thinking, oh, it's just a thin cotton shirt could really kind of give you artificially high numbers, having a full bladder. Like I talked about empty your bladder, having a full bladder, it could raise your pressure by about 10 to 15 points talking during your blood pressure reading can raise your point, your blood pressure by 10 to 15 points.

So it all comes down to technique, technique, technique. The tools that you purchase can only be so effective at helping to monitor your and guide your health. The technique is worth everything when it comes to using them accurately. Great. Well, as we wrap up our conversation today, lands, you know, we've been talking about monitoring blood pressure at home, but if we have to monitor our blood pressure, that usually means it's pretty high.

So what can we do to just get our blood pressure down in general? For a lot of folks, you know, medication ends up being a very viable option and, and folks talk about that with their doctor. I'm kind of old school. It's like, well, let's try other things before we get to medication. And there is a time and a place for medication, definitely.

But I think if somebody's right on that, that borderline, or if they're on medication, they wanna see if they can get off of it or reduce their medication or avoid having additional ones. That's a recent look at kind of non-medication ways of treating your blood pressure. I think a lot of these are really well known to people what's not so well known is the effects that they can have on your health.

So things like weight loss, all right. For every like one kilogram that somebody loses in their, their body weight. One kilogram is 2.2 pounds. So if you lose basically two and a half pounds, you can drop your blood pressure by about five points simply by dropping two and a half pounds. Following a healthy diet.

The one we recommend a lot in the cardiac world is the dash diet it's dietary approach to stop hypertension dash diet it's rich in fruits, veggies, whole grain foods. Low fat dairy foods, but really looking also at low sodium content of foods and low fat content of foods that can drop blood pressure by like 11 points, just watching the salt intake in your diet.

So cutting out a thousand milligrams a day in of, of sodium in your diet, just dropping it by a thousand over time can drop your blood pressure by five to six points. Increasing your intake of potassium. Okay. So you, you think about potassium foods, you think about bananas is a great source of potassium having about 3,500 to 5,000 milligrams of potassium a day can drop your blood pressure by about five points.

Exercise. Gosh, that's what we spend a lot of our time doing in cardiac rib exercise, aerobic exercise. So exercising 90 to 150 minutes a week can drop your blood pressure by about eight points on average. Doing strength training can also drop your blood pressure by about five points. Monitoring your, your alcohol intake.

So men limiting your alcohol to no more than two drinks in a day or women. No more than one drink in a day can drop your blood pressure by four to six points for your blood pressure. So a lot of ways that you can get a lot of bang for your buck for dropping your blood pressure before medications even become involved or to reduce the amount of medications that you're on, simply by making some different lifestyle choices.

A lot of those, you do. One of them, they start affecting the other. So if you start exercising likely as the case, your weight might, might change some for the better and also drop your blood pressure more. That way, all of those are great things to consider when facing the doctor saying, Hey, you know, we we've gotta have a talk your blood.

Pressure's kind of getting into that elevated stage or that hypertension stage. These are things that could really set you up for having a stroke or a heart attack or. There's easy steps you can do to avoid that, or kind of change the course by improving some lifestyle habits. And like I said, medications at, at have their certain place.

And that's something that your doctor would send, talk to you about at what time that's appropriate and at what blood pressure that's appropriate. Well, some great information covered here today, Lance, thank you so much for joining us. The tips covered in today's podcast are available in a document you may print for future reference.

You'll find it in the resource library@uplandhillshealth.org. It's also listed@thebottomofthehomepageatuplandhillshealth.org under featured health information. This has been the inspire health podcast from Upland Hills health. I'm Caitlin white. Be well.