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Monitoring
High Blood Pressure
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Using a home blood pressure monitor can play an important role in bringing high blood pressure under control. Factors such as time of day, physical activity, diet, certain medications, and emotional stress all affect blood pressure. In addition, some people experience white coat hypertension-that is, their blood pressure appears high when it is measured in a doctor's office but is normal outside of a medical environment. Because home monitors can be used to obtain several blood pressure readings over a single day or longer periods of time, they furnish more complete information about an individual's usual blood pressure than single readings in a doctor's office. In fact, a study presented at the annual meeting of the American Society of Hypertension in May 2001 found that only 24-hour ambulatory blood pressure monitoring (ABPM) was a better measure of blood pressure than home monitoring. (ABPM measures a person's heart rate and blood pressure at regular intervals over a 24-hour period.) Who Should Use a Home Monitor? Self-monitoring of blood pressure is recommended for the majority of patients with hypertension. It enables us to track the effectiveness of blood pressure medications and may improve blood pressure control by increasing patient adherence to therapy. In addition, home monitoring may cut health care costs by reducing the number of doctor visits. Home monitoring, however, may not be suitable for some people because of technical problems-such as a very obese arm or irregular heartbeat-or because it increases anxiety. How Do Home Monitors Work? There are two basic types of home blood pressure monitors: aneroid monitors and electronic, or digital, monitors. Aneroid monitors consist of a dial gauge and a stethoscope attached to an arm cuff; the cuff is inflated by squeezing a rubber bulb. Because correct use of aneroid models requires good hearing and eyesight and a certain degree of manual dexterity, many older people find it easier to measure their blood pressure with an electronic monitor. Electronic units also minimize the possibility of human error, though they are more expensive than aneroid monitors. Electronic monitors are battery operated and use a microphone to detect blood pulsing through the artery. The units are equipped with an inflatable blood pressure cuff, which is attached to the upper arm or wrist. The semiautomatic unit requires the individual to manually pump up the arm cuff. In the fully automatic version, the arm cuff is connected to an electronic monitor that automatically inflates the cuff when the person presses a button. Cuff deflation is automatic in both models. After the cuff is properly inflated, the unit measures the person's blood pressure and pulse and displays the readings on a monitor. Obtaining a reading takes less than a minute. Some electronic models store readings in a memory or provide a printout of readings. Choosing an Electronic Monitor There are several factors to consider when selecting an electronic blood pressure monitor. For example, people who may have difficulty squeezing an inflator bulb should purchase a fully automatic unit. Individuals with visual impairment should look for a monitor with a large, easy-to-read digital display. An error indicator is also useful. Many individuals prefer to purchase a unit that has a memory feature, which ensures accurate recordkeeping. In addition, make sure the arm cuff is the proper size; cuffs that are too tight can elevate blood pressure readings. People with very large upper arms may need to purchase special cuffs, which are available in some pharmacies or can be obtained directly from the manufacturer. Note: We suggest purchasing an OMRON or LifeSource home blood pressure monitor. While wrist monitors are convenient and portable, several studies indicate that these devices may not be as accurate as arm cuff monitors. To improve the accuracy of readings from a wrist monitor, hold the wrist at heart level while the blood pressure is being measured. Finally, no matter what device you select, bring any newly purchased monitor to your next doctor's visit so that it can be checked for accuracy. From the 2002
edition of the Johns Hopkins Hypertension and Stroke
White Paper
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