Discussion about blood pressure that I would like to share with you.
Use the correct cuff size.
The reason I mention the patient’s weight is important. When measuring blood pressure it is necessary to use the correct size cuff.
He admitted that many times he had been tested with a standard cuff. Most times when you go to the physician’s office the standard cuff is attached to the blood pressure monitor; it is generally suitable for average size patients, but in the last decade there are many patients who are no longer considered “average size.”
Using a standard size blood pressure cuff on a tiny elderly woman is no more accurate than using a standard cuff on a large male. It will give you inaccurate results which may lead to a false sense of security or unnecessary anxiety.
Often the technicians pay little attention to the cuff size; try to become aware and mention it if you feel the cuff is incorrect. The actual cuff should cover 80% of the upper arm circumference. It should be snug with no gap hanging, but not so tight that it makes your arm feel like it will explode.
Make sure your arm is elevated to a 90 degree angle related to your heart and not straight down by your side. Bring your home monitor to the office visit and compare both machines.
White Coat Syndrome does exist.
Patients often experience this phenomenon, which is increased blood pressure just while in the physician’s office.
This is possibly due to anxiety about learning the unknown, not following through with doctor’s orders or just being in the office setting. It may be temporary but could be a sign of future consistent hypertension.
The best way to document white coat syndrome is to purchase a home blood pressure monitoring system and check at different times of the day throughout the week. Use a log book for documentation to look for patterns.
The reverse may be true as well; you may have normal readings at the doctor’s office, health fair or pharmacy and high readings at home. This too can lead to hypertension in the future.
Caffeine is a factor.
Caffeine can influence your blood pressure even if it usually runs normal. The theory is caffeine causes your adrenal glands to secrete an increased level of adrenaline (stress hormone) which can raise blood pressure.
Each person reacts differently to caffeine but people who are overweight or older than 70 are more at risk. Try to limit caffeine to no more than 200mg a day or 2 mugs full of coffee or caffeinated drinks. Avoid caffeine after 3p.m. and before strenuous exercise or physical labor.
Try to test your blood pressure about one hour after ingesting caffeine and if your pressure jumps 10 points, think about reducing your caffeine intake. Never stop suddenly since it can produce jitters and headaches.
Alcohol and cigarettes too.
Drinking more then 3 drinks at a time or nicotine from cigarettes can elevate your heart rate and blood pressure temporarily which can become permanent.
Alcohol supplies empty calories which turn to fat as well as interfering with blood pressure medications.
Think about sticking to one serving of alcohol (5 ounces of wine, one 12 ounce serving of beer or 1.5 ounces of hard liquor). Smoking constricts blood vessels which increases blood pressure instantly. Avoid tobacco completely.
Weather plays a part.
Blood pressure elevates in the winter since your vessels vasoconstrict (close up) to help your internal organs achieve proper blood flow.
Blood pressure can change with the barometric pressure during storms and change in weather. Warm weather can vasodilate (widen) vessels to help you cool down and lower blood pressure. Weather related blood pressure issues tend to affect those over age 65.
After menopause, blood pressure tend to rise due to a reduction of the hormone estrogen and an increase of body weight.
As we age hormonal changes can affect men and women in how they tolerate sodium intake. Taking birth control pills may also impact blood pressure values in certain women.
Look for blood pressure patterns
Usually your blood pressure is lowest during the night time when you are in your REM or deep sleep. The pressure starts to rise after 3am due to hormones preparing you to wake up.
It rises progressively during the day with the peak in late afternoon to evening and then drops off again. If this pattern does not exist it could be due to sleep apnea, an adrenal tumor or kidney problems.
Always consult your health care provider if you find abnormal blood pressure patterns. Night shift workers also have changes in blood pressure patterns due to disrupting circadian rhythms.
Blood pressure readings can vary from day to day. If you have diagnosed hypertension make sure you are taking your medication correctly, exercising regularly, avoiding tobacco, practicing stress reduction, limiting alcohol and caffeine.
Try controlling your blood pressure which is an important step in reducing your risk of future cardiovascular disease – especially when you have diabetes!
by Roberta Kleinman, RN, M.Ed., CDE