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Empowering Healthcare Healthy Living Preventive Health Uncategorized

Misreading your blood pressure: 6 ways we go wrong

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Once we’ve established that you’re breathing and you have a pulse, your blood pressure is a crucial vital sign. Even when you’re feeling well, that number can determine if you’re at risk for a stroke, heart attack, heart and kidney failure, vision loss, foot or toe amputations or the other dire consequences of blood vessel damage.

Getting the most accurate measurement is important.

If your real pressure is actually lower than what you measure, you might be overtreated – and suffer side effects from too much medication. If you’re relying on incorrectly low BP readings, you’ll be lulled into a false sense security while high blood pressure is silently damaging the vessels and organs of your body.

Here are six common ways to get the wrong number.

#1 Position and Posture

The ideal position for measuring your blood pressure is sitting with your back supported and your feet resting comfortably on the floor. If you cross your legs or clench your teeth, your blood pressure will go up.

The arm on which the blood pressure cuff is attached should be supported at the level of the heart. If your arm is hanging down, the reading will be higher. If you are contracting muscles, your pressure will go up. Your arm should be supported by the healthcare provider, a table or an armrest.

#2 The Setting

White coat syndrome is when your blood pressure is higher when a doctor or nurse is measuring it. Even healthcare providers can have white coat syndrome, but hopefully their own pressures don’t go up when they look in the mirror.

If I suspect white coat syndrome, I ask my patients to measure their blood pressure at home and at work with a reliable blood pressure machine. I sometimes lend out a calibrated machine from my office. You can find a list of machines tested and approved by Hypertension Canada on the website at hypertension.ca.

I often ask a patient to close his eyes and imagine that he is in his living room, but if he imagines his wife squeezing his arm and telling him to take out the trash, his pressure will be even higher.

#3 How You Breathe

You’ll get a higher reading if you hold your breath, if you are straining and when you’re talking. I politely ask my patients to stop talking and remember to breathe.

#4 Exertion or Exercise

When we exercise, the heart is working harder and both blood pressure and heart rate increase. Once we’re back to a normal resting heart rate, blood pressure is usually lower for the hour or so after exercise. The long-term effect of regular moderate physical activity, such as walking or cycling, is better blood pressure control.

If you measure your blood pressure just after running up the stairs, your reading will be higher but after five minutes, it should be back to your usual resting level. If it isn’t, you may be deconditioned. Ask your doctor to guide you in finding an appropriate level of physical activity.

#5 Equipment

A cuff too small for your upper arm will give a falsely high reading. A cuff too large will underestimate your pressure. Most cuffs have markings to indicate the correct fit.

If you are relying on an inaccurate or unreliable machine at home, you could be under or overtreating your blood pressure. This is especially important if you have a very slow or an irregular pulse rate. If the cuff deflates too quickly, it will not pick up the moment when the pressure in your artery matches the pressure in the cuff. You may get a falsely low reading.

Most pharmacies calibrate their blood pressure machines, but the cuff will not fit every individual and after a thousand people use a machine, it may need recalibration. I frequently see patients bringing in impossibly high and low blood pressure numbers.

When I recheck their pressures and find them normal, I ask them to use the drug store machine as a random number generator for the next 6/49 draw.

#6 Technique

Many patients have an auscultatory gap. In this case, the systolic pressure (the top number in the BP reading) is much higher than expected. When the doctor or nurse is listening over the arm as the cuff deflates, the pulse is heard, disappears and reappears before finally disappearing again at the diastolic pressure (the lower number).

If the cuff is not inflated high enough, the true systolic blood pressure is missed and mistaken for the reappearance of the pulse at a lower pressure.

With very high blood pressure, most machines will miss the top number and give a falsely reassuring reading. This can also happen in the doctor’s office if the cuff is not inflated high enough.

A lot of people recheck their blood pressure right after getting a high reading. They’ll repeat this until they get a number they like better, but with successive readings, they will get falsely low readings due to congestion of the veins in the arm. This muffles the volume of the pulse and results in an incorrect measurement.

It’s better to fully deflate the cuff, take your arm out and wait at least a minute before taking another reading.

Because your blood pressure has a tremendous impact on your future wellbeing, you need the most accurate measurements.

To learn more about “What You Should Know About High Blood Pressure”, come to my next free public lecture on behalf of the Burnaby Division of Family Practice’s Empowering Patients series.

I’ll be speaking on Friday, January 29th at 7 p.m. at the Confederation Community Centre at 4585 Albert Street in North Burnaby (near the Eileen Dailly Pool and McGill library). Register online with lcullen@divisionsbc.ca or call Leona at (604) 259-4450.

 

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Burnaby Division of Family Practice Empowering Healthcare Healthy Living Preventive Health Uncategorized

What you should know about blood pressure

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Have you checked your blood pressure in the past year? Do you know your numbers?

High blood pressure – or hypertension – is an extremely common condition. When unrecognized or untreated it can cause catastrophic effects in your body.

To discover what you need to know about high blood pressure, let’s debunk 5 common myths about blood pressure.

Myth #1: It’s just a number.

Your blood pressure is one of the vital signs measured by health care providers. It is the pressure or force of blood against the inside of your blood vessels as it circulates to all the areas of your body.

The higher number on top is called the systolic pressure and it represents the pressure in blood vessels when the heart contracts. The lower number is the diastolic pressure corresponding to the heart relaxing and refilling with blood.

Pressures too high over time progressively damage blood vessels themselves and the vital tissues and organs they supply. Uncontrolled high blood pressure increases your risk for stroke, heart attacks, heart failure, dementia, kidney failure, vision loss and for men, erectile dysfunction.

Myth #2: I don’t need to worry about it.

High blood pressure is common. More than 1 in 5 adults has it, and your lifetime risk for developing hypertension is approximately 90%.

Blood pressure tends to increase with age. If your blood pressure is in the high normal range (130 to 140 over 80 to 90), you should be checked at least annually because you have a 40% risk of developing hypertension in the next two years.

Myth #3: If I feel good it can’t be high.

Most people with elevated blood pressure feel perfectly normal.

In fact, our brains are more sensitive to abnormally low blood pressure; we might feel lightheaded on standing, break out in a cold sweat, feel nauseous and faint when it’s too low.

High blood pressure often causes no symptoms until vital organs or tissues are significantly affected, such as with calf pain with walking or chest pain with activity due to narrowing of the arteries.

Myth #4: It’s only high at the doctor’s office.

With white coat syndrome, blood pressure is only high in a medical facility but normal most of the time. If you’re pressure is high in your doctor’s office, you should consider measuring your pressure with a reliable machine (See hypertension.ca for Hypertension Canada’s recommended models) not only in the quiet of your home but also at work where you spend most of your time.

When I discovered that some of my patients had higher blood pressures in their workplace than in my office, I coined the term, “white collar syndrome.”

Sometimes the presence of a spouse in the same room results in a higher reading; for others, a lower reading. You can probably guess which way it might go in your own home.

Myth #5: If I start taking medication for my blood pressure, I’m stuck on it for life.

Medications that lower blood pressure are not addictive and don’t cause dependence. But if you are already taking a drug to control blood pressure, if you stopped it or lowered the dose without medical guidance, your pressure would rise again.

The best way to manage blood pressure may be a combination of stress management, healthy lifestyle changes and medication if necessary. Each individual should work with a doctor who can find the best, most effective, custom fit.

There are proven lifestyle practices that can improve your blood pressure.

If you smoke, quit.

Limit alcohol to two or less drinks per day,14 drinks per week for men and 9 drinks per week for women. A standard drink is 1 can (341 ml) of 5% beer, 1 glass (150 ml) of 12% wine or 1.5 oz (45 ml) of 40% spirits.

Some individuals are sensitive to salt, and their blood pressure improves on a low sodium diet.

Maintain a healthy weight. For overweight individuals, a drop of 10 to 15 lbs can lower blood pressure.

Moderate dynamic physical activity (such as walking, jogging, cycling or swimming) 30 to 60 minutes 4 to 7 days a week can lower blood pressure.

The DASH diet was found to lower blood pressure. This is a diet high in fruits, vegetables, low fat dairy products, fibre, whole grains and fish, and low in saturated fats and transfats.

Dr. Herbert Benson demonstrated that the Relaxation Response common to meditation, prayer, yoga and mindful breathing can lower blood pressure.

To learn more about “What You Should Know About High Blood Pressure”, come to my next free public lecture on behalf of the Burnaby Division of Family Practice’s Empowering Patients series.

I’ll be speaking on Friday, January 29th at 7 p.m. at the Confederation Community Centre at 4585 Albert Street in North Burnaby (near the Eileen Dailly Pool and McGill library). Register online with lcullen@divisionsbc.ca or call Leona at (604) 259-4450.

Davidicus Wong is a family physician and his Healthwise columns appear regularly in the Burnaby Now, Vancouver Courier, Richmond News and the Royal City Record.

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Bring Your Best to a New Year

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As we grow older, each year seems to pass more quickly.

When I was five years old, a summer seemed to last a year; now each season passes in a flash. As we accumulate years in age, each year, month, week and day becomes a relatively smaller proportion of the time we have experienced. And maybe we’re not as attentive.

Yet with each New Year as I review the old calendar, I am always surprised with what has happened in the span of just one year. The media recapitulates the big world events with retrospective spins, but what matters most to you and me are our personal experiences.

There were birthdays, anniversaries and many other celebrations; time spent with family and friends; plays and musicals seen with my wife.

There were hard times too. I looked after two dear patients who died from the most aggressive cancers. Though palliative care is a special opportunity to give my best in the worst situations and care for a whole family when they need it the most, each visit to home and hospice takes its toll. I die a little with each death.

Last year, my wonderful Aunt Cecile passed away in hospice. Though we miss her deeply, we were fortunate to have had the time to express our love and say goodbye.

There were changes in our relationships: meeting some for the first time; saying farewell to others; a deepening of some friendships; a drifting apart with others.

Taking stock of the old year is practice for looking back at one’s life.

Before moving on, I ask, “What am I most grateful for?”

I reflect on the good fortune not just the bad; the wonderful, kind actions of others; my gracious patients who entrust me with their care; my colleagues who support me in our shared calling; the many good people I have worked with to improve the health of our community; my best friends, and my family.

What have I survived? How have I been helped? How have I helped others? What have I learned? How have I grown? The answers are measures of a year and of life.

Entering this New Year, what will we do differently? What activities should we do more of? What should we reduce? What should we cut out all together? What can we create?

This life and each moment are precious. We have nothing to waste.

This year, I’ll be continuing my work with the Burnaby Division of Family Practice in our free public health lectures.

On Friday, January 29th at 7 p.m., I’ll be speaking on “What You Should Know About High Blood Pressure” at the Confederation Community Centre at 4585 Albert Street in North Burnaby (near the Eileen Dailly Pool and McGill library). Register online with lcullen@divisionsbc.ca or call Leona at (604) 259-4450.

Davidicus Wong is a family physician and his Healthwise columns appear regularly in this paper. For more on achieving your positive potential in health, see his website at www.davidicuswong.wordpress.com.