We sat waiting in yet another medical exam room, my mother perched on the exam table, legs dangling. A nurse came in wheeling a device. She began circling my mom’s forearm with the blood pressure cuff.
My blood pressure rose: “Her feet have to be supported and her arm should be chest high,” I said, my strained voice betraying the stress of telling a nurse her business.
“That’s true with a manual cuff,” she said. “I have the IVAC automated device here.” Later, I checked with two doctors. The protocol for taking blood pressure is the same, manual or automated.
In the past year my mom’s blood pressure has been taken in medical exam rooms of two university research centers and an assortment of doctor’s offices. Nobody takes blood pressure properly. Rushed nurses are unconcerned about it, but small variables can make a difference in readings.
The American Heart Association’s Dr. Michael Hochman says:
Full bladder can add 10 to 15 points.
Poor foot or back support can add 6 to 10 points.
Crossing legs adds a couple of points.
Holding your own arm up or letting it hang can add 10 points.
Blood pressure cuff over clothes can add 5 to 50 points.
Cuff too small can add 2 to10 points.
Talking or being talked to can add 10 points.
Dr. Raymond Townsend, conducting a study for the American Heart Association says, “With just one or two simple errors in measurement techniques, a patient could suddenly find himself classified as having high blood pressure.”
Townsend goes on, “Of all the things that we do in clinical medicine, what is the single most important difference we can make to help someone live longer and live free of target organ damage? There's only one answer. It’s to measure and treat blood pressure correctly.”
Reading the proper methods for taking blood pressure below, you will likely know something your medical practitioner does not.
Empty bladder prior to measurement .
Rest for about 5 minutes in office before taking blood pressure.
Be seated, both feet flat on the floor.
Back should be supported.
Prop up arm on a support that is chest high.
Do not cross legs.
Cuff should be on bare arm, 2 to 3 cm above elbow.
Cuff should fit your arm, neither too tight nor too loose.
Do not talk, answer questions or even listen to information during the test.
The most accurate measure of your blood pressure will probably be with the purchase of a blood pressure cuff, used at home near the same time every day. Record the reading, and take the dated record along with you to your doctor visits. Even if the nurse or doctor takes blood pressure properly, visiting the doctor makes some people nervous, altering readings. A home record can give the doctor valuable information.
Dr. Townsend conducted tests of medical students from first year to fourth at a 2015 American Medical Association (AMA) meeting. "Out of 11 possible things to do right, the average they got was four.” Their potential mistakes tell patients that, “Suddenly they have a disease that they didn’t have yesterday,” says Townsend. Or a symptom is missed that could lead to a stroke or heart failure tomorrow.
It’s up to us to take control of our blood pressure readings.
