Home blood pressure monitoring. Do you need it?  How to do it?

Blood pressure is an important vital sign.  Blood pressures should routinely run less than 135/85.  Some patients only have high blood pressure in physician or dental offices.  This is called “white coat hypertension.”

How to best monitor your blood pressure? I urge patients to do home blood pressure monitoring.  This entails using an appropriately fitting upper-arm cuff on a bare arm, emptying the bladder, avoiding caffeinated beverages for 30 minutes before taking the measurement, resting for five minutes before taking the measurement., keeping both feet on the floor, uncross your legs while sitting, keep the arm supported, with the bp cuff at heart level, do not talk during the blood pressure test.

How many readings to take?  Ideally, take two bp readings in the morning and in the evening.  Separate the two bp readings by at least one minute.  Do this once a week and record the average of the top number and the average of the bottom number. 

Why do home blood pressure monitoring?  I tell patients that they live in their homes, not my office.  So, if the bp is only high in my office… that’s okay.  Home blood pressure readings can confirm the diagnosis of hypertension after an elevated office blood pressure reading.  

How to pick a good bp machine?  It should be validated and fully automated.  Choose an appropriately sized upper arm cuff.  Have bp machine store measurements.  To get a validated machine, look at https://www.validatebp.org   Wrist cuffs are less accurate and positioning of the cuff over the radial artery may be difficult. 

Will my insurance pay for my blood pressure monitor?  Maybe.  Ask your physician to write you a prescription, then call your insurance to find out if it is a covered benefit.

Ambulatory blood pressure monitoring is another way to check blood pressures.  This involves wearing a monitoring device for 24 to 48 hours.  The bp is measured at regular intervals while the patient is doing normal activities.  This method of monitoring is more thorough, but is not widely available outside of academic medical centers.