New Hypertension diagnosis: help taking BP readings properly (variable depending on what I do)

[Potatosareawesome]

Hi,

BACKGROUND (please scroll for question):

I (41) did a NHS (U.K.) health check, followed by a 7 day home BP Monitoring, giving an average of 151/108

The Dr suggested Ramipril, but also suggested lifestyle changes might work

The last 2 months I’ve changed my lifestyle (instead of asking to go on medication), recording everything, now doing mild exercise every day, eating healthier, reducing caffeine etc.

My weight has dropped around 12kg (10%) and I feel way better.

Originally my BP showed a linear drop too, getting to an average at one point of 124/80, however recently has risen again (I’m not sure why) to an average of 129/88

QUESTION:

As I’ve had a BP reduction, I want to continue with my lifestyle changes (instead of moving to meds).

However, I’ve found (as I’ve now been doing multiple daily BP tests over the 2 months) I think I can sort of semi-consciously “fool” the machine…

If I sit in my chair and take it, it will likely be near 130/90, but if I sort of relax/dissapear in my head and breath very slowly, exhaling more when the monitor is on, it results in lower BPMs 124/80

Which do you think is more valid as a “resting” BP… is it a sort of average when you’re “normally rested” or “the lowest it goes” when you put unusual effort into being rested?

(I’ll obviously discuss this all with my Dr but would be very keen on your thoughts)

[Hidden]

Hello

It’s good you’ve made lifestyle changes, the medication can be an insurance policy though but each makes their own decision. I took it as I didn’t think i could make changes fast enough and two years later the conclusion is due to my congenital heart defect and need to keep heart rate low (like 60) I can’t / shouldn’t exercise. But that’s me, working on diet though.

Regards taking blood pressure, hoping you’ve got a reliable machine, the links might help if you haven’t seen already

bloodpressureuk.org/

NHS checker is also good to interpret readings -

nhs.uk/conditions/high-bloo...

I’ve been advised on here to take three readings, ignore the first and take average of the other two and take that as your reading. You should have been sitting for a while before take and ensure leave a few minutes between each reading.

Regarding your point about “fooling the machine”, in some ways right. If you keep moving (the right monitor will result in an error message anyway), talk and be agitated then yes it will be higher. Bit like when you go doctors and it can often be higher - some say white coat syndrome.

So if you relax, sit right, have the cuff at right height, leave enough time between and before taking readings you should get a truer reading.

Hope helps

[Potatosareawesome in reply to Hidden]

Hi fishface,

Thanks for your helpful advice.

I’ve checked your link and fortunately my machine is clinically validated

I’m not sure I’ve actually asked my question very well… what I’m trying (badly 😂) to ask is:

1). I sit down, wait 5mins so I’m relaxed, put the BPM on and go = 129/89

2). I sit down, wait 5mins so I’m relaxed, put the BPM on AND then sort of fool the machine by entering a hyper relaxed state (more than I normally would in a typical day) and breath slowly = 124/80

Is 2 ok to use to track my BPM or should I use scenario 1 as it’s more “typical” of my relaxed state?

(with both I take 3 and average)

Thanks for your help

[Hidden in reply to Potatosareawesome]

hi sorry I missed this earlier, based on 1 and 2 there is very very little between them, they will make very little difference to any decisions on how well your BP is being managed. What it shows is you can make a very very minor difference but not sufficiently to make a decision different based on reading and a decision based on reading 2. Those readings dependent on your age and height seem pretty normal. hope helps

[Hidden]

Forgive me and I may be wrong but it seems to me you are trying to artificially drive down your BP readings so as to avoid the GP recommending medication. If you are trying to induce a semi shut down body state to get lower readings, that doesn't fool the BP machine, it only measures what it detects, it has no intelligence to decide what state your body is in whether resting, semi comatose or otherwise! So in my view you should be taking your BP readings as a best of three in a normal relaxed state with the cuff at heart height which I understood is the norm (rather than a false resting state) and that will be assessed as such by the GP, and a decision made based on that as to whether meds are required. But if you are reluctant to take meds and they are recommended, your GP should be able to explain to you what additional risk you are taking on to help you decide what to do, for no-one can insist you take them, that is entirely your decision.

[Potatosareawesome in reply to Hidden]

Thanks LowerField that was exactly what I was asking

I take my BP daily adopting exactly the recommended posture (BPM at heart level etc), but the guidance just says “relax” and I couldn’t exactly work out what this meant as I seem to (after measuring BP for 2 months) actually enter a deep state of relaxation where my BP drops considerably vs “I’ve sat still and am not doing anything but not consciously trying to intensively relax”.

I will check with my Dr (not easy to get hold of or (seems) particularly knowledgable about hypertension) first, but sounds like I should be ignoring these “deeply relaxed” readings and selecting the ones where I’m just sitting still/being “averagely” relaxed.

Thanks

[devonian186 in reply to Potatosareawesome]

Do you take a morning and an afternoon reading?

What is likely to have changed during the winter is the temperature of the room in which you take a reading which if cool will likely raise your BP. So before you become too concerned check your readings from different times of the day and ensure the room is warm and that you are relaxed rather than in a catatonic state or one of anxiety

[Anynomous]

Hi ,

You could try bp band like Aktiia . The are not accurate as ambulatory bp machines which take readings every 15 minutes like traditional upper arm cuffs machines . However they are good at tracking your bp silently for whole day. As far as your readings go the relaxed state is the state which you will consider relaxed without bp machine on a idle day.

Thanks.

[Potatosareawesome in reply to Anynomous]

Thankyou, it’s very expensive but I tempted by this device, it looks incredible!

[Anynomous in reply to Potatosareawesome]

you could save by referring it to yourself. These days I think like , If we can buy a similar product to our loved one then we can buy it for ourselves . 🙂

[Mart25]

I have been on this forum before commenting on questions like yours. My Omron BP monitor says "Avoid eating, drinking alcohol, smoking, exercising, and bathing for 30 minutes prior to taking a measurement. Rest for at least 15 minutes prior to taking the measurement". Only then will you get a proper resting measurement. So a bit of mental or physical stress at anytime will increase your numbers, and a bit of deep relaxation will decrease it (as you have found). There are lots of learned medical publications on the question of relaxation prior to taking BP measurements. This one (ncbi.nlm.nih.gov/pmc/articl... suggests you should relax for 25 minutes! Maybe this is a bit extreme!

All the measurements you are taking are valid results but which is most relevant? It seems to me that you are trying to assess the state of your heart and circulation system in the type of rest that is normal for you, and can be reproduced. If you live your life in a permanent state of very deep relaxation (which I doubt) then your low BP measurement ("fooling the machine") is OK. But this feels wrong to me so, personally, I take my measurements after 10 mins of sitting, mentally alert and breathing normally.

I also recommend measuring a few times a day maybe once or twice a week for a few months and plot the numbers on a graph. It's all a bit geeky but it's very helpful (and hopefully reassuring). Also useful when anyone asks whether you know your blood pressure!

[Potatosareawesome in reply to Mart25]

Thankyou, (I can’t load the link you’ve put, it says there isn’t an article there), but that’s kind of what I suspect.

Fundamentally I want to know is it safe to continue with lifestyle changes as an approach to avoid medication but without exposing myself to unnecessary risk (gets complicated re. increased stroke risk vs reduction of other risks through being healthier).

I’m actually being super geeky, am measuring at least 3 times a day (same time, position, eating status etc) and all is plotted on a colour coded spreadsheet with 2 auto generating graphs!

I think, reading the other bits here, you’re right and I should relax (as in not have just run up the stairs), but not try to relax to a state which is atypical of my normal life as this isn’t representative of my “resting” state

[fishonabike]

I speak from personal experience of Hypertension as well as being an ex-nurse

The advice for taking BP readings is to take them when you are relaxed and to take repeated readings (three is good) then note the average - it is normal for the first reading to be higher than subsequent ones - i find it is usually much higher when an automatically inflating cuff is used, like they often use in hospital or the self-testing monitors in GP waiting areas and pharmacies - it have a monitor with a cuff i inflated myself.

Basically your approach sounds good, you are getting steady readings in a normal range and you have increased your activity levels as well as reducing you weight. At that level I don't think many GPs would be pushing you to take medication.

I was reluctant to take medication and resisted initially, eventually hospitalisation for a heart event which was treated with hypertensive meds helped me decide to take them

I have since brought my BP and weight down, like you through "lifestyle" measures and reduced my medication.

Like you I find that a bit of mind-clearing and focused relaxation helps with my readings - if you find this keeps your BP at a "normal level" why not try doing it anyway, during the day, as a calming/relaxation exercise

[Potatosareawesome in reply to fishonabike]

Thankyou.

A little concerned you did what I did and then had a heart event, but I guess that’s the risk we all have and it’s nice to hear you think my BPs are now almost in the non medication range.

I’m keen to give lifestyle changes at least one more month (as I feel amazing) and see what happens, but I’ll avoid the “deep relaxation” state when doing my measurements but try and do it in the day for health benefits (hadn’t considered that idea!) thanks a lot for suggesting it (and great to hear from a real clinician, thanks for your valuable time!)

[fishonabike in reply to Potatosareawesome]

Your Blood pressure readings are below the current threshold for treatment with medication - see nhs.uk/conditions/high-bloo...

My own heart event (Takotsubo Syndrome) was one for which the risk factors are currently unknown, it can happen to people with low and normal blood pressure

[Milkfairy Heart Star]

Hello,

My Cardiologist has asked me to monitor my blood pressure at the moment.

He instructions were to disregard the first reading and take it roughly at the sametime each day.

I take lots of medication that lowers blood pressure anminy BP is still borderline.

You have had great advice from everyone already.

The one thing I forget sometimes is to sit with my feet flat on the floor.

bloodpressureuk.org/your-bl...

[Potatosareawesome in reply to Milkfairy]

Thankyou

[fishonabike]

i'm not sure how important the "feet flat on the floor" instruction is - in hospital most in-patient's readings are taken while they are in bed, feet nowhere near the floor! - i think it's more about keeping still in a neutral position (e.g. legs & arms uncrossed, not lying all curled up or face down)

[Milkfairy Heart Star in reply to fishonabike]

I think the guidance applies to those taking their blood pressure at home in a sitting position.

I am unfortunately a regular at my Cardiologist's clinic.

The nurses before they take my blood pressure always ask me to sit, to uncross my legs and put my feet flat on the floor.