This arrived in my inbox today and I thought it should be posted as there are often discussions about white coat syndrome and BP measurements. They are a bit scathing about the lack of checks by doctors - though also seem unaware that in the UKK in the past BP checks WERE done at every visit to the GP or hospital outpatient appointment. This lack of checks is a recent development.
"A new fact sheet from the PAHO lists the following eight requirements for obtaining an accurate reading: don't have a conversation, support the arm at heart level, put the cuff on a bare arm, use the correct cuff size, support the feet, keep the legs uncrossed, ensure the patient has an empty bladder, and support the back.
Though most guidelines recommend taking three readings, the "pragmatic" focus proposed in the international consensus accepts at least two readings separated by a minimum of 30 seconds. The two readings should then be averaged out. There is evidence that simplified protocols can be used, at least for population screening.
The authors of the new document also recommend preparing the patient before taking the measurement. The patient should be asked not to smoke, exercise, or consume alcohol or caffeine for at least 30 minutes beforehand. He or she should rest for a period of 3 to 5 minutes without speaking or being spoken to before the measurement is taken."
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When about a month ago I actually got to see my GP she said...have you taken your blood pressure lately? I replied yes, it was 155/75, she looked at her watch and said....that's fine!.....only on here do I read about taken a reading on both arms....so I did, there was a little difference....
It isn't really necessary all the time - but if you have checked it and there is a big difference, it needs to be investigated, Otherwise, just use the arm that is most convenient.
Never knew about the empty bladder, that was not mentioned when I learnt to take BP in nursing school! But then that was a long time ago, with the big metal box and a stethoscope🥰
I have just been called for an annual chronic disease check at the GP. In the letter it says to bring my own recent weight and height (this latter is difficult for someone livign alone who may have lost height due to vertebral fracture), and encourages me to have my own BP machine and to take 3 readings in the week before the check up. It does say to take 2 readings but nothing about the time of day, not eating, supporting arm etc etc. How can they assess my management without accurate readings of any of these things. Having lost 2 cm in height, by BMI will appear higher on their calculation and I might be started on other medication on that basis....all very unsatisfactory.
I was asked to do the same. I refused. I can't measure my height, I haven't got a long enough tape measure. My weight was done at my last BP check in April. Their scales add about 5lb to my weight compared to mine at home; so I said it was pointless to do it or it would appear that I've lost weight.
Regarding your list, most of the nurses comply (it's always the nurses who do it not the GPs). However to get to the nurse's office you have to climb a steep set of stairs, and they certainly don't give you 5 minutes first!
The worst is at rheumy appointments. I'm usually rushing and a bit nervous. Before I see him I have my weight and BP checked by a nurse. They give you no time to relax and refuse to take more than one reading. Last time it was 150/78. Normally I'm around 135 systolic. It wasn't remarked on though.
I had a hypertension review recently at the GP surgery. The nurse was very thorough and asked if I eat salt with my food. I said no. At the end she advised me to cut down on salt!
My mum was in a care home. They used to check her BP daily. Very good, I hear you say. Except they did it over her clothes, didn't rest her arm above her heart, and kept her chatting all through.
If you get a home BP monitor it will give full details of how to take your BP - and BHF amongt others have videos online. I always take mine at different times of day just for comparison. ..
I don’t monitor mine all the time, but about every 3 months I do a week’s worth of readings…am, pm and evening…and send off to GP. If you send it via eConsult it also works out the average - which is what is usually shown on records - but you can also print off all readings.
Many moons ago, the staff nurse in previous surgery said, come in 5 minutes early to you can sit down and relax in the waiting before I take readings.
Never been asked to take my own height and weight (although usually do to check against my home scales).
My BP machine is quite old and the instructions have long since disappeared. I do find that the time of day, whether sitting, lying, etc makes a lot of difference. Your GP sounds very good.
Hmm, I'd have to engage them in a probably useless conversation along the lines of well stretched out on a bed I'm my old height of 5'8" but sitting here in this little plastic chair the curve makes me more 5'4", well, maybe 5'5" but of course if I could sit right back and stretch out of my waist I could increase that a bit - which height would you like! I can stand completely upright in a swimming pool. How about that?
I’ve just had my 5 yearly NHS health check. They took my weight but not height and the results came back with adjustments to height according to my age, 1cm reduction per 10 years prior to age 70.
in other words, they assume that you are going to lose height...that seems strange. I know I have one wedge fracture and a subsequent degenerative scoliosis...so the height loss, though small is a physical change. Do you mean after the age of 70 compared to the height before that...??? If you have osteoporosis, you could have already lost height bu age 50 or 60....?
From my results I assume after 70years you lose more. Height also varies during the day so you are taller at the start and shorter by the evening when your spine has compressed a bit from being upright. The whole thing isn’t very accurate, only a best estimate for the average person
I went for my cataract op on Thursday and the student nurse took my blood pressure whilst a second nurse started asking me questions! Also the arm being tested was not supported.
I did try not to answer her but she kept on asking questions!
I’ve taken my bp at least once every month since previously being on medication. I record the reading and share it with my GP who documents it in my file. Sometimes my (nurse) daughter takes it with the machine at home, or I use the new bp machine in the pharmacy.
More recently I had my first appt with a new dentist and was surprised that they took my bp before doing any work on my teeth. Given I have a bit of a phobia of dentists, it was 186/112. They refused to clean my teeth or do any dental work until I provided them with a letter from my GP indicating it was white coat syndrome and indeed not chronic high bp. I thought this strange and it was certainly a new practice in Ontario, Canada (I checked with two other dental offices in town, indeed it is a new protocol for new patients). So off to my GP I go with my latest readings in hand….117/74 was the last reading and no reading higher than 140/90 in the last 6 months. I left with the letter and forwarded it to the new dentist’s office.
Just goes to show you that indeed white coat syndrome exists. Makes me wonder how many patients are prescribed bp meds after a high reading at an office visit??
They shouldn't be but I bet they are. The 24 hour Holter BP is better if something of a pain, taking BP every half hour in the day and hourly at night. I was amazed how well I slept though
Yes, 5 years ago my new GP got me to wear a holter for 24hrs. It revealed a reading of 221/96 while I was sleeping!! Hence I began medication immediately (Feb/18). GP told me it’s was either due to lifestyle (obese, inactive), or genetic.
By Aug/19 I was off of it altogether as my weight loss combined with a more active lifestyle resulted in my bp lowering and I was getting dizzy spells. First I took half dose for a few months and monitored my bp weekly. Then I stopped the 1/2 dose with continued monitoring. I consider myself fortunate as both my parents took medication for high bp.
A one-off high bp reading should not be enough to start someone on medication.
It's all good in theory , it's something I've been considering for years , especially as I found it rather annoying that GPs always assumed my Tachycardia was ' white coat syndrome' and based in Anxiety , rather than the real cause that the activity, positional change and sitting with my legs down was causing the increase in HR and Hypotension and proving the problem , that I had Dysautonomia.Unfortunately, it falls foul of practicality, as most of us have to do some exercise to get from the car to the waiting room they would have to ask us to arrive 30 minutes before the appointment.Then , we have the effect of quickly getting from the waiting room into the the consultation room.
At a normal GP appointment we are lucky if we get 10-15 minutes to do or say all that needs doing . I doubt any GPs are going to be willing to let us sit for 5 minutes to calm down after we walk into the consultation room. Or if we did , many people would be so worried that there time was ticking away their blood pressure would increase and they would end up having a ' white coat syndrome' reaction anyway.
Now , I've finally been diagnosed ( and I'm able to fight my corner ) I have to have my BP and heart rate checked in a more systematic way similar to this. I do arrive 30 minutes before seeing the GP and they put me in an empty consulting room to lie on the bed. Then , they take the first reading in the supine position from both arms . They get me to stand up , after 1 minute they take the readings again in a standing position, I then sit back down and after a minute they take it again.
By doing this they can judge how my BP and Heart Rate are improving and my medication is managing to control the swing of levels that happen between movements.
But , the only way that they can manage this is by scheduling my three monthly check as the first of the afternoon , allowing me in early to lay down in the nurses room then the GP comes to see me there.
It's interesting, that's virtually what I do at home when doing a cuff reading but I don't think at any time I've had BP taken at the surgery or hospital etc has any of that happened.
Its interesting to me that this says not to talk. I worked out for myself that if my blood pressure is taken when I have been talking that it goes up considerably. I have never seen anything that says support the feet, always feet flat on the floor. At our gp surgery they have installed some sort ofcontraption where the patient takes their own bp by inserting their arm into a sleeve and it’s taken and recorded automatically. I haven’t used it. It take mine at home and usually do 3 readings am and pm and then average over a week. Anyway have managed to get off bp tablets and hope that I can stay off for good.
One day I suddenly had significant rectal bleeding, my GP carried out an internal examination then took my blood pressure which strangely enough was very high! I thought at the time it was not the right way to go about things.
we bought a home monitor at GPs urging. Once a year in order to continue getting repeat meds (HRT for me) ( amolopidine him) they ask for readings and accept whatever we say. No idea if it’s the right size or if we’re doing it correctly but seems to keep them happy. If we drop down dead I guess it will be our own faults 😉
I always refuse to have my BP done on my right arm. It hurts like hell! It sometimes means moving furniture about as they're set up with the chair on the right side of their desk.
Makes sense. GP's give you like 5 minutes for the entire appointment. Haha. They should test BP each apt (as it's a silent killer). My former dentist used to do this first thing.
My BP shoots up every time they attempt to use an electronic machine. I have big arms and the cuffs are too small so when they inflate they cause great pain and most often bruising. This in turn puts the BP reading up.
At home I use my own monitor and sit quietly, legs down, arm supported and my readings average 135/70. But I am still on BP meds as the doctors and nurses get much higher results in clinic.
My own GP will take the time to find the extra large cuff which can sometimes take him the entire consultation time. His measurement is about 140/80. Still a bit high.
Recently when having surgery the anaesthetist and doctors in the private hospital asked me why I was taking BP meds. They did not think my BP showed high blood pressure. Even after not taking the meds before the op. They were getting readings of 120/70! They were using the correct equipment and I was comfy though.
It's an absolute minefield. For now I take the drugs but when I see my gp next I will tell him about my hospital experience and see what he thinks.
I think my BP peaked last year when I was caring for my hubby. That would obviously push up the BP what with the extra strain and my own various problems. Very useful info PMRPro thanks for posting 😀
This made me smile because of trying to get my mum to keep quiet while I did her BP. She usually managed around 5 seconds. She would be quiet if the nurse did it but was always looking at me trying to have a telepathic conversation. (She had high bp but also the sudden drops so was on hardly any meds at the end - a difficult balance.)
One question - what is the relationship between BP and bladder?
All good advice. We have the opposite situation here in the US. You get your BP taken at every opportunity and even have appointments just to have your blood pressure checked. Since I do have white coat syndrome, every appointment is like going for a school exam that I am afraid I will fail.I have a solution for the twice weekly at home reading. Odd, but it works. I take 2 readings but do not look. The machine has memory. And at the end of the week, I check the readings at same time for both days.
Not ok in a situation you need it immediately but great for routine checks. It is less stressful. Better than skipping doing it.
Does anyone else on here have absent BP readings? I cannot get my own using my own device (but use family as a control and it works fine on them) and the hospital/GP can never get one either. This is one of the reasons why I am more likely to have Takashu's than GCA. It feels odd to me that I am clearly alive and kicking but that a BP reading seems impossible to get. It's also difficult for the hospital to get my pulse and oxygen sats through my finger too - although my Apple Watch seems to pick up my wrist pulse fine. I just wonder if anyone has any tips or alternatives that their medics have tried in similar circumstances - thanks
It is important to identify your pulse and make sure the device is in the right place - arm arteries don't come as standard and if it lies deep, the microphone may not pick it up! Some doctors aren't patient enough to find the artery and listen with a stethoscope and expect it to be automated ...
Thanks, yes they can occasionally find it using the old fashioned method with a hand pump and stethoscope but as you say most of the time they don’t even have the old equipment to use
someone told me that bp should be taken twice with a 10 minute interval just to make sure correct reading. Be lucky to get once now. Soon GPs won’t have anything to do. Pharmacist and physiotherapists doing much more work for GPs. Until something goes wrong then watch the ‘fan’ 😊
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