Hello – this may sound like an odd question, but please humour me! 🙂
About six months ago there were concerns about my blood pressure being consistently high, so I was prescribed Ramipril. A couple of months ago, I developed a fairly persistent cough and vertigo/dizziness, and felt bad enough to call 111 on Sunday. I was asked to take my blood pressure and it was high enough that I was given an out-of-hours appointment the same day. (The readings taken in the surgery were similar, so I don't think it was an error on my part, or a fault with my home machine.) The doctor suspected the coughing and vertigo might be side-effects of the Ramipril, and changed my prescription.
I was re-checking my BP this morning and something occurred to me – I find the process of taking my blood pressure to be quite painful, when the cuff reaches maximum inflation. Not "screaming" painful, and I resist hitting the stop button as I know it will deflate soon and I can just about bear it for those few seconds. However I'd say it's worse than "discomfort" and – crucially – it's bad enough to raise my stress levels so I feel my heart beating faster, which I think must elevate my BP.
My reason for asking this in a thyroid forum: I've got quite hefty upper arms (I use an XL cuff), and when I do the "arm-pinch test" I can't pinch any flesh, so I'm wondering could excess mucin / myxodema be a factor in how painful I find BP tests? I may be talking rubbish here or clutching at straws, but I'm wondering have any other members of this group had problems with BP tests?
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Taffhamster
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Absolutely - I have to very consciously relax and slow my breathing and not focus on the pain. It's very common for people with bigger arms/more fat or fluid on the upper arms to find it very painful, because the cuffs just aren't designed for us, even bigger ones. Excess mucin or lipedema make pressure on the area very painful - I have lipedema to a degree, mainly thighs, and kneeling can be excruciating. Really low tolerance for anything squeezing/pinching arms or legs. It's a known thing that fat people can get artificially raised readings, especially when standard cuffs are used, e.g. in GP surgeries. I tend to assume my actual BP is a couple of points lower than the reading for that reason. My systolic is always disproportionately high compared to my diastolic because I have a low HR, and I do wonder if the stress of taking the readings is a factor.
If my BP is high then the cuff can be really painful when its almost and at full pressure.
If my BP is normal then its not relaly painful just uncomfortable.
I was out with a friend recently and they were wearing a BP monitor which they were finding painful at pressure. Sure enough their BP was high and now on BP meds.
Thanks for your replies – it's hard to quantify beyond the cuff being tolerable during the time it takes, but painful enough that I can feel my body getting stressed and my pulse/heart getting faster until it deflates. It may even be a "chicken and egg" thing. The cuff is more painful because my BP's high, and because the cuff is painful, it feels like my BP is elevating even more. (I'm not sure if the machine is built to take this effect into account?) I try to relax before hitting the on switch, so the difference before and after can feel quite significant.
It’s great when someone raises these ‘oddities’. I definitely get this too - not always but enough times to notice it and my BP is nearly always unreadable when this happens. It especially accompanies other symptoms of ‘unwellness’, which I associate with my hypothyroidism. I think at those moments my mucin is particularly firm - in fact pretty solid. I am now thinking of course this will have an effect on blood pressure results! The machines extremely unlikely to be designed to take this particular anomaly into account. Crikey maybe none of us are really suffering from high blood pressure after all? Chicken and/or egg? Great you brought this up.
Thank you – I do have runs of failed readings (which of course means having to suffer more cuff-squeeze until it works!) but again, it's impossible to know how often this happens to other people. (I'd guess it's likely most BP machines have a blip now and again.)
Painful BP tests are quite common - in hypothyroidism as well as for other reasons.
Do you ever switch arms? It is regarded as quite good practice to test both arms on the same occasion when commencing regular tests. Then just doing "the other" arm every so often. Some issues result in significantly different values for each arm and that could be important.
But it also gives the first arm a brief rest!
I suspect machine readings take the cuff pressure up higher than a skilled doctor or nurse needs when doing it manually.
Thanks – I got asked to switch arms during the 111 call, and it's something I'll try to do from now on. (I'm right handed, so I tend to cuff my left arm, but cuffing my right wasn't really that much more tricky.)
Great point about machine readings – although machines seem to be the norm in GP surgeries these days. I can't remember the last time I had a manual test – not sure I ever did, in fact. Worst of all are the big machines that take several measurements in one go. On the one hand, sticking your wrist in one may (or may not) solve the myxodemic upper arm problem. On the other, I'm not convinced my blood pressure's going to be optimum when I'm having my height and weight measured in the corner of a waiting room, however "discreet" it's meant to be. 😱
Old-style mercury sphygmomanometers have almost 100% disappeared.
Even those which remained in place for a long time should now have gone because they do need maintenance. And it was the effect of mercury on maintenance staff that was the single biggest reason for them finally disappearing. Not the more minor effect on nurses, doctors and patients.
The protocol for taking blood pressure properly includes your arm being at the right height, and you neither talking nor being talked to. I too am sceptical about the big machines.
Thanks, I wasn't aware of that – interesting. (And yep, if the old-school sphygmomanometers were giving the maintenance staff mercury poisoning, it's a good thing they've been phased out.)
Great point about the arm being at the right height – that's likely something I need to finesse. I usually sit at my desk at home, with a dictionary or similar propping up my lower arm. That feels about right, but I need to look into it more, I think.
Re. the talking, on Sunday, I did actually have to ask the practitioner (once quite firmly) if we could pause the Q&A until after we'd done the test, which I think she should have known.
I'm really not a fan of the big machines. As well as the public location, you're also standing up, which I don't think is ideal.
Funnily enough, I went to our GP surgery yesterday and, for the very first time, noticed an automatic machine in the waiting area. With a chair! You have to sit to put your arm into it.
I didn't take much notice as I was called through on time to first appointment of the day for a blood draw.
me too! I hate having my BP taken for this reason. I’m sure it makes it even higher than it might be (or maybe that’s wishful thinking). I’m having to check mine at home this week and I hate it.
Thanks – I feel your pain. Literally! 😔 I also worry about "wishful thinking" (or the possibility of the doctor viewing it like that and fobbing me off). But the extreme discomfort is real…
I too find the cuff type really uncomfortable to the point of pain so I bought a type that fits on your wrist. I don’t know if they’re that accurate but they don’t hurt so it’s swings and roundabouts. I’m sure the pain raises your blood pressure.
Thanks – I'll look into that. My machine is a Boots one – recommended by Which? who at the time seemed to favour the upper arm machines for accuracy. I'll see if they have any recommended wrist-cuff machines, though.
Well, just as an add on. My first BP reading is always higher than the second two. Nurse practitioner always dismisses my questions about this. In my mind it's just a stress indicator (although I don't know why). I do my BP at home weekly and it's always the same, 1st high next 2 lower. I'm always wondering if the BP meds need to be adjusted but of course no answer they just look at the 1st two readings.
Interesting! I know my BP can vary sometimes and I'll put it down to something as daft as did I have to scrabble around for the machine or stand up too quickly after getting it from a low drawer! It does often take a few attempts (and efforts to relax verging on meditation!) to get a consistent result!
I had a bad reaction to my last tablets (Candesartan) and stopped taking them. About 2 weeks ago - just to clear my system out from my point of view. I dare say she won't take kindly to that but hope eventually to get one that I get on with. It will irritate her that I'm now going to be on my fourth trial, there were a few snippy remarks on my last visit. I don't think it's an exact science though.Good luck.
Blimey – surely she can't expect you to take meds you don't get on with? No call for her to get snippy. Good luck finding something that works for you.
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