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Is there an optimum time to take home readings of BP?

Posted , 5 users are following.

jane243
jane243

When diagnosed 3 years ago [163/90], my GP said to take 2 home readings twice a day at random times and to record just the lower of the 2 readings. Taking it twice or even 3 times I could get a variation of up to 20 sys. between the first and the last reading. The second readings I would take in the evening and those were invariably lower. 

If I take the early readings after breakfast instead of before  I mostly get  really low readings, around the 110 syst. level [why?].  I want to keep these numbers as low as I can but which of the two times gives the most accurate figure?  After some months the rules changed and i was instructed to take the 2 readings as before but to do an average of them and this is what I do still.

Before I have my 6 month check up I have to do the same readings and record every one for 8 days pror to the check up then do an average of them all to show to her. Based on these figures she will presumably assess if the dosage of Losartan 50mg is the right dose.

I just can't help worrying that I get wildly variable readings, do other people get these fluctuating readings?

It would appear that as long as the average overall is fine then there is nothing to worry about, is this right?

 

0 likes, 17 replies

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  • SteveDrakey
    SteveDrakey jane243

    Posted

    I think so, I think the it's the fact that you get a decent amount of low readings reduces any problems caused by having high BP

    My reading were high (100/160) in the morning and normalish on the evening (80/130). A 24 hour test reviled they were mega low during the night (60/90)

    On the 24 hour monitor I peaked at 200 on top number but I was lifting stuff at one point.

    My morning reads are better now as I eat better, drink less and exercise more. Those numbers are now it was when the doctor was getting concerned.

    The doc was very pleased with my very low overnight reads.

    • jane243
      jane243 SteveDrakey

      Posted

      I'm not sure that having suffiicent low readings to counteract the high ones is really the best thing, although I know the drs say it is OK.  I also know that BP changes throughout the day but by how much is considered normal I wonder.Are you on medication?
  • lily65668
    lily65668 jane243

    Posted

    I'll be interested to see other people's views on this one, as my readings vary wildly too, and at different times of day. I'm having a problem with isolated systolic hypertension - the type where the systolic goes up but the diastolic goes down - but don't have it all the time. There's no regular pattern throughout the day either. Whatever time of day I take my BP the reading can be anywhere from a low 100/60, to a normal 120/80, to 150/90, and often to a worrying 160/50 - the latter being a sign of atherosclerosis. Unfortunately, I get the high systolic/low diastolic readings far more often than the normal ones. My GP says there's not much point in my taking an average, given the major fluctuations in my diastolic. It doesn't seem to be down to a faulty home monitor as he gets an unusually wide variety of readings when taking my BP too.

    I have a good lifestyle - normal weight, non-smoker, moderate alcohol consumption, plenty of exercise, good diet and low salt intake - and am not currently on any BP meds.

  • robert25274
    robert25274 jane243

    Posted

    You should not be taking BP after eating breakfast, nor directly after waking. The first of your two readings should be taken before you eat or take any medications, and at least 30 minutes after any caffeine or nicotine intake. Eating food increases blood flow to the many small blood vessels that supply the stomach which in turn raises blood pressure.

    Ideally you should be sitting quietly for 3 to 5 minutes before taking your blood pressure and ensuring your arm is resting at roughly the same level as your heart. As with avoiding a reading after eating, you should rest at least an hour after any moderate excercise. Further, the amount of fluid in your bladder can also affect readings, when full your blood pressure can be as much as 10-15 mmHg higher than when empty. When you take a reading you should wait a minute or two then take a second, or even a third, to ensure the readings are consistent.

    Your second reading should be in the evening, again before any meals, or at least 2 hours after eating, and at least 30 minutes after any caffeine or nicotine intake.

    There is no balancing out of blood pressure taking readings that offset one another. Everyone has a blood pressure profile, with blood pressure changing throughout the day in response to the daily routine. Some people subconsciously take readings when experience has shown them it will be low, while it may provide a measure of reassurance, it is not helpful in terms of giving an accurate measure of their blood pressure changes throughout the day.

    The above was taken from a sheet provided by my doctor when he diagnosed high blood pressure, some I double checked with my better half who is a pharmacist enabling me to add the info about blood pressure increasing after food and when the bladder is full.

    • jane243
      jane243 robert25274

      Posted

      Thank you for that Robert,it would have been helpful if I'd had an information sheet such as that. Much of it is well known of course but I don't actually understand the penultimate paragraph:  how can I arrive at an average [which my dr asks for] without balancing out the different readings? I've only been told to take it twice a day. I know not to take a reading immediately after eating or having a hot drink or exercise but in fact exercise lowers my BP significantly for some reason and after a brisk walk the BP is likely to be below 100. Half an hour [at least] after breakfast and after doing the usual household chores including filling the coal bucket I will sit for several minutes then take a reading.  It is likely to be well below 120 syst and more likely around the 110 mark.  For most of the 3 years though I have taken it before breakfast and before taking the pill and before having anything to drink,  though after i've fed the dog and generally been up and about for a short while.  The reading then can be high, 150 occasionally but mostly 135>. Given what you are saying it seems my readings are totally opposite to what I would expect.
    • lily65668
      lily65668 jane243

      Posted

      Hi Jane,

      I might be wrong, but I think what Robert is saying in his penultimate para is that it isn't reasonable for your doctor to ask you to provide an average BP per day as it wouldn't mean very much. My own GP has told me this. He prefers to see a chart of recordings taken throughout the day - or at least morning and evening. Obviously, this doesn't mean a huge amount either, but at least it gives a better indication of what might be happening, to help your doctor decide whether it would be useful to put you on proper 24-hour monitoring for a day.

    • derek76
      derek76 robert25274

      Posted

      While I agree with all of what you say what happens in hospitals if you are a patient ? They are not taken at times like that and most mornings they go round wakening patients to take their BP,  
    • derek76
      derek76 lily65668

      Posted

      Even then they ignore dangerous highs or spikes and take the average telling me it is the verage that counts.
    • derek76
      derek76 jane243

      Posted

      Did your BP monitor not come with an instruction book advising how and when to take it. Does it have the facilty to download your readings to your computer. With my one if I take two or three readings in a ten minute period also gives me the average although it discards it when the next reading is taken.
    • robert25274
      robert25274 derek76

      Posted

      In hospital they will take more than a couple of readings, often obs are done hourly or two hourly giving a fuller picture of your blood pressure profile during your stay. Further, the time is recorded on the chart. The doctor knows what part of the hospital routine is going on when a reading was taken, the time patents are woken, fed and watered etc and they understand how that can affect the reading. If there is a reading that is unusual they will speak to the staff to ask if there was anything in particular that may have affected it.

      Most patients recording at home are asked to record two daily readings, at each reading they are instructed to take two or three readings and to give an average at that point in the day. This is to remove patient error, account for anxiety and so forth and it is only used as a guide to average blood pressure. What the doctor is looking for are spikes or unusual drops, or gradual changes over time which they may then investigate further. If they want a more accurate picture they will typically instruct the patient to take more readings through the day, or will even fit them with a 24 hour monitor asking them to keep a log recording meal times, when they drank fluids, woke up and so on.

    • robert25274
      robert25274 jane243

      Posted

      Sorry for the confusion Jane, I edited what I was saying before posting and somewhere along the way lost my train of thought,(time they added an edit function here). The first line of that paragraph was directed specifically at SteveDrakey's comments about lower readings reducing the impact of higher readings, but in editing was not as clear as I would have liked. I had intended to point out that while I understood what he was saying, his assertion was not strictly true and he should not interpret his readings in that way.
    • derek76
      derek76 robert25274

      Posted

      In the times I have been in hospital they have have never taken more than one reading during ward rounds. Different at outpatients where they will take several.

       

    • robert25274
      robert25274 derek76

      Posted

      I was not talking about general admissions, but hospitalisation for a condition where blood pressure is a major concern, such as hypertensive crisis, pulmonary edema, stroke, heart attack, renal failure or during the first 24 hours of post operative care. Conditions where monitoring a patients blood pressure profile is essential.

      For a general admission even where a paitent has a history of high blood pressure, assuming a blood pressure reading is normal there is no need for continual readings.

    • derek76
      derek76 robert25274

      Posted

      I have been a patient for aortic valve replacement as well as having a pacemaker fitted and kept for two nights because of complications.

      Also three two night stays with AF and BP as high as 239/123. Itnever varied much when out of ICU.

    • robert25274
      robert25274 derek76

      Posted

      Then you were likely fitted with an arterial transducer not realising what it was. These take the form of a thin wire or cannula placed directly into the artery in the arm and hooked up to a heart rate monitor to enable real time blood pressure and blood oxygen readings.
    • derek76
      derek76 robert25274

      Posted

      No I was not. You must go to more efficient hospitals than I do.
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