Blood pressure monitors and how to use them; taking a blood pressure measurement; continuous monitoring

ahimsa said:
But a machine at home is meant to be a screening device, not a substitute for a doctor's measurement. The alternative would be either no regular measurements or going to a doctor's office regularly - not practical.
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Also if you have been traumatized by doctors , you are likely to have a hyperintense version of the already common "white coat syndrome" unlikely that I could ever get a reading at a doctors office that reflects my usual BP
 
I got the Omron HEM-8712. (Who knew morons come in different models? I, of course, got the most basic one. :jimlad: )

Did have to fork out extra for the larger cuff, coz apparently I have fat arms. :rolleyes:

Omron use 'intelli-sense', which limits the cuff inflation, so it is not uncomfortable to use, just a bit tight at its peak pressure, which is only for a few seconds.

Seems to work well. Getting fairly consistent results. Nearly always between 100-120/65-85, with pulse between 60-100. Which I am happy with.

Will take the machine with me when I next visit the GP and check it against his machine and also a manual reading. But assuming my home readings are accurate, then there is definitely a white coat effect for me of around 5-10 points higher for readings in the clinic.

Thanks for advice and comments. :thumbup:
 
Our GP has 2 Omrons which are used by patients for a week at home to try and address white coat syndrome.

You put your name on a list.
It's used where it's thought there may be a problem, and if there is intermittent use is encouraged if people can't/ don't have a monitor of there own.

As these are the same model as GPs and serviced by them it it consistent.

It may be other GPs have a similar system which light be a way to try one out in the first instance.
 
Thanks everyone for the comments on this thread. I've just discovered that if I give home machine readings they won't make me drag my carcass to the surgery for blood pressure checks. Nothing wrong with my blood pressure (apart from.when they wind me up!), but if I wanna keep my meds it's gotta be done.

Based on comments and price I've gone for a Moron M3 Comfort. And I actually searched for Moron :facepalm: :oops:.

There's a new model M3 out so I managed to bag a good discount in an the old model which should do me.
 
Invisible Woman said:
Thanks everyone for the comments on this thread. I've just discovered that if I give home machine readings they won't make me drag my carcass to the surgery for blood pressure checks. Nothing wrong with my blood pressure (apart from.when they wind me up!), but if I wanna keep my meds it's gotta be done.

Based on comments and price I've gone for a Moron M3 Comfort. And I actually searched for Moron :facepalm: :oops:.

There's a new model M3 out so I managed to bag a good discount in an the old model which should do me.
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We bought an Omron M3 Comfort a couple of years ago and have been pleased with it. The Comfort cuff seems to result in more stable readings than our older Omron, which had a traditional wrap around cuff. It's quieter, too, than the older one, which is helpful as we are all three of us "white-coat" and just hearing someone else inflate a machine will make my BP rise. I think you'll be pleased with it.
 
Commonly Used Arm Positions for Blood Pressure Readings Can Lead to Overdiagnosis of Hypertension

A study led by Johns Hopkins Medicine researchers concludes that commonly used ways of positioning the patient’s arm during blood pressure (BP) screenings can substantially overestimate test results and may lead to a misdiagnosis of hypertension.

In a report on the Tammy Brady, M.D., Ph.D., vice chair for clinical research in the Department of Pediatrics at the Johns Hopkins University School of Medicine, medical director of the pediatric hypertension program at Johns Hopkins Children’s Center, deputy director of the Welch Center for Prevention, Epidemiology, and Clinical Research and senior author of the study. And they underscore the importance of adhering to clinical guidelines calling for firm support on a desk or other surface when measuring blood pressure, the investigators add.
LINK
 
Arm Position and Blood Pressure Readings: The ARMS Crossover Randomized Clinical Trial (2024)
Hairong Liu; Di Zhao; Ahmed Sabit; Chathurangi H. Pathiravasan; Junichi Ishigami; Jeanne Charleston; Edgar R. Miller; Kunihiro Matsushita; Lawrence J. Appel; Tammy M. Brady

IMPORTANCE
Guidelines for blood pressure (BP) measurement recommend arm support on a desk with the midcuff positioned at heart level. Still, nonstandard positions are used in clinical practice (eg, with arm resting on the lap or unsupported on the side).

OBJECTIVES
To determine the effect of different arm positions on BP readings.

DESIGN, SETTING AND PARTICIPANTS
This crossover randomized clinical trial recruited adults between the ages of 18 and 80 years in Baltimore, Maryland, from August 9, 2022, to June 1, 2023.

INTERVENTION
Participants were randomly assigned to sets of triplicate BP measurements with the arm positioned in 3 ways: (1) supported on a desk (desk 1; reference), (2) hand supported on lap (lap), and (3) arm unsupported at the side (side). To account for intrinsic BP variability, all participants underwent a fourth set of BP measurements with the arm supported on a desk (desk 2).

MAIN OUTCOMES AND MEASURES
The primary outcomes were the difference in differences in mean systolic BP (SBP) and diastolic BP (DBP) between the reference BP (desk 1) and the 2 arm support positions (lap and side): (lap or side − desk 1) − (desk 2 − desk 1).

RESULTS
were also stratified by hypertensive status, age, obesity status, and access to health care within the past year.
Results
The trial enrolled 133 participants (mean [SD] age, 57 [17] years; 70 [53%] female); 48 participants (36%) had SBP of 130 mm Hg or higher, and 55 participants (41%) had a body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or higher. Lap and side positions resulted in statistically significant higher BP readings than desk positions, with the difference in differences as follows: lap, SBP Δ 3.9 (95% CI, 2.5-5.2) mm Hg and DBP Δ 4.0 (95% CI, 3.1-5.0) mm Hg; and side, SBP Δ 6.5 (95% CI, 5.1-7.9) mm Hg and DBP Δ 4.4 (95% CI, 3.4-5.4) mm Hg. The patterns were generally consistent across subgroups.

CONCLUSIONS AND RELEVANCE
This crossover randomized clinical trial showed that commonly used arm positions (lap or side) resulted in substantial overestimation of BP readings and may lead to misdiagnosis and overestimation of hypertension.

TRIAL REGISTRATION
ClinicalTrials.gov Identifier:NCT05372328

KEY POINTS
Question What is the effect of commonly used arm positions on blood pressure (BP) measurements compared to the standard, recommended position?

Findings This crossover randomized clinical trial of 133 adults showed that supporting the arm on the lap overestimated systolic BP by 3.9 mm Hg and diastolic BP by 4.0 mm Hg. An unsupported arm at the side overestimated systolic BP by 6.5 mm Hg and diastolic BP by 4.4 mm Hg, with consistent results across subgroups.

Meaning Commonly used, nonstandard arm positions during BP measurements substantially overestimate BP, highlighting the need for standardized positioning.

Link | PDF (JAMA Internal Medicine)
 
I would not recommend Omron to people who often have a very narrow pulse pressure. My Omron only works when I'm lying down, it refuses to give me a reading when my body is in an upright position (orthostatic blood pressure). Many others in the Swedish dysautonomia groups have noticed the same problem with their Omrons too.
 
It is very unlikely that blood pressure is different
In different rent arms. (There are some rare causes due to blockages.) It is much more likely that different readings reflect unreliability of the device. The NHS seems often to use unreliable machines. The only thing I now trust is a traditional manual machine and a stethoscope.
 
This advice is completely useless and ill-informed.
Which is not surprising I am afraid.

Taking a blood pressure is quite a tricky skill, which medical students and junior doctors used to spend a few years getting really good at. All the stuff about cuff size and level is pretty irrelevant. You don't really know you are measuring it right unless you are familiar with the subtle changes in the sounds that you hear with a stethoscope. These days nurses just rely on the machine to 'hear' which is highly unreliable.
 
I don't know what the 'Nursing in Pactice' website is - never heard of it. I suspect it is a commercially sponsored dumbed down site for selling stuff to health professionals.
 
I am not clear why we would want continual blood pressure tracking? Maybe to look for episodes of postural hypotension?

It looks as if the cuff less tracker gives a fairly similar result to a cuff-based system for continual tracking but I doubt that in any way resolves the problems of body cuff based BP measurements as one offs. It sounds as if the cuff less system has to be calibrated first and maybe at that stage exactly the same problems might creep in.

I don't really understand the figures but it says 1.6 + 10.5. 10.5 is a big difference for a standard deviation (if that's what it is).
 
Jonathan Edwards said:
It is very unlikely that blood pressure is different
In different rent arms.
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I consistently get lower readings in my right arm. I even bought another machine to check if it might be an error, although I don't see how it can be over a period of weeks, taking multiple readings at different times.
Jonathan Edwards said:
This advice is completely useless and ill-informed.
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Jonathan Edwards said:
I don't know what the 'Nursing in Pactice' website is
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this is taken from gpnotebook.com
The blood pressure is measured with a sphygmomanometer.
use a machine with validated accuracy that is calibrated and properly maintained
  • the systolic pressure is the maximum pressure in an artery just after left ventricular contraction. The diastolic pressure is the minimum pressure in an artery during left ventricular filling
  • the blood pressure is usually measured with the pressure cuff around the upper arm and the stethoscope placed over the brachial artery in the antecubital fossa. The patient should be sitting with the arm at the level of the heart
  • as the pressure in the cuff is reduced from above the systolic pressure down to zero, five characteristic Korotkoff sounds are heard. The pressure at which a sound is first heard is the systolic pressure (Korotkoff I). The pressure at which silence begins corresponds to the diastolic pressure (Korotkoff V)
  • the pressure should be measured to the nearest 2 mmHg
  • to determine the extent of the hypertension the blood pressure should be recorded twice per visit
    • blood pressure should initially be measured in both arms as a significant number of patients, particularly the elderly, have large between arm differences
    • (>10 mmHg) and the arm with the highest value used for subsequent measurements and this recorded. Two measurements (1-2 minutes apart) should be taken on each occasion, the initial value being discarded if there is a large (>10 mmHg) difference between the first and subsequent readings and further measurements made
    • in order to assess orthostatic BP changes, particularly in elderly or diabetic patients and in those with symptoms suggesting postural hypotension, measurements should be repeated after the patient has been standing for 1-3 minutes, again with the arm supported
    • while undergoing evaluation of mild hypertension and assessment of overall cardiovascular risk, paired BP recordings should be repeated on two or three further visits over the subsequent 2-3 months. For those with moderate or severe hypertension on initial recordings, and/or evidence of target organ damage further assessments should be made over a shorter period e.g. 3 to 4 weeks, as prolonged periods of observation before starting treatment are unnecessary and unwarranted (2)
  • all adults, aged 40 years or more, should have their blood pressure measured routinely at least every 5 years until age 80
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BP measurement (difference between blood pressure measured in both arms) – GPnotebook
 
mango said:
I would not recommend Omron to people who often have a very narrow pulse pressure. My Omron only works when I'm lying down, it refuses to give me a reading when my body is in an upright position (orthostatic blood pressure). Many others in the Swedish dysautonomia groups have noticed the same problem with their Omrons too.
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@mango have you or others found a different home blood pressure monitor that works better? My Omron gives me the E5 (pulse not detected) error when standing (and sometimes seated). Omron customer service essentially told me it's not their problem because you're only supposed to use them seated on a hard surface. They suggested I take my BP manually (not something I know how to do and not convenient to do 3 times in a row for orthostatic vitals). Thanks!
 
My experience with an Omron was it gave persistently higher readings than the machine in the doctor's surgery. I even took it into the surgery one day so we could do an immediate side-by-side, and it was definitely high, by about 10-12 points, IIRC. (Was a while ago, and didn't test it enough to know how consistent that error was.)
 
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