UKH

So I had to go for a blood pressure test today due to check before the Dr prescribed something which is reliant on good blood pressure. 

To their surprise as much as mine, it was really quite high. I am a little overweight at the moment, but not enough that they would expect that level of blood pressure given I have no other risk factors. 

So, nurse suggested it could be "white coat syndrome" and said I should get a monitor to do home readings for a couple of weeks and go back after that. Fair enough.

Doing some googling once I got home, it seems a combination of decongestants that I have been taking and ibuprofen could have an effect, and that tied with having cycled up hill to get there and still coughing my guts up all day are the likely candidates. Anyway, Dr said she still wants me to do home tests to rule out anything else. So that's fine and I bought a monitor. 

Tried it immediately when I got home and blood pressure straight away into acceptable range, even if still a bit high, so I guess that's the white coat bit dealt with. Probably still got decongestants and ibuprofen in my system though and I had just cycled home too. So interesting to see the difference just from being at home!

But I also read that eating changes it too. So I tried again after dinner (it's a fun toy to play with!), and I was shocked at how much lower it was! It was down at 111/ 78!! 

So, I guess the moral of the story is that if you want low blood pressure, just eat constantly! 😜😂

I'm sure you've done your research but a lot of those home BP monitors are little more than toys so (and I'm not usually a glass-half-empty kind of guy) I'd not assume these latest readings are accurate.

I have slightly high blood pressure but I’m in my late 70’s. 
Before going for any checkup I take 6 readings morning and night, discount the highest and lowest and get an average. The first reading always seems to be high, more than 10 points then the others settle down, in my case around 130/70. 
I recently visited the doctor with a worrying problem and he measured my blood pressure at 195.

A pharmacist once told me that you shouldn’t have hot drinks before a test and sit calmly for 10 minutes. 

I bought it from the pharmacy and it is the same make as the one the nurse used. Can't tell if the same model or not but looks about the same. So I presume it's fairly accurate.

A few years ago I had a possible problem with my blood pressure & after a while we bought a monitor from the local pharmacy. We also still had one from our GP so for a few days used both together. The one we bought was systematically lower but by a fairly constant amount, eg would read 100 rather than 12O, 110 compared to 130 etc. Similar for my wife.

More recently we did another comparison & found the same difference.

I bought one from Lidl. The nurse checked it against hers and said it was fine.

My blood pressure goes up dramatically whenever I read the Daily Telegraph, Express, or Mail,

You are being alarmist.

You can buy exactly the same ones as are used by GPs - e.g. Omron or A&D - and you can (if you are sceptical) have them checked by the GP. They work.

The NHS recommends home monitoring, so don't be dissuaded by people saying they don't work. I get quite bad white coat syndrome (despite, or perhaps because, I work in a medical field). Getting much lower results consistently at home is fairly normal and a good sign.

The 'White Coat Syndrome' is a definite effect.

Now that you have a monitor at home, take regular readings over the course of a week or so. You will then have a a good baseline from which you and your GP can figure out whether or not any further action is advisable.

Even the Boots own brand one that costs around £20 is made by Omron and perfectly fine.

I have been playing with it a few times through the evening and finding results all totally normal and healthy. I do think the decongestants etc earlier will have had an impact (when I mentioned it to GP on the phone, she agreed). I'm sure I will find it an interesting couple of weeks to see when it peaks and troughs etc. 

I'm still going with my take away point though that continuously eating seems to be the answer to good blood pressure 😃

Yes, the one I bought is Omron and that was what the nurse used too. 

Validated monitors for home use

https://bihsoc.org/bp-monitors/for-home-use/

That's what my surgery told me. So I pulled out my monitor and said "okay, let's compare it to your test method..." Result: statistically insignificant difference.

I did a set of morning and evening tests for a week, having measured high in surgery. Result was consistently lower, and consistent from day to day, and between morning and evening.

Are the monitors oscillometric, or doppler in mechanism? I seem to remember that the ones which I have seen at the GP's surgery were doppler machines.

Those are not words which I know!

It's a cuff that goes around the upper arm and it inflates until it feels uncomfortable and then slowly lets air out while the wee machine does some magic 🤷

Could be loads of different reasons, I had a high BP reading at a company medical before due to fighting an infection.

The whole 'we need your blood pressure reading' can be a bit of a joke tbh. I couldn't be prescribed HRT until supplying a reading. Went after lunch and after a strong coffee. The surgery doesn't do blood pressure readings so I had to try 3 pharmacies before finding one that did on the spot testing. Was then shut in a tiny room with a young chap with a very arsey attitude. For some reason the reading was a touch on the high side...

That's a doppler machine, which is probably better for overall accuracy, though I'm not sure if the other type may be less inclined to read quite so high with stressful circumstances.

It’s worth reading what the instructions say with the monitor.This includes the seating position and usually you should sit down and wait for 2 minutes before testing..It’s surprising how few people follow those...and then are surprised by the poor results.

White coat syndrome is well known.

Have you any nursing friends…if so ask them for advice on best way.

omron is a good make.

I think Omron digital BP monitors, like most others, are oscillometric. A quick Google suggests doppler machines may be more accurate but require more skill to use correctly, so less suitable for home use.

I got an Omron X2 basic,(£25ish)  its a upper arm cuff type, it was on the list for the approved devices for the Zoe blood pressure research trial, wrist based units were not acceptable for the trial.

Yes, mine  (which we bought at Boots) is exactly the same model they use on me at my GP surgery and at my cardiac rehab clinic at the local hospital.

I get white coat syndrome so I regularly have to monitor my blood pressure at home for them both. It's usually two readings per day over a week or two weeks and then they take an average. I was told that it's normal for blood pressure to fluctuate somewhat throughout the day, I assume depending on your activities.

Edit: Oh, my GP said two take two readings each time a few mins apart and record the second, which in my case is usually lower (sometimes notably so). I don't know if it's because you're less relaxed the first time, maybe?

‘accurate’ is a bit of a moveable feast with regards to blood pressure. I’ve been running research programmes and supporting clinical studies for the last seven years in this area. 

There are something like 21 major disturbances to BP measurement, of which white coat syndrome is a major factor. Some positive and some negative, which gives a huge potential range of +25 to -15 mmHg influence on cuff readings. As you correctly say, food intake is one. The oscillometric cuff you’ve purchased is perfectly fine for everyday use, and isn’t influenced by another of the disturbances … clinician bias which is one of the 21 disturbances!

This isn’t to say that the readings are ‘wrong’ necessarily, just that they don’t always reflect the ‘underlying’ BP which is the measure we are searching for. If you want the best chance of a reliable reading, 5-10 mins sitting relaxed and semi prone, then 3 measurements at 5 min intervals and calculate the mean value. Not perfect but works ok. If you’ve done heavy exercise etc, it takes much longer to reach equilibrium.

Not really, just flagging up that the figures may not necessarily be accurate.

Just to be clear, I didn't say they don't work I said they may not be accurate. For the record I have an Omron one too. 

A one off high BP isn’t too much to worry about, a trend over time is more useful. 
There isn’t much research yet on what acceptable home BPs should be, but a rough estimate is they should be about 5-10mmHg lower than in surgery equivalents.

Lots of things can temporarily send BP up. We used to think that the average or lower readings were most important, but more recent evidence suggests that peaks are harmful too. Worth checking both arms: if 1 is always higher, that’s the 1 to use, and a difference of 20 or more between arms is an independent risk factor for cardiovascular disease. 

Depending on age, there are thresholds for grade 1 and 2 high blood pressure. In grade 1, in the absence of other risk factors, you don’t usually need treatment yet, just yearly monitoring. (It’s been a while since I checked NICE guidelines, so the particulars might have changed a little.)

Most home BP machines are pretty good nowadays, if a reasonable brand as opposed to an Aliexpress special.

You can always try changing lifestyle factors for 3-6months first before treatment, and get depressed that they often make very little difference! (Occasionally they do, but they need pretty significant changes.)

I'm not really worried, all readings since have been low. I have been playing with taking them before and after showers, after coming in from dog walk or after being up a ladder doing DIY etc. Just playing with all the different permutations out of interest.

My first reading when I got home yesterday was still a little high, but I would still have had the effects of the decongestants then. Since tea time yesterday I have had no decongestants or ibuprofen in my system, and all readings have been somewhere around about 115 over 75, give or take. Certainly all have been lower than 120 over 80. I think the high when the nurse took it will have been a combination of factors but cold and flu drugs will have been one factor, white coat syndrome another and probably cycling up there and going straight inot a hot building which makes my cough worse will also have been a factor. 

I have no lifestyle factors to change if it was staying high! I could do with losing a few kg, but I'm not so overweight that it would be significant, but that is absolutely the only thing. My diet is very high in fruit and veg, home cooked about 80% of the time, I don't add salt to anything even when cooking, I do a physically active job and am very active in my free time too, I don't drink or smoke, I'm not stressed. 

The nurse was pretty sure that it was white coat syndrome precisely due to all of my lifestyle factors. But obviously had to follow up just incase. 

I will keep checking it for 2 weeks as they asked, but I am pretty sure I'm not going to see anything too worrying. 

I successfully brought mine back down into the healthy range by eating a varied but high plant based wholefoods diet with no added sugar for three months. 

Seems like as long as I stick to that diet it's staying at the top of the healthy range for now.

There’s the cold/flu you were taking the drugs for as well, of course…

I find I can consciously reduce my BP quite a bit, which I guess is the virtual equivalent of taking two readings and going with the second.  But then I once took part in an experiment where I had my BP done while waiting to board a flight and they repeated it several times to try to get it higher!

You cycled there? That would do it! I cycled to a work medical once, really steep hill on the route, hot summer day and almost arrived late because I couldn't find the right building - needless to say the BP was a little raised! Usuallly get around 105/65 on the sofa in the evening.

I cycle everywhere! But yes, it is at the top of a hill.

My mum said she used to get told off by nurses at her anti natal appointments when pregnant with me because she cycled there with my toddler brother in the bike seat on the back and that raised her blood pressure. She pointed out that trying to wrestle a toddler onto a bus while 8 months pregnant was not going to leave her with any lower blood pressure!! 😂

I did have a wee bit of a wait to go in and I assumed it would have dropped, but I think the other factors kept it high.

Yep, during exercise systolic will easily go over 200.  That’s a none issue, chronic high blood pressure is the problem that causes health issues.  Where as regular exercise keeps your arteries and veins elastic which helps keep chronic blood pressure lower.

I was going to say, that routinely, whenever I have had BP measurements, then I deliberately try to relax and put my pressure down. I find that it's a bit like that process whereby you relax your parts of your body in procession, starting with your toes, then your feet, and work your way up your body. I can actually sense that my BP is heading lower.

We got a "health monitoring" machine at work last week, which I avoided to start with.

Eventually gave it a go, it measures height weight, body fat etc etc. According the machine my blood pressure was very very high and I should contact a doctor immediately. It also stated that blood pressure doesn't vary much!!!!!!! 

Taken in isolation I would have been concerned, fortunately I have a monitor at home (Omron) which gives consistently better results all linked to their app so I can track it as well. 

The above mentioned machine also said my BMI was very high (it always has been even when I had very low body fat) BMI has to be the most pointless measurement ever. It also stated I have a lowish body fat, which I certainly don't at the moment.

Overall, the machine is completely useless. 

The advice that I had from a pharmacist friend for taking your blood pressure was this.

Do it at the same time every week, not every day.

Sit quietly for 15 minutes first.

Have your arm level with your heart.

Take three readings and average them (I think he said this) or discard the first reading then average.

https://www.bloodpressureuk.org/your-blood-pressure/how-to-lower-your-blood...

BMI too thin, fat, obese, etc levels are okayish as an indication if you lead a sedentary lifestyle. They're no good if you do a sport that gives you significantly more muscle and bone mass etc.

There are several top sports people who are BMI obese, I think Michael Jordan was one (when he was playing).

Thr British Hypertension Society have a list of approved models. I usually suggest that patients buy Omron brand.

For diagnosing hypertension, or monitoring the effects of medication changes, we ask patients to check their BP morning and evening for 4 to 7 days. And then we calculate the average.