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The Villages
Wednesday, July 24, 2024

Self-monitoring of blood pressure better than just doctor monitoring

Dr. Gabe Mirkin

Checking your own blood pressure several times a day may offer better blood pressure control than just taking occasional blood pressure measurements in a doctor’s office (JAMA Netw Open, 2024;7(5):e2410063). In this study, doctors followed two groups of patients:
• 111 patients, 40 years and older, with uncontrolled hypertension, who received educational materials and instructions for self-monitoring of BP with a home monitor and medication adjustments as needed without contacting their healthcare clinicians.
• 108 patients in a control group who received only the usual care for high blood pressure, including medication and education on BP control.

The patients who monitored their own blood pressures had:
• lower average systolic BP readings than patients who received the usual care (3.4 points lower)
• lower average diastolic BP reading than usual care (2.5 points lower)
• the same percentage of people who achieved the target BP (64 percent of self monitoring and 54 percent of doctor’s only monitoring)
• the same incidence of side effects, use of health services, and behavioral changes such as smoking status or body weight

Benefit of Frequent Blood Pressure Measurement
High blood pressure is an extremely important risk factor for heart attacks and strokes, the leading causes of death worldwide. More than half of patients with high blood pressure do not get their blood pressures down to normal (Int J Cardiol, 2016;218:83-88). Many studies have shown that self monitoring of blood pressure combined with lifestyle changes and medication help to control high blood pressure (Lancet, 2018;391(10124):949-959).

Blood pressure measurements can vary throughout the day. Blood pressure tends to rise when you are cold, anxious, frightened, are suffering from sleep apnea, drink coffee, take certain drugs such as cold or allergy medications, eat fermented, pickled, brined or cured foods, drink alcohol, smoke, talk, laugh, exercise, feel stress or anxiety, or have sexual relations. Thyroid disease or any source of acute pain can also raise blood pressure.

Definition of High Blood Pressure
The World Health Organization states that high blood pressure affects one in three people worldwide and usually causes no symptoms until a person suffers a heart attack or stroke. The 2023 American Heart Association report tells us that fifty percent of North American adults suffer from high blood pressure and one third of those have high blood pressure that is not controlled by three different medications. High blood pressure is defined as anything greater than 130/80 by almost all of the major medical groups, including the American Heart Association and the American College of Cardiology (N Engl J Med, 2015; 373:2103-2116). Known causes of high blood pressure include diabetes, dehydration, cardiovascular disease, obstructive sleep apnea, kidney disease, thyroid problems and nervous system problems.

My Recommendations
I recommend buying a blood pressure cuff (upper arm, not wrist) and taking your own blood pressure. You can buy one at your drugstore or on Amazon for less than $30. You should check your own blood pressure because getting only occasional blood pressure measurements in a doctor’s office can miss high blood pressure. If your average systolic blood pressure is over 130 or your average diastolic pressure is over 85, you should immediately make all of the lifestyle changes that will help to lower it. Your doctor may feel that you need medications to lower high blood pressure, but everyone can help to prevent and control high blood pressure with lifestyle changes, whether or not they are taking blood pressure medications.
• Eat a plant-based diet that is heavy in fruits, vegetables, whole grains, beans, nuts and other seeds. Restrict mammal meat and processed meats, sugar-added foods and drinks, and fried foods
• Avoid extra salt. Don’t use a salt shaker and check the labels for salt in foods.
• Exercise. Check with your doctor, and try to exercise for at least 30 minutes each day.
• Try to get 7-8 hours of sleep each night.
• Avoid habits and exposure to everything that increases cell damage such as smoke, alcohol, recreational drugs, herbicides, insecticides, air pollution, and so forth.

Dr. Gabe Mirkin is a Villager. Learn more at www.drmirkin.com

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