Indeed, it might be useful for you to measure your own blood pressure at home. Home measurements have the great advantage that they can be done when you are relaxed and unflustered and that you can do them as often as you like, without worrying about taking up your doctor’s or your nurse’s time. They are usually lower than measurements taken in hospitals, but little different from measurements taken in a general practice’s surgery by a doctor or practice nurse.
Many general practice teams now like to have 28 home measurements (usually made twice daily everyday for two weeks) before starting treatment, especially in borderline cases. They are extremely useful early on, before any treatment starts, mainly in order to decide whether to start treatment now, or whether to wait for a while to see if your apparently high blood pressure is sustained.
Most people have no problems with taking their own blood pressure measurements accurately once they have had some basic training and practice. On the other hand, a few people may have difficulty. People with an irregular pulse caused by atrial fibrillation (a condition characterized by quivering of the upper chamber of the heart instead of pumping in an organized way) or frequent extra heartbeats may produce lots of odd sounds at levels above systolic and below diastolic blood pressure, so it may be impossible for them to take an accurate blood pressure measurement. The best anyone can do in these cases is to make a rough estimate of the level at which sounds appear and disappear. There are also a few people in whom sounds are still audible down to 0 mmHg, which again makes accurate readings extremely difficult. Many of these can get a diastolic pressure by removing all clothing from their arm, or sometimes by using the other arm.
Unfortunately, not all doctors agree that people should do their own measurements at home. Many specialists and some general practitioners disagree with home readings. These doctors either suggest that it is not possible for people to learn to measure their own blood pressure accurately or, alternatively, that the procedure will frighten people and make some of them obsessed with excessively accurate control of their blood pressure. There is now a handful of published research evidence on this topic and all of it supports the view that any literate person who can drive a car, use a typewriter or word processor or understand how to use a programmed electric cooker or washing machine is certainly able to measure blood pressure as accurately as any doctor or nurse and possibly better than many. It also shows that for nearly everyone who wants to do these measurements themselves, anxiety is thereby reduced, not increased. Anxiety does increase in about 5 percent of people, but only if they are pushed into doing measurements against their own inclination.
Home measurements are probably less useful for follow-up once treatment has started. Nobody with blood pressure high enough to need medication, not even doctors or nurses, should attempt to manage their problem entirely alone. Medical decisions about starting, changing, interrupting or stopping treatment need to be made objectively, against a background of experience with many other cases and knowledge about other complicating risks. Such judgment is not possible for a person with high blood pressure acting alone, however much they may know. Home measurements of blood pressure can be useful in follow-up, if they add to the evidence normally available to a blood pressure clinic, but they cannot replace regular skilled and independent advice.
Michael RussellYour Independent guide to Blood Pressure
