The Art of Healing

Your Guide to Home Blood Pressure Monitoring

• Charlyce Davis

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February is Heart Health Month!
You can proactively care for your heart by becoming an expert on checking her blood pressure at home.
You will learn:

  • The details of what's measured when you measure your blood pressure.
  • How to measure your blood pressure
  • How to choose the right blood pressure cuff for your specific needs.
  • What normal numbers are

The website you may use as a resource when shopping for a blood pressure cuff can be found here:
https://www.validatebp.org/

References: 
Primary Care Medicine, 8th Edition: Office Evaluation and Management of the Adult patient by Allan H.  Goroll and Albert G. Mulley.

Welcome to the Art of Healing Podcast.
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Speaker 1:

Welcome back to the Art of Healing podcast. This is Dr Charlize. For today's episode, I'm rebroadcasting an episode that came out sometime back that is circling around our theme this month of heart health and a holistic approach to heart health, so I'll go ahead and get this episode started. Thank you so much for joining me. So what is a blood pressure? So, blood pressure, which we all will probably be familiar with, when you go into your doctor's office or you go in for a health screening, there's two numbers that are generated. So, whether you measure your blood pressure at home which we'll discuss how you wanna approach that or if someone's doing it for you medical assistant or a doctor a cuff goes onto your arm and the cuff is to apply pressure to your arm, applying pressure to those tissues. And then, if the blood pressure is being done manually I'm sorry, so it's done with someone who's listening with a stethoscope, they'll be placing the stethoscope near, or hoping to get near, what's called the brachial artery, because they're gonna be listening for when the pulsation comes and when the pulsation ends, and that's how we generate the systolic, which is the top number of your blood pressure, and the diastolic, which is the bottom number of your blood pressure. So when we're measuring those in the clinic, that's how it's done manually in the machines that we use, because a lot of times we're relying on vital signs machines because it makes it a little bit more convenient because we can get the blood pressure and the pulse at the same time and if you're checking your blood pressure is at home you very likely are using a machine that does the same thing to get your blood pressure and your pulse at the same time. So it's pretty much the same concept. That cuff goes on. It's trying to measure the pulse in the brachial artery which scientifically we assume is an excellent reflection of what the pressure in your entire artery system is. I won't dwell too much on some of those details for the listeners, because there is a pressure system somewhat in the vein system of your body. However, we don't tend to monitor that for a number of reasons. And we are measuring one particular artery, the brachial artery. We assume that's the best reflection.

Speaker 1:

But these artery system in your body, the arterial system, is varied. It starts with your heart, of course, in the center of your chest, and then there's what's called the great vessels, so the main conduits that are carrying the volume of blood that eventually has to get to your entire body. And then we start to get branched down to medium-sized arteries which are like the arteries in your neck the carotid artery, which we all know how to check our pulse, probably by lightly placing two fingers on this space, sort of beneath your jawline, you can feel like pulsation and the brachial artery, which can be felt. It's a little bit harder. We'll talk about that here in a second. And as well as the pulse in your wrist, the radial artery, there's actually a similar pulse in your ankle it's called the posterior tibial, which you can actually feel as well. We'll talk about that here in a sec. Then there are smaller arteries that we can't necessarily fill with our fingers, that are also still contracting and taking blood to tissues away from the heart, and those get all the way down to a very, very small air into the arterioles and capillaries, which is a microscopic system where the actual function of blood oxygen exchange, all of the business of metabolism and how your body is going to get oxygen into the tissues and get carbon dioxide out of the tissues. That's the business end of all this deal. But when we're measuring blood pressure in the clinic, when you're measuring your blood pressure at home. That's what you're checking is the business end, that's, the medium-sized arteries, which we assume reflects the overall health of the arterial system.

Speaker 1:

Alright, so how do you check your blood pressure? So, of course, when you go into your care provider's office physician or health screening they take that part over for you, but for a number of reasons, maybe for your own curiosity, or maybe you've been instructed by your physician, maybe your cardiologist has said you need to do this, maybe there's some specialty things going on in your life. So how do you check your blood pressure? So, the average person, when you're going to pick a device to do it, you're going to have a lot of options. You'll have the options of cuffs that go on the upper arm, you'll have options on cuffs that go just on the wrist and, even as I make this podcast, the options are getting even more and there may be more options that I'm going to be frank, I may not be aware of.

Speaker 1:

So, between a wrist cuff and an arm cuff, which should you choose? And my recommendations are the arm cuffs, which and I'm sorry I almost forgot you can also get the manual system, which is this FIGMO monometer, and that's going to be the arm cuff and a stethoscope where you'll manually do it the manual system some people may want. But I'll advise you it's very difficult to do your own blood pressure manually because you've got to pump the cuff up and you've also got to be listening. But it can be done and it can be accurate with practice. But the cost of an automatic cuff be it a wrist cuff or an arm cuff the prices are so reasonable and those technologies have memories and can track and some of them get even fancier where they can tell you trends and give you a lot of data that I would tell you maybe consider getting an automatic cuff.

Speaker 1:

So between the options, depending on your lifestyle and information you're needing. So if you are fairly healthy and you don't really have many medical issues and your doctor or care provider has not given you specific directions and you're just wanting to know what your blood pressure is or you're tracking just for your own personal reference, things like your pulse and your blood pressure and your weight and your oxygen saturation, for you a wrist cuff might be ideal because they take up very little room. If the need arises, like if you have to travel for work or travel for family, a wrist cuff can easily go in your bag without taking up much room, and a wrist cuff can be one of the easiest to use because you just get it on your wrist and you're done. If you're under the care of a provider and you have been diagnosed with maybe one or two medical issues so I'm going to include weight or weight related issues, diabetes, definitely high blood pressure or any heart related issue and if your doctor has specifically asked for numbers at home or tracking and your doctor isn't necessarily prescribed a certain type of monitor or hasn't necessarily put you on anything, I would recommend you consider getting an arm cuff, the reason being is it going to be slightly more accurate than a wrist cuff. The arm cuffs tend to have a little bit more as far as features that they offer and likely if this information is being tracked because there's going to be decisions made on things like medications or treatments or anything like that then we probably need to step it up and go ahead and get the the cuff automatic that goes on the upper arms. It should be a larger cuff.

Speaker 1:

When you're deciding on which one of those wrist cuffs will likely be adjustable, so they'll come in one size Arm cuffs. It gets a little bit tougher. So please be aware that you don't want a cuff that's too tight. So if you're a gentleman who's taller, larger, has a larger upper arm, then you probably need to have a cuff with a large or an extra large cuff with it, or a device that may even have an option of cuff sizes. Most, for the most part, the over-the-counter devices are adjustable, but we get into a lot of trouble if someone has a larger arm or, for instance, if you're weight if you're over 250 pounds likely you're going to need a larger cuff because if the cuff is too tight we'll get elevated readings. On the other end of that, if you are a smaller individual and I'm just picking weight if your weight's under probably 120 pounds, we need to make sure the cuff fits you tightly enough. So as you're shopping for your device, you need to make sure that the cuff is adjustable for a smaller person who may be under 5 foot 5, maybe under 120 pounds. You may do better with just a wrist cuff to sort of take out that confusion, but you'll want to make sure you've got the option of a medium, small or even extra small cuff when it's time to check your blood pressure.

Speaker 1:

If you're using a wrist cuff, you want to make sure that you sit for at least five minutes. You want to be resting, so with feet planted on the floor, you do want to, as much as you can, you know, kind of tone down stimulation so you may, you know, maybe not even tune in too much like the television or anything, maybe just sitting and breathing. You know, as I said this and I guess you listeners know what I'm gonna bring it up you might want to use this five minutes of rest to meditate, but you want to have five minutes that you sit quietly and not drink any fluids that are hot, because hot fluids can mess with your blood pressure readings. Then, if you're using a wrist cuff, you want to make sure that you get it on with some tightness in your directions where your device should instruct you. But just as because you're listening, so you want to try to, you know, make sure that it's fitted.

Speaker 1:

If the device indicates to you that there's any particular part that needs to line up with an artery on your wrist, likely you're looking for the radial artery, which will be on the the side of your thumb. You can find your own radial artery, but like if you know how to check your pulse on your wrist. But you can use two fingers that you place lightly. You can trace the line down from your thumb along the outside of your wrist to the bony part of your hand and then come a little further. If you don't feel a pulse, simply lighten the pressure and keep getting lighter, and you should feel a pulse there. So if your device tells you to line it up with an artery, that's the one you're after on the wrist cuff, and then the wrist cuff is best kept at heart height. So then you'll lightly place your hand either like over your heart or gently rest it over your heart, and that helps with the accuracy of the reading.

Speaker 1:

If you're using an arm cuff, your arm cuff may have an indication as well that it wants you to place a marker of some sort on an artery. So I'll talk readers through it best that I can. But this is when you're looking for your brachial artery and you can actually find your own brachial artery. We just don't do this a lot. But you want to flex your arm, so you're like Popeye, and you want to flex your bicep so you make it really big. Then, with two fingers maybe, fill the top of the bicep and then just start to roll down towards your body and you're going to try to gently lift and push the bicep muscle to the back and outside of your body and Somewhere in that region that's where your break heel artery is Now finding it can be a little bit more difficult. But if you just fill around your bicep and you may even need to come like a little towards your, your armpit, which we call axilla, and Then you'll feel a very light pulsation there. And whenever you're trying to find a pulse, if you're using your fingers and you push down and you don't feel it, always go a little lighter. Go a little lighter and then you may feel the light thrumming there. This is an out-to-the-letters word.

Speaker 1:

Listening to a pulse. It's so different from your heartbeat, which is the love dub. A pulse is just a woof woof, so that you know that's what you're listening for. And of course, if you get the old-fashioned manual cuff and you're listening to the stethoscope, you hear the woof woof, so it's not like our love, love dub we hear with the heart. So when you start measuring your blood pressure that home whether you're doing it for personal interest or you've been instructed to it may take a little practice. So try to be patient and Many times your, your, your physician, may be completely open to this.

Speaker 1:

If you've bought your device, especially been instructed, and you're having trouble using it for your, take it into your next doctor's visit and Actually every doctor's office. I mean, I probably shouldn't say every office, but we all have nurses and medical assistants who Absolutely love to help our patients use their devices Because they check vital signs and they actually are expert in this skill, especially nurses. So if your doctor has a nurse in the office or a medical assistant and you're having trouble using your device, you want to ask them and they can definitely walk you through the proper use and how to use that device and Many times and we do this in my practice will even compare it to our measurements so that you know you're getting the right accuracy. So if you've been in depth, if you've been instructed to check your blood pressure and you're having trouble, ask your doctor's office. It doesn't really take the doctor, I mean really the nursing staff. This is where they reign supreme over the measurement of vital signs and they often can point out Things in your technique to help you do this better. Okay.

Speaker 1:

So once you have your cuff and you've started measuring the numbers that we're hoping to see, so in the History of medicine, in evidence-based medicine, high blood pressure is one of those topics that has a lot of evidence behind it as far as what might make you sick, what might damage your body or your heart. So, on average, your cystolic, or that top number we're hoping, will be around 120 and that's a millimeters of mercury. Mmhg is how we measure in medicine, but you'll just want to know 120 and the Bottom number, or the diastolic, we're hoping will be less than I Still say, 70, although the updated guidelines take it up to 80. So somewhere between 70 and 80 are normal. Now, if you start, if you've decided to start checking your blood pressures on your own and You're finding out your numbers are not around there. If they are higher than that, it is time to see a physician or a care provider for some further guidance, for some confirmation of the numbers.

Speaker 1:

I Think most of us are aware that something like high blood pressure is Not very likely to cause symptoms that you will notice. I no longer saying no longer causes symptoms. High blood pressure Absolutely causes symptoms. It's just that the symptoms don't stain out. They tend to be subtle. So would you be noticing your blood pressure? I think absolutely you are. You just haven't really had the mindfulness to take note yet. If your numbers are lower, there could be an issue that requires some assessment. So if your top numbers like 70 or 80, the systolic same deal probably time to go ahead and see a physician if you're not seeing one already.

Speaker 1:

So typical question I get is, or response I will often get when I'm seeing patients, is I have white coat high blood pressure? Medically we acknowledge the term white coat high blood pressure and that's saying that in many individuals the stress of being seen in a medical facility, every nuance that goes with it, often creates stress in our body that's subtle, in its subconscious and that by the time you're evaluated your blood pressure is running higher. But in a normal setting, in your normal life that your blood pressure would actually be normal. Do we treat white coat hypertension? This has been a back and forth debate for many years.

Speaker 1:

The way I advise patients is that if your blood pressure is high only when you're seeing me because it is stressful by the time you get there on your schedule and all of the things that go with it. I do think this is time to start monitoring at home with a wrist cuff or an arm cuff. But you also should be aware that if your body is responding to stress this way, you're going to have stress in traffic or in a meeting or doing an argument with a loved one and, depending on what's going on in your life. If you're having multiple episodes of this kind of stress, is your blood pressure in fact starting to run higher more than it's not? So while we say that if someone has white coat high blood pressure, they may not require treatment, I advise patients that your body is responding to stress and not necessarily that we need a medication. But let's acknowledge the fact that we're putting some strain on your cardiovascular system and let's make sure there's not other things we can do to reduce that strain Along that line's.

Speaker 1:

Another question often get is I'm just nervous when I'm here and this is why my blood pressure is high absolutely, and I actually I kind of go through some of the same thing as well. Anytime you're not in your native setting, you'll be nervous, but the same thing. If we're starting to see that stress response, then I think that's worthy of monitoring to see if you're doing that in multiple places, or you're doing that work and at home in the morning, and if we're starting to see some of a pattern with that. So in the show notes I am going to include a website called EP Validate. The website would be wwwvalidatebporg, spelled wwwv-a-l-i-d-a-t-e-b-porg. Once again, thank you so much for joining me for this episode. Don't forget to take your show notes for updates, ways that we can stay connected. If you're interested in holistic heart health, you can check out my offerings at drsharlisecom. And don't forget to check out the vibrational healing program available on YouTube. Now Check the show notes to sign up. Thank you,

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