Blood Pressure, What Is It? How to Check it? What's Normal?

This podcast is the first of 5 related podcasts covering high blood pressure.  

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 a 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.

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Transcript

Speaker 1: 0:55

Hello and welcome back to the Art Healing Podcast. This is Charise and thank you so much for joining me for today's podcast. So starting for the month of August, um, for a couple of reasons. I'm gonna be focusing on matters related to the heart, um, particularly blood pressure. So, um, this podcast, we're gonna discuss blood pressure, what it is actually into a little bit more detail. And then over the next few podcasts, we're gonna get a little, little deeper as far as high blood pressure, um, what it means, how we manage it. And then we're going to end the month of August with, um, getting going a little bit from the science of high blood pressure, my favorite transitions into the, the magic and the woo woo part of high blood pressure and particularly, um, things we can do with mindfulness. And then we'll end the month. Um, if listeners want to stay with me for this journey of August, we'll end the month with, uh, meditation exercise we can do to reduce our stress for those individuals who are wanting to work with their mind and their heart with their blood pressure. So what is a blood pressure? So blood pressure, which, um, we, 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, um, whether you measure your, your blood pressure at home, which will discuss, um, the how you wanna approach that, or if someone's doing it for you, a medical assistant, a nurse or a doctor, you know, a cuff goes onto your arm and the cuff is, um, to apply pressure to your arm, applying pressure to those tissues. And then if the blood pressure is being done manually, uh, meaning, I'm sorry. So it's done, you know, with someone who's listening with a stethoscope, um, they'll be placing the stethoscope near or hoping to get near what's called the brachial artery cuz 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. And the machines that we use, cuz a lot of times we're relying on vital signs machines cuz it, it makes it a little bit more convenient cuz we can get the blood pressure and the pulse at the same time. And if you're checking your blood pressures at home, you very likely are using a machine that does the same thing that gets your blood pressure and your pulse at the same time. So, um, it's pretty much the same concept that cuff goes on, is 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. Um, 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. Um, however, we don't tend to monitor that for a number of reasons. And, um, we are measuring one particular artery, the brachial artery, we assume that's the best reflection. But, um, this artery system in your, your body, the arterial system is very, is varied. Um, it starts with your heart, of course in the center of your chest. And then there's what's called the great vessels. It's 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 branch down to medium arteries, which are like the arteries in your neck, the carotid artery, which, um, we all know how to check our pulse probably by lightly placing two fingers on, um, the space, sort of, uh, beneath your jaw line you can feel light 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, your wrist, the radial artery, um, there's actually a similar pulse in your ankle. Uh, it's called the posterior tial, which you can actually feel, um, as well, we'll talk about that here in a sec. Then there's smaller arteries that we can't necessarily fill with our fingers that are also still contracting and taking blood to tissues away from their heart. And those get all the way down to a very, very small area into the arterials 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, um, that's what you're checking is the business end. That's the medium size arteries, which we assume reflects the overall health of the arterial system. All right, 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. Um, maybe there's some specialty things going on in your life. So, um, how do you check your blood pressure? So, um, for the average person, when you're going to pick a device to do it, um, you're gonna 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, um, even as I make this podcast, the options are getting even more, um, uh, fancier and there may be more options that I'm gonna be Frank I. May not be aware of. So between a risk cuff and an arm cuff, which should you choose? And um, my recommendations are, um, the arm cuffs which, um, and I'm sorry I almost forgot. You can also get the manual system, which is this Figma manometer. Um, and that's gonna be the arm cuff and a stethoscope where you'll manually do it. Um, 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 gotta pump the cuff up and you've also gotta be listening. Um, but it can be done and it can be accurate with practice. But the cost of a, of an automatic cuff via risk cuff or an arm cuff, the prices are so reasonable and tho 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. So between the options, depending on your lifestyle and the 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, um, and you're just wanting to know what your blood pressure is or you you're tracking just for your own personal reference, things like your pulse and your blood pressure and your weight and your oxygen saturation, um, for you a wrist cuff might be ideal cuz they take up very little room. Um, if the need arises, like if you have to travel for work or travel for family, a risk cuff can easily go in your bag without taking up much room. Um, and a risk cuff can be one of the easiest to use cuz you just get it on your wrist and, and you're done. If you are under the care a provider and you have been diagnosed maybe with maybe one or two medical issues. So I'm gonna include, um, weight or weight related issues, uh, diabetes, definitely high blood pressure, any heart related issue. And if your doctor has specifically asked for numbers at home or is tracking and your doctor hasn't necessarily prescribed a certain type of monitor or hasn't necessarily put you on anything, I, um, would recommend you consider getting an arm cuff. Um, rea being, is it gonna be slightly more accurate than a risk cuff? Um, the arm cuffs tend to have a little bit more as far as features that they offer and um, likely if this information's being tracked because there's gonna be decisions made on um, 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 when you're deciding on which one of those, um, risk cuffs will likely be adjustable. So they'll come in one size, um, arm cuffs, it gets a little bit tougher. So, um, please be aware that you don't wanna 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. Um, they 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, you're um, if you weight, if you're um, over 250 pounds, likely you're gonna need a larger cuff because if the cuff is too tight, we'll get elevated readings. Um, 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, um, 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 five five, maybe under 120 pounds, um, you may do better with just a risk cuff to sort of take out that confusion, but you'll wanna 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. If you are using a wrist cuff, you wanna make sure that you sit for at least five minutes. Um, you wanna be resting so with feet planted on the floor, um, you do want to um, as much as you can, um, rule, 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. And you know, as I said this, and I guess you listeners know what I'm gonna, I'm gonna bring it up, you might wanna use this five minutes of rest to meditate. Um, but you wanna have five minutes that you sit quietly and, um, um, not drink any fluids that are hot. Um, because hot fluids can mess with your blood pressure readings. Then if you're using a risk cuff, you wanna make sure that you get it on with some tightness in your directions where your device should instruct you. But just as cuz you're listening. So you wanna try to, you know, make sure that it's fitted. 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, um, 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 rested over your heart and that helps with the accuracy of the reading. 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, and I'll talk readers through it, um, best that I can. But this is when you're looking for your break your artery and you can actually find your own break, break your artery. Just don't do this a lot, but, um, you wanna get your flex your arm so you're like Popeye and you wanna flex your bicep so you make it really big. Then with two fingers, um, maybe fill the top of the bicep and then just start to roll down towards your body and you're gonna 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 brachial artery is. Now finding it can be a little bit more difficult, but if you just feel 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 are 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 isn't note to the listers where you're listening to a pulse. It's, it's a little different from your heartbeat, which is the love dub. A pulse is just a woo 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 this to the scope, you hear the woo. So it's not like our love dub we hear with the heart. So when you start measuring your blood pressures at home, whether you're doing it for a personal interest or you've been instructed to, um, it may take a little practice. So try to be patient and, um, many times your your, your physician may be completely open to this. If you've bought your device, especially you've been instructed and you're having trouble using it for your uh, um, take it into your next doctor's visit. And actually, um, every doctor's office I don't have, I mean I probably shouldn't say every office, but um, we all have nurses and medical assistants who absolutely love to help our patients use their devices, um, because they check vital signs and they actually are expert in this skill, um, especially nurses. So, um, if your doctor has a nurse in the office or a medical assistant and you're having trouble using your device, you wanna 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, we'll even compare it to our measurements so that you know you're getting the right accuracy. So if you've been, if you've been instructed to check your blood pressure and you're having trouble, um, ask your doctor's office, it doesn't really take the doctor. Um, 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, so um, once you have your cuff and you've started measuring, um, the numbers that we're hoping to see, so, um, in the history of medicine and 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 systolic or that top number we're hoping will be around 120 and that's a millimeters of mercury. Mm, HG is how we measured medicine. But you'll just wanna know one 20 and the bottom number or the diastolic we're hoping will be less than, I still say 70, although the updated guidelines taken up to 80. Um, 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. Um, I think most of us are aware that um, something like high blood pressure is not very likely to cause symptoms that you will notice. I no longer say no longer cause a symptoms, high blood pressure absolutely causes symptoms. It's just that the symptoms don't stand out. They tend to be subtle. So, um, 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. Um, so if your top number's like 70 or 80, um, the systolic same deal, probably time to go ahead and see a physician if you're not seeing one already. So, um, typical question I get is, or response I'll 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 it's 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. Um, do we treat white coat hypertension? This has been a back and forth debate for many years. Um, the way I advise patients is that if your blood pressure is high, only when you're seeing me, cuz it is stressful by the time you get there on your schedule and all of the things that go with it, um, I do think this is time to start monitoring at home with a risk cuff or an arm cuff. But you also should be aware that if your body is responding to stress this way, you're gonna have stress and traffic or in a meeting or during 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 lines, another um, question often get is, I'm just nervous when I'm here. This is why my blood pressure's 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, um, if we're starting to see that stress response, then I think that's worthy of monitoring to see if you're doing that multiple places, are you doing that work and at home and in the morning. And if we're starting to see some of a, a pattern with that. So, um, in the show notes, um, I am going to include a website called, um, BP Validate. The website would be www.validatebp.org, spelled www.validatebp.org. Um, we'll include that in your show notes. That website will give you the recommended, validated tested blood pressure cuffs that you may wanna shop for. So that way you'll have a little bit of guidance because if you don't have a blood pressure cuff and you start to shop for one, you're gonna find out there are many, many options out there available to you. Um, for this episode, I did use some reference material I will include in the show notes. One of those reference materials is the primary care medicine office evaluation and management of the adult patient. And I will show my credits in the show notes for this. Um, once again, thank you so much for joining me for this topic. Um, I'm really grateful that, um, I could create some space to discuss blood pressure cuz it's, it's very important and I spend most of my days on this. Um, as always, I'm so grateful I know that your time is valuable. Um, I am focusing on the topic of blood pressure for a very specific reason. I'm working on a project that has gotten my heart racing and, um, as I'm working on this and developing it, um, discussing and really tuning in to blood pressure is one of the aspects of this. So of course if you'd like to know more or get updates on this project and what's coming up,

Speaker 2: 24:38

Definitely um, tune into healing arts health and wellness.com and sign up for my newsletter so I can update you on this, on this project in more matters of the heart. Thank you so much and I'll talk to you next week. Bye bye. I.