Do you Really Need to Check Your Blood Pressure at Home?

Podcast Transcript

Announcer:
Welcome to Love Your Heart, brought to you by Cleveland Clinic Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Luke Laffin, MD:
Hi. My name's Luke Laffin and I'm a preventive cardiologist at the Cleveland Clinic. I also run our hypertension center here in the Heart, Vascular & Thoracic Institute at the main campus of the Cleveland Clinic.

Luke Laffin, MD:
One question that I oftentimes get from my patients is, "Do I really need to check my blood pressure at home?" And it's a good one because for years, we've been accustomed to coming into the doctor's office, be it a cardiologist, primary care provider, and you sit down and the medical assistant or nurse checks your blood pressure. Then you go about your daily visit. It's really important to note that blood pressure in the office is not as well correlated with cardiovascular outcomes as measuring blood pressure outside of the office. And there's a few reasons for that.

Luke Laffin, MD:
Number one is that the office is an isolated setting and it's very common to have things like white coat effect or white coat hypertension. And you may have heard of that before. Essentially what that means is that blood pressure levels in the clinical setting or an office setting are significantly higher than those readings outside of the clinical setting. That's one reason to measure out-of-office blood pressure.

Luke Laffin, MD:
The other reason to measure out-of-office blood pressure is to detect for what we call masked hypertension. Masked hypertension can be thought of as the opposite of white coat hypertension. Masked hypertension means that blood pressure in the office setting is fine. Looks pretty normal. But then out of the office setting is significantly higher. We know that whereas white coat hypertension doesn't tend to have adverse cardiovascular events, masked hypertension certainly does. So it's really important to measure out-of-office blood pressure.

Luke Laffin, MD:
When we talk about measuring out-of-office blood pressure, there's two major ways that we do it.

Luke Laffin, MD:
The first is 24-hour ambulatory blood pressure monitoring. That's a study typically ordered by your medical provider where you wear a blood pressure cuff for 24 hours. The cuff inflates every 15 to 30 minutes, it's attached to essentially what looks like a 1990's cell phone. And that readings gets sent back to your physician with an average blood pressure over the 24-hour period. This can be helpful, but it's only a one-time measurement. What can also be helpful is home blood pressure monitoring, which is highly recommended by the American Heart Association, particularly in those individuals with a known history of hypertension.

Luke Laffin, MD:
How we measure blood pressure at home can be a little bit variable, but really focusing on measuring at times of the day when it tends to be the highest, which is in the morning and in the evening, measuring properly or appropriately. So trying to remember key things like sitting for five minutes before we measure blood pressure. Also, making sure we didn't have a big cup of coffee or a cigarette before we measure our blood pressure. And then also simple things like urinating before we measure our blood pressure. A full bladder can raise blood pressure as much as 10 to 15 millimeters of mercury. So we don't want to be getting abnormal or erroneous blood pressure readings at home because then we risk making wrong decisions about medication treatments.

Luke Laffin, MD:
How often we measure is up to you and your doctor in terms of conversations. Typically, what I tell patients, it's about three to five times a week while we make medication adjustments. But then if things become stable, really a couple times a week or even less is very reasonable just to make sure that we're still on the right track. Nice thing is, is that with the advent of the electronic medical record, oftentimes we can upload those readings directly into the cloud or into the electronic medical record just for your medical provider to see. So talk with them about that as well.

Luke Laffin, MD:
Overall home blood pressure monitoring, there's lots of great machines out there. What I oftentimes point people towards is going to the American Medical Association's website, validatebp.org. These are the devices that people can use that have been best validated for measuring home blood pressure. There's about 15 of them or so, but take a look and that's a great resource where then you can use those names and ultimately find a place to purchase one of those to use on your own.

Luke Laffin, MD:
Overall, I highly endorsed home blood pressure monitoring. I think it's very helpful, particularly when it's integrated into your electronic medical record. And particularly when you can then have a conversation or a dialogue with your medical provider about what the next steps are based on those home blood pressure readings. Thank you.

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