Q. It’s best to check your blood pressure after sitting quietly for 5 minutes. I got these instructions while participating in a 10-year Women’s Health Initiative study. At the doctor’s office, they tend to take your blood pressure after you have marched down the hall and you are answering questions. I worry that some of your readers may have been put on blood pressure pills unnecessarily because of this practice.
A. You are quite right that the stress of fighting traffic to arrive at the office in time, together with the hustle of getting you ready for the doctor, can contribute to elevated blood pressure. Some people get so anxious about having their blood pressure measured that it spikes much higher than it would normally be. This is called “white coat hypertension.”
The best way to deal with this may be to measure your blood pressure at home (after you have been sitting quietly for several minutes). Keep a record of the readings, and bring it to the doctor’s office along with your blood pressure monitor so that your physician can calibrate your machine against hers and get a sense of how you fare outside the office environment. Using the correct size blood pressure cuff is also critical for an accurate reading.
For more information on proper measurement technique and many non-drug approaches to lowering blood pressure as well as the main antihypertensive medications, you may want to consult our Guide to Blood Pressure Treatment. You might be surprised at how effective diet and exercise can be, if the right regimen is followed rigorously.

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  1. BobK
    Reply

    I have trouble getting accurate numbers at home. I purchased a rather expensive BP digital device from one of the recommended BP monitors manufactures. They recommend that 3 readings be taken each reading about a minute apart. However, in doing this I get large variations in the readings. The first is always the highest, the second is normally the lowest (by about 15 or more points systolic) and the third varies from the lowest to somewhere in between.
    I’ve sent my unit back to the manufacturer and they said it was within calibration. I’ve tried all of their suggestions regarding sitting, arm height, etc., and still get variations in my readings so I don’t know which number to believe. After months of emails back and forth the service rep said to go with the first number as it is the most accurate. Has anyone else had this problem?

  2. BP or no BP?
    Reply

    My Systolic ranges 140 to 160 but my diastolic is optimum.
    Should I go on BP medication?

  3. JWM
    Reply

    Can somebody tell me how the wrong size cuff can cause erroneous blood pressure readings? Cuff too big? Just takes a few more pumps on the bulb. How can one’s arm tell the difference?
    Thanks,
    JM
    PEOPLE’S PHARMACY RESPONSE: The cuff is calibrated to give an appropriate reading. If it is not the right size, it throws the calibration off.

  4. BJMA
    Reply

    What is the norm for the change in BP from sitting to standing? Mind will change, sometimes the top number will go down and bottom number will go higher when standing. Pulse rate is a lot higher when standing. Is this normal?

  5. STEVE
    Reply

    I wonder how many of us might get a poor doctor / patient relationship by trying too often to correct the doctor and staff and being marked as a know-it-all trouble-maker. I sometimes feel a negative attitude from doctors that I have seen. It may be that my communication to the doctor may not have come over correctly, but the more those of us patients try to correct the trained professional expert, the more the chance to create bad vibes.
    Overall, I think that if a doctor and staff are doing much more good than harm on the most important parts of health, then keep that doc. Do not get on his / her bad side and receive unintended bad service from that human being. In this article, taking a blood pressure monitor to the office is a very good example of taking creditable proof for non-offending communication. I wish all communication would be so simply enacted. Sure would like to hear some comments back on my viewpoint.
    PEOPLE’S PHARMACY RESPONSE: Steve, it is important, if difficult, to keep the communication positive. Nobody likes to feel criticized. Thanks for your perspective!

  6. MMB
    Reply

    In addition to conversation, not supporting bare arm at heart level, not sitting 5 minutes I would add that usually a patient has just been weighed and this adds a bit of stress. Having a full bladder and being in a cold room will also give falsely high readings.

  7. Walter M.
    Reply

    It is essential that the arm that is used for the BP measurement is supported on a table or desk. I tried measuring my BP on an arm that I elevated to my heart level and found that the systolic BP was 30 – 40 mm Hg higher than when the arm is supported

  8. DWD
    Reply

    But if you are in situations where your blood pressure is elevated from the hustle of life then isn’t that the number you want? Since your blood pressure is elevated a large percentage of your waking hours then isn’t that higher blood pressure affecting a person’s health? Unless one normally spends their life sitting quietly.

  9. DM
    Reply

    This is so true. For years, I paid a higher health insurance premium than I should have because my PCP’s records furnished to the insurance company showed elevated blood pressure readings. I refused, however, to take blood pressure medication, as my pressure was good when I checked it at pharmacies. I finally learned to demand a blood pressure check at the end of my doctor visit…not at the beginning!!

  10. nathan m.
    Reply

    My blood presure varies from perfectly normal to borderline to high dependent to circumstances.

  11. jla
    Reply

    I have horror stories of how my blood pressure has been taken in doctor’s offices. Through wrinkled fleece shirts, standing up, with the reading device on the back of my arm, with my arm dangling down, and once with my arm being held straight up in the air while I was laying down. I’ve also experienced too much pressure on the arm, resulting in an error, then having the assistant reduce the pressure and immediately trying again. Now whose pressure would not increase under any of these circumstances?
    The above incidences happened in the offices of specialists or while in the hospital. My primary care doctor and his staff always make sure they hold my arm under their arm when taking pressure readings.
    I have learned to speak up and always ask the treating physician to take my pressure at the end of my appointments as well.

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