One of the most fundamental measurements that is taken at almost every doctor’s visit is blood pressure. After you get weighed, a nurse frequently will check to see whether your blood pressure is within the “normal” limits. Not infrequently, blood pressure measurements are taken incorrectly as this reader reports:
Q. I recently had a doctor’s appointment and the nurse measured my blood pressure while I was sitting on the exam table with my arm dangling at my side. It was 153 over 95 and that was entered into my chart. At home it was 135 over 82.
The doctor is talking about starting me on a diuretic to lower my high blood pressure. I’m not convinced I really need it.
A. Proper blood pressure measurement requires the patient to be seated in a chair with back support and both feet on the floor. The arm should be supported at heart level, the cuff should be the right size and there should be no talking. Otherwise, the reading could be inaccurate.
What’s the Big Deal?
When a blood pressure reading is falsely elevated either because the cuff is the wrong size or your arm is in the wrong position, you could be falsely diagnosed as hypertensive. That can set in motion a domino effect.
First, you are labeled with a chronic condition: high blood pressure or hypertension. That can affect life insurance, health insurance and employment. It also affects sense of self. You are now no longer “normal.” A diagnosis of high blood pressure can also lead to medication, with potential side effects.
Let’s just take cuff size, for example. If you have a large arm, a cuff that is too small can falsely elevate blood pressure. When was the last time someone actually measured your arm to see if it required a larger cuff? Did the nurse have a larger cuff available. And by the way, a very thin arm should not be measured with a standard sized cuff either. That could lead to an inaccurate reading.
Do NOT Talk!
Talking while your blood pressure is being taken can increase the reading by 10 to 20 points. If the nurse ask you something personal or emotional, the reading could go even higher (Angiology, July, 1982). This is not something most health professionals are aware of.
Reader Stories about High Blood Pressure & Faulty Measurements:
This report came from D.B.
“Just after I entered menopause, my doctor felt I had high blood pressure – even though readings were taken incorrectly. (I was having lots of trouble sleeping at the time.) She put me on a diuretic called HCTZ. After a couple of days, I was feeling really awful. Dizzy, nauseated, shaky, no energy. After four days, my heart was racing – 120 beats/minute – and I was just relaxing in a recliner reading the newspaper.
“I called to report the side effects and was told by the nurse that these side effects were not listed under this medication. I let her know that they were listed in the info I got from the pharmacy.
“After talking with the doctor, the nurse said they’d switch me to a Beta Blocker, until I reminded her that I have asthma – so a Beta Blocker would not be a good idea for me! I think my electrolytes were completely out of balance. No one ever suggested a smaller dose or anything else.
“I recently worked with a functional medicine (FM) practitioner to figure out why I couldn’t lose weight and was still very fatigued. Since then I have lost about 25 pounds of fat and have healed my esophagus of Barrett’s and healed SIBO and have lots less inflammation, and guess what! My blood pressure is much better. Funny, though, the FM practitioner never takes my blood pressure the same way twice and often does it incorrectly, too! I still take my own blood pressure at home a couple times a week, just to keep my eye on it.”
Louis in Florida makes a good point:
“In addition to no talking, I have found that no body movement-head, arms, legs or shifting around will result in a most accurate reading, whether at home or in the doctor’s office.
Differences of 10 to 40 points higher occur with movement.”
Nurse Carol reports her own experience:
“I always take my BP at home for the week prior to my doctor visit and give her the readings. As a registered nurse, I am appalled by what I see when the assistants take BP’s. You are sitting on the end of the exam table with your legs dangling and your arm is hanging down.
“They also never seem to put the cuff on tight enough to pick up an accurate reading. My brachial pulse is difficult to palpate so the cuff needs to be snug to pick up the pulse. I have had readings of 180/110 with the cuff is not even touching my skin but when the cuff is on snug the reading comes down to 120/80. The assistants also don’t allow for a 10 minute rest period after escorting you to the exam room. I bet over half of people on drugs for hypertension have normal blood pressure.”
Anyone who would like to learn more about proper blood pressure measurement techniques and ways to control hypertension with and without drugs may find our Guide to Blood Pressure Treatment of interest.