Take my Blood Pressure Right Please!

Since May is Blood Pressure Awareness Month I have to tell you about my pet peeve: blood pressures that aren’t taken right.  How often have you had the experience of rushing to keep a  doctor’s appointment during a busy day in your life, be brought into the exam room, directed to jump onto the table, and immediately have your blood pressure taken by the medical assistant? You figure the person taking your blood pressure knows what they are doing. You think she didn’t make the cuff tight enough but you don’t want to say anything. You are nervous about being at the doctor’s office where your blood pressure is always higher than when you take it at home but the office routine is the office routine. No one ever comes back to repeat a reading. You notice that the medical assistant takes your blood pressure over the sleeve of your sweater even after you offer to push your sleeve up but you aren’t sure if that is right or not.

Now please don’t think I’m singling out medical assistants as being incompetent in blood pressure taking.  I have seen doctors and nurses take blood pressures wrong. My own doctor would often take my blood pressure with my arm way above my heart….wrong, wrong, wrong!

So here’s what I want to see when blood pressures are taken. No drinking coffee, no smoking, and no exercising before you have your blood pressure taken. Those are the things you can do to assure accuracy. I remember when I was a smoker. I’d always have a cigarette on my way over to the doctor’s appt.. Was my blood pressure higher then normal then? You bet! And think about exercise. Taking your blood pressure immediately after an aerobics class is not the best time. And what about those older men and women who struggle to walk down a long corrider using all the energy they can to make the distance to the exam room and then their blood pressure is taken as soon as they park their walker. Why can’t we just tell the nurse or the medical assistant to come back when we have caught our breath!

Patients always ask me if it is okay to have their blood pressure taken over their clothes. The answer is no. You just don’t get the most accurate blood pressure over clothes. I admit that I have on occasion taken a blood pressure over clothes. Usually it is when the person is healthy, has no history of hypertension, and the clothing is very light. Or I may take it over clothes if it is just impossible to get the sleeve up and it isn’t appropriate for them to undress. This doesn’t happen often. I always strive to take it on a bare arm.

Now the part that really gets me is when the position of the arm isn’t correct. When my doctor lifted my arm way up I always felt like telling him to please don’t take my blood pressure that way. I never got up the nerve though. I’d just stew after the visit. The arm should be at the level of the heart and well-supported. Any higher or any lower affects the accuracy of the reading.

The cuff should be snug but not tight. The cuff shouldn’t be popping off as the blood pressure is being taken. If you have very muscular arms or obese arms, make sure the right size cuff is being used.

Finally, if there is a need to take your blood pressure more than once, and actually that is a good idea according to the American Heart Association, then the taker should wait at least one minute between readings. That assures time enough for the blood vessels to return to normal before the blood pressure is taken again.

I came across two websites that have credible information about the process of blood pressure taking: http://www.steeles.com/catalog/takingBP.html#hearing and www.americanheart.org. Speak up. Insist on having your blood pressure taken the right way.

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2 Comments on “Take my Blood Pressure Right Please!”

  1. Jo Diffenbaugh Says:

    Thanks for verifying correct way to take B/P. Started with a new PCP and from first 140/70 reading stated I had hypertension. Now I’m even more nervous at each visit. Always rushed, sometimes over clothing – even a sweatshirt – never checked a 2nd or 3rd time during the visit.

    I’m 64yo female with no hx of hypertension. Average B/P 110/70.

    I monitor B/P now at home in prep for next visit.

  2. Jane Says:

    As a well-informed patient, and former medical paraprofessional, who has taken thousands of client B/P measurements, I have been attempting for over a decade to get providers and their staff to take one of the most straightforward, evidence-based evaluations of health, and to no avail.

    I do speak up, every time, except this last, when, after going through hell, trying to figure out how I could get dental care, I decided what money I had should go to an oral surgeon, as I knew full well, that at least three teeth had to be extracted.

    The “surgical assistant,” first did not give me a thyroid collar when I asked for one, even though I had stated I had had recent nodular biopsy. It was clear that this ignorant so and so had decided that I was “one of those patients” who exaggerated radiation exposure, and she told me about the most recent conference she’d attended where she learned that the exposure from the panorex was pretty much nonexistent.

    Now, things have been exceedingly bad for me for the entire year. I agonized over how I was going to manage to pay for any dental visit whatsoever. Having finally decided, and having driven quite a distance, which I do not do easily, now, and having previously had this oral surgeon attend to my needs, very well.. I surely did not want to make a scene, even as every nerve in my body was screaming – “GET OUT.” But I let her proceed – no collar.

    Now, the recent actual studies suggest that it probably makes little difference whether a thyroid collar is offered or not, and it can obscure structures if not positioned carefully, but I say – err on the side of safety.

    So, then, I’m rushed down the hall, and put in a room. I honestly cannot recall who took my blood pressure, (manually), but when I started to remove my arm from my sweater, she said, and I would swear to this in a court of law, “This is a new kind of cuff that can be used over clothing.” Tell me — what the hell do you do, other than leave?

    Now this visit, with no work done, cost $240.00. Cash. That is over one quarter of my sole Social Security income, and I have zero assets. My blood pressure reading was astronomically high, but it was not due to the latter compared to the idiocy I was dealing with. You can imagine how insane it was to attempt to have my arm at heart level, and in the position I was sitting, it was impossible. The arm was unsupported, but extended – that’s good for how much Hg increase? Not insubstantial.

    However, this blood pressure reading was completely unique, so presented an acute issue. The dentist had said they would repeat the B/P, as much as they all got on the white coat syndrome bandwagon, which, of course, also further increased stress. It wasn’t repeated.

    The oral surgeon, with whom I had complete trust in the past, also did not properly examine my mouth when I explained that I had a gum line lesion for two months. She looked in my mouth, but would have had to pull my cheek way out in order to see that back tooth and gum.

    I don’t want to let all this go, and I want to complain to the office. Guaranteed that I will then be dismissed as a patient, and, apart from this oral surgeon’s excellent reputation, there aren’t others in the area.

    But, if I keep this to myself, (and the world wide web), I will implode. I already had lengthy discussions and a visit with my cardiologist, and, indeed, while not as severely hypertensive as the dental office reading, my pressure is abnormally high. I think the reason for that is that I have absolutely had it with the lies, the hopeless incompetency, et all, and at a time of life, and situation where I could well use the income these idiots are making, if only I could work. Now, my cardiologist is involved…

    I am grateful to have found the post. I have run copies of an 8 page manual on proper technique, which includes the effects of improper technique, and taken it to provider’s office. Guess how much that has made a difference, other than in their attitude towards me.

    One of the most direct, and effect methods of gaining evidence, and they might as well be sharing a muffin with you for all they understand about its importance. Of course, the automatic machines are worse, re-pumping…

    I guess I’ll have to find an oral surgeon, somewhere. But they’ll hear about this.

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