You’re probably checking blood pressure wrong.
Why does it matter? Because we’re making life and death decisions based on numbers that don’t reflect reality. Managing chronic hypertension (blood pressure elevation) has huge consequences in terms of reducing risk of cardiovascular disease, stroke, kidney failure, vision loss, and more yet we either over-treat or under-treat patients because we don’t use the proper technique when checking their blood pressures.
One clarification: this most directly applies to outpatient measurements in stable patients. EMS and hospital providers may need different techniques given the specific limitations and demands of those situations and we shouldn’t be making long term hypertension management decisions based on those crappy measurements anyways.
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Hey what’s up Z-Pac, it’s your boy, Dr. Zubin Damania, AKA ZDoggMD. It’s chaos over here, I apologize but it raises my blood pressure to be in an active construction zone which is what I’m talking about today which is blood pressure measurements.
Listen by current definitions, something like 50% of Americans have high blood pressure. This is insane, especially in light of the fact that we most often measure it wrong, especially healthcare professionals who should know better.
So, here, it just kills me that we’re making life and death decisions, putting people on medications, giving them a stigma of a disease, affecting their life insurance and we’re not even measuring blood pressure right. Here is how you measure blood pressure and I want you listen in and take notes, especially if you’re a student, okay, even if you’re not.
First of all when you measure blood pressure you better pick the right cuff size. If the cuff is too big or too small, you’re gonna get erroneous readings, okay? It should fit comfortably around the arm. Do not put it over clothes. The shirt should come off, it should be over bare skin, all right?
When you check a blood pressure, ’cause people are stressed, they’re walking in, they’ve been waiting in the lobby, they’re crazy. Five minutes of quiet time before you check their pressure. Now this is really hard in our chaotic healthcare environment but if we’re gonna make life and death decisions, we need to at least, we owe it to our patients to do it correctly, okay.
Make sure the room isn’t too cold or too hot. Make sure the patient has voided their bladder, make sure that they’re not going crazy with construction and remodeling and make sure that you take the blood pressure with the feet flat on the ground, okay? The back’s supported in their chair. Right, back supported in the chair, right Erick? That’s right.
– [Erick] That’s right Z.
You take the pressure with the arm at heart level supported on something, okay? Because otherwise you’re gonna get erroneous readings and you wanna do it two measurements, roughly a couple minutes apart and if those measurements differ by more than a few millimeters of mercury, you probably wanna take a third measurement.
Remember that blood pressure varies over the course of a day and so you may wanna check it in the morning, you may wanna check it at night, check it at home, teach your patients how to do this at home because people get white coat hypertension and then they’re treated for something that maybe they don’t have. It’s very, very important.
Now remember the key things are if the back isn’t supported, if the feet aren’t flat, don’t let the legs be crossed, stop talking to your patient when you’re checking their blood pressure. Tell them to be quiet, talking will change the blood pressure.
Now look at my blood pressure, it’s going through the roof right now because they’re drilling in my house. Probably, we’re gonna hit a gas main and explode. This is the wrong time to check my blood pressure, all right. Let me chill for five minutes.
Now listen why is this important? Nurses and doctors and MA’s, people who are checking blood pressure, patients at home, if you screw this up, it’s a life and death thing. If I start you on hydrochlorothiazide and Lisinopril because I think your blood pressure’s high and it’s not, I am doing you a disservice. You may pass out, you may have syncope, you may hurt your kidneys, why because I screwed up.
So, guys here’s the call to action. We did a longer video on this, there’s plenty of resources online on how to take a correct blood pressure. The machines by the way are not bad. Sometimes it’s helpful to put a patient in a room and have the machine check it because then you lose a little bit of the white coat aspect.
So it is a lot of nuance here but the bottom line is just check the damn blood pressure right and the other thing is check the pressure, that’s a key thing, right? So many people just don’t aren’t even screened.
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