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Blood Pressure in general

Medical Questions and Medical Opinions

What are normal results and when should I see a doctor?
  • The following table represents the values (units mmHg) supplied by the World Health Organisation (WHO):

Range Systolic Diastolic Recommendation
blood pressure to low < 100
< 60 Consult your doctor
blood pressure optimum 100 - 120 60 - 80 Self-check
blood pressure normal 120 - 130 80 - 85 Self-check
blood pressure slightly high 130 - 140
85 - 90
Consult your doctor
blood pressure to high
140 - 160
90 - 100
Seek medical advice
blood pressure far too high
160 - 180
100 - 110
Seek medical advice
blood pressure dangerously high > 180
> 110 Urgently seek medical advice!

  • It is recommended that you record your blood pressure values frequently and discuss them with your doctor. If your systolic values are frequently above 140 and/or the diastolic values above 90, you should consult your doctor. It is normal that blood pressure values are sometimes higher and lower and there is no need to worry if the results are sometimes higher than the above limits. But if your pressure is above the limits in most cases, you should consult your doctor!

What is «White Coat Hypertension»?
  • White Coat Hypertension (WCH) is the popular name for the effect that the patient's blood pressure might be detected on a higher level, when the measurement is performed by a doctor (in his typical white coat) or a nurse. This effect is caused because one often can be excited or nervous during such «official» measurements and the pressure will be accordingly higher. The problem is that the person may not have a pressure that is too high under normal conditions but might be diagnosed as hypertensive based on the doctor's measurement. Home devices are the best choice to prevent this «white coat effect». Some longterm studies have shown that people who have a higher pressure at the doctor also have a high risk to develop hypertension. Thus, these patients should check their pressure frequently.

Does blood pressure depend on age?
  • In an average population, blood pressure in the elderly is higher than that in younger ages. This is based on reduced blood vessel elasticity in higher ages.
  • The blood pressure should not frequently move above 140 / 90 mmHg even in higher age groups.

Medical Questions and Medical Opinions

In the following please find medically related questions and answers related to blood pressure and blood pressure monitoring. They are copied and translated from patient information of the Swiss Heart Foundation and we would like to thank the foundation for their kind permission for letting us use the following information.
- Swiss Heart Foundation
Schwarztorstrasse 18
CH-3000 Bern, Switzerland
phone: +41 / 31 388 80 80
fax: +41 / 31 388 80 88

Is it true that blood pressure is mainly measured with the "oscillometric" technique? What does this mean?
  • In a doctor's practice or hospital, blood pressure is commonly measured with the conventional «sound method». Heartbeats are listened to with a stethoscope. These sounds in the blood stream occur in the arteries of the upper arm when the pressure in an inflated blood pressure cuff is slowly released. The first audible beat indicates the systolic blood pressure; the last audible beat indicates the diastolic pressure. Blood pressure measurements are read off a mercury column and are for that reason given as millimetres of a mercury column (mmHg).
  • Oscillometry uses a different measurement principle. Most of the presently available devices for selfmeasurement use this method. Electronic microprocessors in oscillometric devices calculate blood pressure from the pressure fluctuations (oscillations), which occur due to the pulses in the blood stream. As beats are not relevant in this method, neither a stethoscope nor a microphone (integrated into the blood pressure cuff) are necessary. The blood pressure and pulse rate values can be read from an optical display at the end of measurement. Although these devices do not contain a mercury column, they show blood pressure in mmHg. With irregular pulse rates it is recommended that a doctor take the measurement.

What should be considered when doing self-measurement?
  • Patients with high blood pressure should regularly measure their own blood pressure, since this gives the doctor valuable indications about the effectiveness of the treatment. The measurements should be recorded in a blood pressure record book and also fill in the «comments» section with observations such as: feeling unwell, dizziness, disrupted sleep, forgotten to take medicine, or physical or mental problems. It is important that you always measure your blood pressure on the same arm or wrist, morning and evening at the same time. You should not smoke, drink coffee or alcohol beforehand. Take your blood pressure measurement after a 5 minute rest, sitting and in restful surroundings. Make sure that the measurement is taken at the height of the heart. Compare your measurement with that taken by your doctor and get your blood pressure device calibrated (every 2 years) at specialized shops.

Is a wrist device advisable for self-measurement?
  • The newly developed wrist devices also measure blood pressure using an oscillometric method. They are fully automatic: they inflate the pressure cuff automatically and automatically release the pressure again at the correct rate. Wrist devices measure blood pressure fairly reliably, if used correctly.
  • Fully automatic finger devices, which measure blood pressure and pulse rate on the index finger, frequently give faulty readings, due to index finger is not held steady at the height of the heart or if the small terminal branches of the arteries «arterioles» are constricted due to cold fingers.

Is it possible for my blood pressure to drop too low due to treatment?
  • Blood pressure may drop too low due to treatment. This can lead to dizziness when standing up quickly or bending down, extreme tiredness and lack of energy. If you notice these typical symptoms of too low a blood pressure (hypotension), you should talk to your doctor about a possible adjustment of the treatment. However, if you have low blood pressure without any problems, no changes to treatment are necessary.

Are side effects to be expected with drug treatment?
  • At the beginning of treatment, a medication may temporarily trigger a physical or mental reaction, with tiredness, dizziness and difficulties in concentration if blood pressure drops quickly. The body gradually gets used to the lower level of blood pressure and the problems disappear with time. Few people taking a particular pressure reducing medicine have continuing side effects. There are side effects that are typical of a certain type of drug, which cannot be avoided by reduction of the dosage. An example is the troublesome, but harmless dry cough, which may be contracted by those taking an ACE inhibitor. If the cough is very disturbing, your doctor may switch to another drug (eg. angiotensin II antagonist).
  • Skin disturbances, such as itching or rashes, also require a change of drug. With calcium blockers, the following harmless side effects have been observed: headaches, facial redness, swollen legs and ankles (oedema), as well as constipation. The most commonly reported side effects of beta-blockers include tiredness, potency problems, cold feet and hands. Low calcium levels in the blood, gout attacks and muscle cramps are possible side effects of diuretics. The best-tolerated drugs at present are the angiotensin II antagonists.

Can I stop taking medication due to side effects?
  • It's unwise to neglect blood pressure treatment, if disturbed by side effects, so discuss any side effects immediately with your doctor. It is usually possible to improve tolerance by switching to a reduced dosage, changing to a different preparation or changing from a single drug therapy to a combination of 2 drugs.

Can I stop taking medication at the weekend or on holiday?
  • Whether you take adventurous, leisure or active holidays, you must continue taking your medication, since as soon as you interrupt the treatment, your blood pressure will increase. When flying, it is advisable to take your medication in your hand luggage, in case your luggage is mislaid. For overseas trips, it is best to ask your doctor as to when you should take your medication, due to time differences.

Can I stop taking medication when I feel relaxed?
  • Nervous stress and tension, which temporarily push blood pressure higher, are normal and not to be confused with high blood pressure. Your doctor has diagnosed you with high blood pressure, i.e. your blood pressure is mostly too high when resting and not just when active or when stressed and under tension. You should therefore not stop taking your medication, even if you feel relaxed. Your blood pressure will otherwise again rise to the original level.

Will I have to take «blood pressure reducing medication» for a long time?
  • Damage to artery walls and an excessive strain on the heart, brain and kidneys can only be avoided if your blood pressure is properly controlled. This requires treatment with medication over a long period if you have seriously high blood pressure, once the remaining possibilities (dietary recommendations, reduction of excess weight, salt and alcohol reduction, control of stress, giving up smoking) have been exhausted and it has not been possible to reduce your blood pressure to a value of 135/85 mm Hg.
  • Changes in lifestyle and the removal of risk factors have a very positive effect and frequently allow the dosage of medication to be lowered after some time.

The medication has led to a potency disorder. What can I do?
  • Apart from medications, which can cause or contribute to potency disorders, there are other factors that are relevant, such as: age, physical and mental state, alcohol and nicotine consumption, as well as accompanying illnesses like diabetes.
  • The extent and speed of blood pressure reduction, as well as the preparation used can also have an influence. At high dosage, drugs such as beta-blockers and diuretics lead to potency disorder side effects sooner than do calcium antagonists, ACE inhibitors and angiotensin II antagonists. Do not delay in discussing any impairment to your potency with your doctor. If your medication is responsible, he may be able to reduce the dosage or switch you to a different preparation.

Are there unsuitable sporting activities if you have high blood pressure?
  • With basic high blood pressure, the small terminal branches of the arteries (the arterioles) are constricted, so raising resistance to circulation. Muscle movement causes a widening of the arterioles, since working muscles demand more oxygen rich blood. Regular stamina training of at least 30 minutes duration has a good effect on high blood pressure, as in for example: walking briskly, mountain walking, jogging, cycling, cross-country skiing, swimming (without time pressures and not in water that is too cold or too warm), dancing.
  • The large muscle groups move rhythmically together in these activities. The pulse rate becomes faster and blood pressure increases, but not too sharply. However, sporting activities that mainly strain the muscles without a regular movement are unsuitable. This type of sport (e.g. weightlifting) causes a sudden sharp increase in blood pressure.

Reliable Readings with Microlife Blood Pressure Monitors
Everyone's blood pressure is subject to wide variations. It is influenced by physical activity, daytime and mood. During the stress and strains of everyday life, deviations of 30 mmHg within minutes are quite normal. For this reason, persons who measure their blood pressure with a home monitor and take multiple readings can be confused by variations. While doctors are able to take solely a single reading at a certain point in time, the home monitor will indicate the normal range of deviation.
The leading specialists in the field therefore recommend that the patient perform this task him or herself by a home device. When this is done, it is important to use a medically proven instrument. All monitors have been developed in close cooperation with doctors to ensure constant precision of readings taken by patients.

Please note the following to obtain reliable results with the lowest possible range of deviation:
  • Blood pressure readings should not be taken during the stress and strains of everyday life. We recommend to take at least one daily reading at the same time and under relaxed conditions. The range of variation in the readings will be much lower when taken 30 minutes after the evening meal and while engaged in a relaxing activity than when taken during the day. Of course, readings should occasionally be taken during the day for the purpose of establishing your personal blood-pressure profile.
  • Accustom yourself to achieving a relaxed state before taking a reading. A reading taken immediately after sitting down or e.g. in the presence of a group of people is not normally useful. Do not take readings immediately after a meal, drinking, smoking, physical activity or excitement.
  • The reading should be taken after 5 minutes of relaxation in a comfortable sitting position. Apply the cuff according to the instructions.
  • After pumping up the cuff, breathe normally and do not speak. Avoid all movement and muscle tension.
  • The mean of several readings taken under similar situations on different days is your normal blood pressure.
  • When taking several readings in succession, wait at least 15 seconds between them.
  • When using a wrist device, make sure that it is at the same level as your heart.
  • A series of readings are often taken at the pharmacy or in a store for the purpose of comparison. Such results are rarely useful as the conditions under which they are taken are not normally acceptable. Comparative readings are useful only when made in a quiet environment and with the required intervals between individual readings. At the same time however, the readings will not normally be identical due to the normal variation in blood pressure.

High Precision when Measuring Blood Pressure at Wrist
The two arteries at the wrist are located directly under the skin and are surrounded by much less soft tissue
than in the upper arm. Furthermore, these arteries are significantly thinner than the artery in the upper arm.

The differences specified above result in the following advantages and disadvantages for patients:
  • The wrist device is located close to the arteries from which signals are obtained, and the cuff does not surround as much soft tissue as when applied to the upper arm. Therefore, patients with large amounts of soft tissue on the upper arm have significantly fewer problems when taking readings at wrist.
  • The thinner vessels at the wrist are more susceptible to arteriosclerosis, which often accompanies the aging process. In the presence of this condition, the wrist device can often produce error messages.
  • Taking readings at the wrist is generally preferable and faster than at the upper arm. As a result, the blood pressure will be checked more often.
  • Readings taken at the wrist are more sensitive to movement and can therefore produce error messages.
  • The wrist monitor must be held at the same level as the heart when a reading is taken.

This means that wrist devices are more suitable for:
  • Relatively young and middle-aged persons [except for those suffering from arteriosclerosis].
  • Persons who should always have a blood pressure monitor with them.
  • Persons who have difficulties positioning the cuff correctly due to an overabundance of soft tissue on the upper arm.
  • Persons who are able to sit still and hold the device at the same level as the heart when a reading is taken.
  • Persons who must check their blood pressure frequently.

Wrist devices are less suitable for:
  • Older persons [but only if they suffer from arteriosclerosis].
  • Persons who are not able to sit still and hold the device at the same level as the heart.

Statements: Blood Pressure Monitoring with digital Home Monitors
The following listed quotations are extracts of the symposium: 19. / 20. Juni 1996, Dublin, Ireland
«A centenary tribute to conventional blood pressure measurement: wither blood pressure
measurement in the next century?»

Prof. Eoin O'Brien [The Blood Pressure Unit, Beaumont Hospital, Dublin, Ireland]*

«For it is somewhat ironic that the mercury sphygmomanometer, the cornerstone of the Riva-Rocci/ Korotkoff
technique, is likely to fall into disuse shortly, near the centenary of its introduction.
There are three reasons for this eventuality: mercury is likely to be banned from hospital use because of the
danger of toxicity, accurate automated devices are now available to replace the mercury
sphygmomanometer and with the advent of 24-h ambulatory blood pressure measurement into clinical
practice, more reliance is being placed on blood pressure behaviour than on casual measurement
of blood pressure levels.»

Prof. Bernhard Waeber [Division of Hypertension, University Hospital Lausanne, Switzerland]*

«It is well known, however, that blood pressure measured conventionally by a doctor often poorly represents
the blood pressure prevailing during the everyday activities of the patient.»
«The auscultatory method {means stethoscope method} has its shortcomings; foremost among these is
observer inaccuracy and bias. There can exist large differences among observers measuring the same
blood pressure and, furthermore, the observer frequently tends to choose either 0 or 5 as the last digit.»
«Fully automated devices, being simple to use, are probably the most suitable.»

Dr. Paul L. Padfield [Department of Medicine, Western General Hospital Edinburgh, UK]*

«Conventional measurement of blood pressure utilizing a mercury sphygmomanometer, although potentially
accurate, is subject to a number of errors relate to both the observer and the patient.»
«In two separate studies we have shown that home or self-monitoring of blood pressure represents an
effective way of detecting hypertensive patients.»
«We have demonstrated that simple home monitoring devices will identify the same proportion of patients
who have white-coat hypertension as the more expensive ambulatory devices and thus we would recommend
these for use in family practice. Given the high prevalence of hypertension, or apparent hypertension, we
would advise all practitioners to invest in electronic self-monitoring devices...»

* all above are original extracts of scientific papers published in the journal «Blood Pressure Monitoring»,
Vol 1 Suppl 2, December 1996 (Rapid Science Publishers, 2-6 Boundary Row, London SE1 8HN, UK)