How's Your Blood Pressure?

[Doug_Tipple]

As we age, it is not uncommon for our blood pressure to slowly creep up to what the doctor’s diagnose as hypertension, or high blood pressure. Along with millions of other people, I have been taking medication to lower my blood pressure. My problem is that my blood pressure rises every time I walk into the clinic for an office visit.

First of all, with the new paperless system in my HMO clinic, the nurses don’t even know the reason for my visit. My personal folder is no longer lying on the table; everything is supposed to be on the computer screen, if you can get to it. Secondly, even though the nurses passed their licensing exams and once knew how to correctly take a blood pressure reading, my observation is that they no longer are following those guidelines. They seem to be in too much of a hurry to take an accurate blood pressure reading. Once the pressure has been pumped up to around 200 mm of Hg, it is not uncommon for the nurse to drop the pressure to 50 mm in only 3 seconds. With the normal heartbeat at a little over one beat per second, you cannot take an accurate reading in this manner. You would like to have a reading with more accuracy than plus or minus 20 mm of Hg. It makes a big difference if the systolic reading is 120 instead of 140. The doctor needs correct information in order to plan a course of treatment. If I mention this to the doctor, he takes the reading himself, knowing, of course, that I am watching. The reading is always significantly different from the reading taken by the nurse.

While I am on the soapbox, another thing that bothers me has to do with calibration of the gages in the clinic’s examination rooms. Because of the dangers of mercury contamination, standard gages using a column of mercury on the wall are no longer allowed in the building. The dial gages that are being used were probably accurate when they were purchased, but with repeated use and the normal bumping, the gages lose their calibration. With no standard gages in the building, there is no way to know whether any of the gages are accurate, or not. As someone who calibrated pressure gages in an aerospace manufacturing plant, I had to recalibrate gages and certify accuracy by comparison with standard gages that were routinely sent to the National Bureau of Standards. Agreeing with my concerns about the accuracy of the blood pressure readings, my doctor approached the clinic directors about having a standard mercury gage so that they would be able to verify the accuracy of the gages that were being using throughout the clinic. “No”, was the answer that came down from the directors.

The bottom line is that I like my doctor and don’t want to go elsewhere for medical care. I suppose I should lighten up and be more trusting, knowing that it is next to impossible to change the way things are done in a large organization. It might help lower my blood pressure, as well.

[Loren]

Having read this post, I now understand why you are on medication to control your blood pressure Doug.



Loren

[dwinterfield]

I suppose I should lighten up and be more trusting, knowing that it is next to impossible to change the way things are done in a large organization. It might help lower my blood pressure, as well.

Merry Christmas and Happy New Year. And don't forget to take your pills.

[Innocent Bystander]

It similar here, Doug.

A friend of mine, who is a little older than me, had a prolonged drama over possible high blood pressure. She is retired, and relaxed, and is not such a person as would give you to think "High Blood Pressure" when you see her.

There was such an argument over this label of "High Blood Pressure" that she was required to wear a monitor for a couple of days. That proved the label wrong.

She had had her BP taken at half-past ten in the morning. She normally only gets up at ten (Envy, envy!) so was in an early-morning (for her) rush and flap when the BP was taken. She is so laid-back that no flap was obvious. But at least it got sorted out.

Society seems to be a little over-protective these days. Perhaps we shall see dressmaker's pins banned, soon.

[emmline]

Fortunately we have the equipment and know-how to take bp's at home here, so we try to establish a baseline for several days prior to doc visits.

[Doug_Tipple]

Fortunately we have the equipment and know-how to take bp's at home here, so we try to establish a baseline for several days prior to doc visits.

Yes, it is a good idea to establish a baseline reading. I have a digital BP monitor at home, and I often check my BP at the pharmacy. So, when I get a spurious reading at the doctor's office, I know that something is amiss.

Thanks, you'all, for the greetings. I will be a good boy and take my pills as the doctor ordered.

[rh]

My problem is that my blood pressure rises every time I walk into the clinic for an office visit.

This is an old phenomenon sometimes known as "white-coat hypertension".

First of all, with the new paperless system in my HMO clinic, the nurses don’t even know the reason for my visit. My personal folder is no longer lying on the table; everything is supposed to be on the computer screen, if you can get to it.

This is a more recent phenomenon, which could be called "HIPAA hypertension". It can affect health care providers as well as their patients.

Secondly, even though the nurses passed their licensing exams and once knew how to correctly take a blood pressure reading, my observation is that they no longer are following those guidelines. They seem to be in too much of a hurry to take an accurate blood pressure reading.

And this would be a case of "HMO hypertension". Reduced staff with increased workload makes for some pretty shoddy healthcare.

You have my sympathies.

I try to listen to the wisdom of my 4-year-old son when he says "Papi, now take a deep breath, like Yoga."

[Tony]

.....my doctor approached the clinic directors about having a standard mercury gage so that they would be able to verify the accuracy of the gages that were being using throughout the clinic. “No”, was the answer that came down from the directors.....

I thought all mechanical and electronic measuring devices used in the medical field require periodic calibration/certification.

Maybe this is only for hospitals and not private practice.

There's a medical equipment company who sends out a repairman to calibrate all the scales and blood pressure machines at my doctor's office (so he claims) and he has someone do this a few times a year.

[susnfx]

Every blood pressure cuff, EKG machine, and centrifuge in our allergy/asthma clinics must be calibrated yearly. We use the mercury blood pressure gauges (as far as I know, we've never been told not to, and we have a clinic administrator who's adamant about being in compliance with everything). We were given a new type of BP cuff (some sort of automatic thingy) to try by a physician's supply company and it read almost everybody's pressure as sky high--we gave it back.

My blood pressure can vary a lot depending on the mood I'm in, how nervous I am about the visit, the type of gauge they use, and on and on. Unless it starts showing really high consistently, I don't worry about it.

Susan

[burnsbyrne]

Doug,
About 12 years ago I co-wrote, with a biomedical engineer and a cardiologist, a short book about how to get accurate blood pressure measurements from all the modern devices, including arterial catheters. In your post at the beginning of this thread you correctly identified several mistakes that will cause an erroneous reading. The last time I went to my doctor I mentioned to him that I thought the med tech who had taken my BP had made several errors of technique, including letting the pressure drop too fast. My advice was not received very well. The doc's face got red but he was very polite. I went to see him again last week and, surprise, the med tech took my BP exactly the same way as before. Luckily my wife and I are both nurses - she read my book - and we can take each other's BPs. I am taking medication to lower my BP now and, like you, I would like to know that my BP is being measured accurately.
Mike

[djm]

Since we're going all medical here, I just read this neat thing that if you are beginning to have a heart attack you should force yourself to take deep breaths and cough as hard and as deeply as you can. Apparently this will force you to keep breathing more and will partially aid to keep the heart moving.

djm

[Nanohedron]

Gawd, how I hate to be a wet blanket, but now y'all are dispensing advice. Makes my blood pressure go up.

STOP IT, and Merry X-mas.

[peeplj]

I am not seeking advice, nor seeking to give it.

Just want to relate a true story.

I once fired a doc primarily over blood pressure.

In his office, taken using a small cuff that would just barely close around my arm, by a nurse who seemed positively angry that she had to interrupt her day to take my blood pressure...surprise! My numbers were pretty scary.

I take my blood pressure periodically at home (actually, Shan takes it: we take each others'), and the numbers are pretty much normal.

He refused to believe the numbers I get at home. He basically called me a liar to my face.

He put me on strong B.P. medicine. I became dizzy; I became ill. I started sometimes becoming confused. Not a pretty picture. I don't know which is scarier: sick and confused and logged in as root, or sick and confused and driving a car on Interstate. I've had to do both.

When I stopped taking the med (and immediately started improving), the doc was furious. I don't know what my B.P. was at the time, but considering that his face was brick-red, I would say there's a decent chance his was off the charts.

Found a new doc, and in her office, taken by a polite nurse with a properly sized (which is for me, large) cuff, my blood pressure was absolutely normal.

She sent me to another doc for something unrelated; in his office, taken by his gruff-and-no-nonsense nurse with a standard-sized cuff, again, B.P. was normal...on no medication at all.

I won't redundantly restate my merely obvious conclusions for fear of violating board policy...but I think the story (which is true, and recent) speaks volumes for itself.

--James

[rebl_rn]

Oh, don't get me started on taking blood pressures. I have never had a health care professional do it on me correctly except for my coworker who taught classes in taking blood pressures to health care professionals. The biggest thing I've never had anyone do is the two-step method - where you first pump up the cuff slowly, while feeling the pulse, until the pulse stops, note the reading, release the cuff, and then inflate again going 20 mmHg or so higher than that reading when the pulse stopped. And yes, you have to release the cuff sloooowwwwllllyyy to get an accurate reading, but it really doesn't take all that much longer.

I could go on but I'll stop. But you're right, Doug, health care professionals don't take BP's properly and it bugs the heck out of me!

[jim stone]

There is a great deal of incompetent and unprofessional
medical care, I'm afraid. I've fired the last three doctors
I've been to, one made serious mistakes in prescribing
medication (he admitted this), another began yelling at me
when I asked questions, a third demanded (wouldn't
take no for an answer) that I take tests
that specialists say involve more risks than benefits
for someone in my condition--the test was more likely
to kill me than the condition it was testing for (or lead to
a false positive that would lead to a test that would kill me).

A study done during Clinton's admin showed, if I remember
aright, that maybe a thousand people every day die
in hospitals due to sheer mistakes.

It's really sad and scary. I'm beginning to factor into my
decisions the risk of seeing a doctor.