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I think the bigger issue with measuring blood pressure is that, aside from diagnosed diabetics, it's a measurement done infrequently and at mostly arbitrary tim

I think the bigger issue with measuring blood pressure is that, aside from diagnosed diabetics, it's a measurement done infrequently and at mostly arbitrary times. Your blood pressure reading on the day of a doctor's appointment, right after you've driven to the appointment, made your way through the intake pipeline, and finally sat down in the chair, is not representative of its reading during a typical day in your life. Other factors like recency of coffee or alcohol consumption, exercise and sleep, all combine to make blood pressure a fairly variable statistic with limited diagnostic power when it's only measured infrequently. Regardless of whether you're lying down, standing up, or sitting in a chair, it would be beneficial to take more frequent blood pressure readings, throughout the day and during typical routines, than it would to only take them every time you visit the doctor. This seems like common sense, and you can even buy blood pressure sensors for $20 on Amazon, but how many people take their blood pressure on a regular basis? Once you're a diagnosed diabetic, then maybe you start measuring it every day - but wouldn't it be better to start such a habit before you become diabetic? After all, if you're continuously measuring a variable then you can notice patterns and anomalies, and take steps to mitigate them - possibly avoiding becoming diabetic before it's too late. It seems the limiting factor is sensor technology, which is obviously lacking compared to wearable sensors for tracking heart rate. Any health-conscious person with an Apple Watch or similar wearable device can easily track their pulse throughout the day. But no similarly accurate and seamless sensor exists for measuring blood pressure (as far as I know?), so nobody measures it as frequently as they do their pulse. Once we have the technology to accurately and passively measure blood pressure throughout the day, preventive medicine will become much easier, and people will have a better feeling for how their blood pressure responds to small changes in their environment and lifestyle.

zwieback 3y ago
Yeah, I have a machine and unless I take measurements very frequently (different times of day, etc.) it's really hard to make sense of the numbers. You really need to get a long term chart to weed out the noise. I've been getting much better readings at the doctors but then I realized I always ride my bike there, sit in the waiting room for a while and then get a low reading. Not representative!
- _ph_ 3y ago
  I am not sure, while the values obtained this way might require calibration, it sounds like very controlled conditions to me. The exercise should bring your body into a very controlled state, beyond the physical load very relaxed. So after a short rest, this should be a good time to get reliable readings. But I am not a doctor.
  - zwieback 3y ago
    Yeah, agreeed, and I think the BP is a bit lower because I'm warmed up and then rested a bit. My worst BP is in the mornings after getting up and sitting and drinking coffee.
- gryfft 3y ago
  I've been using Google Fit to track my blood pressure over time. I've been measuring every other day. The charts really are helpful. The biggest correlation with my blood pressure is how regular my sleep is. Once I started militantly waking and sleeping on a set schedule, the numbers came down. They seem to spike for a few days if my sleep gets messed up badly somehow. I also have been trying to standardize my measurement: same time of day, after sitting quietly alone for five minutes.
ipqk 3y ago
> Your blood pressure reading on the day of a doctor's appointment, right after you've driven to the appointment, made your way through the intake pipeline, and finally sat down in the chair, is not representative of its reading during a typical day in your life. This is a known thing called White Coat Syndrome
- deleted 3y ago
  [deleted]
- Gibbon1 3y ago
  That's actually different. The stress of being at the doctors causes blood pressure to elevate vs more mundane things like running, walking, driving stress. The difference is someone without white coat syndrome will have a lower blood pressure reading at the end of the doctors visit.
  - pixl97 3y ago
    Honestly I think in most US cities the driving stress would drive ones BP far higher. I know one time just right before I got to the Drs office some one almost ran into me, I mean just missed, and my BP was way high still.
_ph_ 3y ago
You are so right. Earlier this year I had to spend a week in hospital and they took a variety of measurements every day. It was interesting to see how much variation there was, especially in blood pressure. But one thing was especially interesting, pulse. As I was wearing my Apple watch, I had the values for blood and blood oxygene before they took them. And with pulse, you could clearly see with the graph, how much systematic variation there was. So their single measurement was not great. Best example, the last measurement was taken before I was about to be released, awaiting the doctors sign-off visit. Of course my pulse was off. But the doctor was quite interested to see my pulse for the last couple of hours. People underestimate how valuable a medical tool the Apple watch already is and how game-changing it can get if they manage to extend the sensor suite - as you say, blood pressure, perhaps also body temperature and glucose level. Another fun fact from the visit, they did monitor glucose level and one morning they did so directly after waking me up. Which caused the nurse to run to get me an early breakfast as it was very low. Not as if I hadn't known for decades, that I need a slow start and at least a small bite for breakfast to get into gears...
- hedora 3y ago
  I recommend Apple Watches, but if money is an issue, or you just dislike Apple, Amazfit has some nice offerings like this band: https://www.amazon.com/Amazfit-Fitness-Monitoring-Tracking-Resistant/dp/B08DKYLK4D https://www.amazon.com/Amazfit-Fitness-Monitoring-Tracking-R... Some of the reports it produces are superior to Apple Health (it measures stress, a proprietary overall health score, and I prefer its sleep monitoring analysis). It’s $39. The 15-25 day battery life claim assumes you disabled most of the functionality. Insert privacy disclaimer here.
inglor_cz 3y ago
There is a device called "holter" that you wear for a day and it measures your BP repeatedly, even during the night. https://my.clevelandclinic.org/health/diagnostics/16330-24-hour-ambulatory-blood-pressure-monitoring https://my.clevelandclinic.org/health/diagnostics/16330-24-h... I have worn a holter several times. I had better results than in a doctor's office. It seems to be a classical case of white coat syndrome.
llm_nerd 3y ago
I suffer from hypertension (which pushed as high as 170/120) and went through a period where I was measuring my blood pressure many times a day to try to essentially hack what the problem was to try to find a natural solution. What I learned is that, for me, -salt intake had zero impact -coffee had no impact -stress level had almost no impact -alcohol had no impact -exercise / activity levels had no impact The single and only controllable factor I could find, short of drugs, was that if I was cold my blood pressure spiked significantly. I had much higher BP in the winter than in the summer, and could improve it by wearing layers, gloves, etc. My body decided to go full ham on blood pressure and it was destroying my kidneys. I would be constantly annoyed by the sound of my own heartbeat doing things like trying to sleep. Telmisartan + Caduet (which is amolodipine + lipitor) and now my blood pressure averages 100/60. And courtesy of the lipitor my cholesterol and triglycerides dropped 60%, from high to normal. Many thanks to the very brilliant people who work in that field and developed those drugs. Anyways, thanks for coming to my TED talk on the magic of modern medicine.
- BaculumMeumEst 3y ago
  Wow, that sounds like quite an ordeal. Glad you landed okay! I had no idea medication could have that strong of an effect. I also have been checking my levels a little obsessively, unsuccessfully trying to find ways to drop them. And like you, I noticed that I spike during cold weather. I’m probably particularly sensitive because I have very low body fat.
  - manmal 3y ago
    You probably tried potassium chloride/bicarbonate already?
    - BaculumMeumEst 3y ago
      I just tried upping dietary potassium with more bananas and avocados and reducing sodium, haven’t looked in to potassium chloride/bicarbonate
Buttons840 3y ago
What you say is true, but at the end of the day blood pressure readings in the flawed doctor's office setting are still correlated with medical outcomes. I just want to speak against a trend people have to dismiss bad medical news by finding excuses. "The blood pressure reading doesn't count because I was nervous in the doctors office"; it's true, but the guidelines have probably accounted for that. "That medical study doesn't apply to me because it was done on the general population, but the general population is overweight and I'm not"; "that study doesn't apply to me because I do yoga, they didn't study people who do yoga"; etc. I know it's hard, I'm in the middle of excusing some bad medical news of my own right now, trying to decide what's best for me. Medicines have risks, untreated conditions have risks, choose your risk, but don't live in denial that the risk exists.
- kalensh 3y ago
  My issue is that blood pressure is being used by many corporations/health insurance plans to determine your premiums. So adding yet another layer of nervousness - you will be paying extra money over the course of the next year if your blood pressure is a little high (threshold is 120/80).
  - pkaye 3y ago
    In the US, your health or medical history can't affect your health insurance premiums. https://www.healthcare.gov/how-plans-set-your-premiums https://www.healthcare.gov/how-plans-set-your-premiums
    - cogogo 3y ago
      It absolutely can affect your life insurance. Understandably that’s a problem of privilege but it’s a truth.
      - pkaye 3y ago
        High blood pressure can be quite manageable with medications for most people and one should qualify for life insurance after that. I know very much about the issue because I had kidney failure due to an autoimmune disease and had to deal with years of dialysis and just recently got a kidney transplant. High blood pressure is a very common issue in kidney failure and even that with the right combination of medications it was mostly manageable. Its much hard to get life insurance after kidney disease. The best shot is through an employer group life insurance plan. And with my last employer I was able to covert it to an individual plan after I left.
serial_dev 3y ago
People mentioned the white coat syndrome, but that's not the only issue. I am not nervous when they measure my blood pressure, but I might have been late to my doctors appointment, so of my 25 min walk to the doctor, I was running half of it. I had non-optimal blood pressure values at the doctor, because I was running not to miss the appointment, and as I arrived, I had to immediately go get my BP checked. After the incident, I religiously measured my BP at home various times a day for a week and my numbers looked okay.
- BaculumMeumEst 3y ago
  I was late to an optometrist appointment a few weeks back. Sprinted up six flights of stairs and into the office. The literal second I got in they called my name and immediately measured BP. The tech looked like they were going to shit themselves.
ljosifov 3y ago
You are spot on. Random once a year BP measurement is not good enough. Doctors are being asked to provide life altering advice while being effectively blind in this case. I have no idea why we don't try harder to make their (tough) job easier rather than just accepting the current (sorry) state. My cars and my computers have more sensors on them than I have on me! That's crazy - I have to drop nearly dead and only then will I go to doctors' for diagnosis and treatment. My car preventative maintenance is miles better. After being diagnosed with elevated BP, I googled and read what I could and concluded: 1) Cheap "BP monitors" on Amazon just show random readings or the same readings so they are worse than useless: someone may actually use them and believe their readings. 2) There are only few smart watches that have BP measuring function. I am currently using Samsung Watch Active2, and it seems to do the job. There is calibration that is good for 30 days only. After 30 days it expires and I calibrate it again. Calibration involves making 3 measurements in parallel, watch on one hand and manual BP monitor on the other. After each measurement on the manual BP monitor, I tell the watch App what was measured. After each calibration I do another 3 measurements in parallel, again using both the watch and the manual monitor. I compare the watch (post calibration) readings with the manual BP readings. Usually the difference is small within few percent. If it is more than 8-10% I redo the calibration. This has happened 2 times in the 25 odd calibrations I have done. Usually the reason is noise instead of perfect silence (person coming in the room and talking, TV being turned on). I have tried using the watch on Person2 after being calibrated on Person1 - and Person2 got crazy BP readings. So the calibration really does something, it is not nothing. The watch measurements also approximately agreed with measurements taken over 24h period when I wore BP holter (automated BP cuff that inflates every 30 mins and measures and records the BP). Over time I have become more lazy with the re/calibration: now several days pass before I re/do it. So I'm acutely aware that any non-100% automated data collection will eventually be abandoned on long enough time horizon. Redoing the same is boring and becomes more so with time.
- atahanacar 3y ago
  >I have to drop nearly dead and only then will I go to doctors' for diagnosis and treatment. This is a healthcare issue specific to your country. It is not a problem of "not enough measurements". Regarding using tech like smartwatches for blood pressure measurement, it is currently not possible. They aren't measuring your blood pressure, they are simply correlating optical data like pulse transit time with your blood pressure, which is mostly inaccurate. If you have to calibrate every now and then using actual bp measurements, then you already have enough data and don't need your smartwatch.
redox99 3y ago
At least in my country, to diagnose you with high BP they'd have you wear a holter monitor for 24 hours.
- readthenotes1 3y ago
  That's standard in the US as well.
  - bradknowles 3y ago
    I've worn a holter monitor. It doesn't measure blood pressure at all. It's just two leads measuring your heart rate activity over a period of time. And not even as good as my Kardia 6L.
hwillis 3y ago
> so nobody measures it as frequently as they do their pulse. Once we have the technology to accurately and passively measure blood pressure throughout the day It's surprisingly tricky. The way a BP cuff works (the auscultatory method[1]) is that the pressure is continuously decreased and you listen for the sound of a pulse. When the cuff pressure is higher than your systolic (peak) pulse, bloodflow is blocked and you don't hear a pulse. When the cuff pressure is lower than your diastolic, the cuff is no longer blocking bloodflow at all, and the pulse suddenly becomes much quieter because it's not restricted. It's only between the two pressures that you hear it extra clearly. So the problem with a sensor is that you can't just measure pressure against the skin. At minimum, it really should actually impede a large artery. You can squeeze the arm as tight as you like but if the brachial artery is not affected then your measurement will be very poor. You can do fancy computer vision etc to look at special veins/arteries, and coupled with some demographic assumptions you can infer somewhat accurate measurements- but they really miss out on outliers, which is really a lot of the point of taking measurements. This also generally will require an upper arm strap or something, and be fairly tight. Not great to wear always At some point, I think we will probably see implantable blood pressure monitoring. We do something similar with implantable glucose monitors- which need regular replacement, unfortunately. BP probably wouldn't. Problem is that direct pressure measurement is usually done by tapping off an artery- something that will never be routine. You'd want to do some combination of acoustic and pressure measurement, and it'd need to be calibrated from a base station regularly. [1]: https://en.wikipedia.org/wiki/Blood_pressure_measurement#/media/File:Blood_pressure_measurement_principle.svg https://en.wikipedia.org/wiki/Blood_pressure_measurement#/me...
- jkingsman 3y ago
  Worth mentioning that BP is about arterial, not venous pressure. Venous pressure is an order of magnitude lower than arterial pressure; usually 0-10mmHg.
  - hwillis 3y ago
    ty, edited. oopsies!
- 3y ago
moffkalast 3y ago
> it would be beneficial to take more frequent blood pressure readings, throughout the day and during typical routines, than it would to only take them every time you visit the doctor It would be, if the most reliable way to get BP data wasn't to apparently violently compress the upper arm until it physically hurts and leave it like that for a minute. How people can do that on any kind of regular basis completely escapes me, and I'm not convinced it's not actively harmful. The wrist monitors are tolerable but seem to be very sensitive to wrist height.
scythe 3y ago
One time a doctor at the on-campus clinic looked at my blood sugar reading said I might be prediabetic. This was an early-morning appointment at a time in my life when I wasn't very used to that and had rushed out of my dorm while scarfing down a bagel that had been hastily topped with the only thing in the cabinet that was in a squeeze bottle — honey! No blood test over the next decade showed even a hint of elevated blood sugar.
- atahanacar 3y ago
  That is exactly why you need fasting blood glucose for diagnosis of diabetes.
m463 3y ago
I have a garmin watch and one wonderful thing it does is show me my resting heart rate, which is a nice indication of my level of fitness (and correlates with good sleep, sickness, etc) It also does nice things like a detailed check of my sleep, how I'm acclimatizing to altitude when visiting the mountains, the number of steps I walked and pulse-ox. I don't know how these correlate to what blood pressure tells you, but I blood pressure will be directly measured in the same way in a few years.
tguvot 3y ago
take a look at aktiia. tracks blood pressure through the day. currently under trials in usa to get fda approvalm but you can buy it from eu
vonnik 3y ago
Fwiw, OMRON produces high-quality blood-pressure monitors for consumers. https://omronhealthcare.com/blood-pressure/ https://omronhealthcare.com/blood-pressure/ Even these, though, tend to overestimate your actual blood pressure, sometimes by as much as 10 points. But having one in the home makes it easy to take several readings throughout the day, since each one hardly lasts a minute.
- smartbit 3y ago
  A few years ago their Bluetooth apps didn’t require registration, now the do. So now you’d need to keep track of the measurements yourselves, e.g. using a spreadsheet. Can not recommend Omron anymore.
- frereubu 3y ago
  Doctors in the UK use Omron monitors.
jliptzin 3y ago
Are you confusing blood pressure and blood sugar? My boyfriend is type 1 diabetic, he measures his blood sugar multiple times a day, but I have never seen him measure his blood pressure.
- hwillis 3y ago
  No- diabetes can have very negative long term impacts on your small blood vessels, particularly in your kidneys. Changes in blood pressure from vascular damage all over your body can be a signal that nephropathy (kidney disease) is not far away. It takes years to accumulate.
  - jliptzin 3y ago
    Thank you. In theory if the diabetic successfully controls their blood sugar for the vast majority of the time does that limit the damage?
Someone 3y ago
> Once we have the technology to accurately and passively measure blood pressure throughout the day, preventive medicine will become much easier How? Do we have any idea what we would do with that data? AFAIK, all treatments we currently have aren’t suited for treating short-duration spikes in blood pressure (do they even need treatment? I wouldn’t know). Also, why would we need preventive medicine for most people with hypertension? https://en.wikipedia.org/wiki/Hypertension#Prevention https://en.wikipedia.org/wiki/Hypertension#Prevention: “The 2004 British Hypertension Society guidelines proposed lifestyle changes consistent with those outlined by the US National High BP Education Program in 2002 for the primary prevention of hypertension: - maintain normal body weight for adults (e.g. body mass index 20–25 kg/m2) - reduce dietary sodium intake to <100 mmol/ day (<6 g of sodium chloride or <2.4 g of sodium per day) - engage in regular aerobic physical activity such as brisk walking (≥30 min per day, most days of the week) - limit alcohol consumption to no more than 3 units/day in men and no more than 2 units/day in women - consume a diet rich in fruit and vegetables (e.g. at least five portions per day); - Stress reduction”
Angostura 3y ago
I'm in the UK with hypertension. My GP surgery sends me a text message every 6 months or so, asking for a week's readings morning and evening, using a home blood pressure monitor - the message includes a link to submit readings. Gets rid of most of my white coat hyper tension
shepherdjerred 3y ago
One easy way to check your blood pressure more regularly is to donate blood! At least in the United States, you'll get your pulse, blood pressure, and iron levels all checked. Additionally, your blood will be tested for some infectious diseases like HIV. Lots of free testing, and you also get to help someone out!
atahanacar 3y ago
Tracking your blood pressure randomly throughout the day will not be meaningful in any way, just like tracking your pulse isn't meaningful. It will only be annoying, as blood pressure measurement is a mechanical process, unlike heart rate measurements which can be done optically or electrically. >right after you've driven to the appointment, made your way through the intake pipeline, and finally sat down in the chair, is not representative of its reading during a typical day in your life. So? It is taught pretty early in med school that before measuring the vitals, you should let the patient rest while you take their story, and ask questions related to things that might change the measurements (did you walk here? did you walk up the stairs? did you drink coffee? did you smoke etc.). And if you still want more measurements throughout the day for various reasons, you can just use holter. >all combine to make blood pressure a fairly variable statistic with limited diagnostic power when it's only measured infrequently. [citation needed] If you are hypertensive, non of the things you've mentioned will matter. Your blood pressure will be high regardless, and it will still be caught. In addition, you can't just diagnose with a single reading anyways. It is funny to read comments regarding medicine on HN.
lm28469 3y ago
> Once we have the technology to accurately and passively measure blood pressure throughout the day, preventive medicine will become much easier, and people will have a better feeling for how their blood pressure responds to small changes in their environment and lifestyle. With 70% of the population being overweight or obese and on a dog shit diet I very much doubt that. We already know what we do is bad, we know how to fix it, virtually no one does it. If people can't be arsed to even walk 30 min a day I don't think they'll care about continuously monitoring their blood pressure. You can track your pulse continuously with ultra cheap gadgets and it'll tell 50%+ of the population their heart is in bad shape, nobody cares The best preventative medicine is your lifestyle, if you wait for symptoms you already failed your body and are 10+ years late to the party

zwieback 3y ago

Yeah, I have a machine and unless I take measurements very frequently (different times of day, etc.) it's really hard to make sense of the numbers. You really need to get a long term chart to weed out the noise. I've been getting much better readings at the doctors but then I realized I always ride my bike there, sit in the waiting room for a while and then get a low reading. Not representative!

_ph_ 3y ago
I am not sure, while the values obtained this way might require calibration, it sounds like very controlled conditions to me. The exercise should bring your body into a very controlled state, beyond the physical load very relaxed. So after a short rest, this should be a good time to get reliable readings. But I am not a doctor.
- zwieback 3y ago
  Yeah, agreeed, and I think the BP is a bit lower because I'm warmed up and then rested a bit. My worst BP is in the mornings after getting up and sitting and drinking coffee.
gryfft 3y ago
I've been using Google Fit to track my blood pressure over time. I've been measuring every other day. The charts really are helpful. The biggest correlation with my blood pressure is how regular my sleep is. Once I started militantly waking and sleeping on a set schedule, the numbers came down. They seem to spike for a few days if my sleep gets messed up badly somehow. I also have been trying to standardize my measurement: same time of day, after sitting quietly alone for five minutes.

ipqk 3y ago

> Your blood pressure reading on the day of a doctor's appointment, right after you've driven to the appointment, made your way through the intake pipeline, and finally sat down in the chair, is not representative of its reading during a typical day in your life. This is a known thing called White Coat Syndrome

deleted 3y ago
[deleted]
Gibbon1 3y ago
That's actually different. The stress of being at the doctors causes blood pressure to elevate vs more mundane things like running, walking, driving stress. The difference is someone without white coat syndrome will have a lower blood pressure reading at the end of the doctors visit.
- pixl97 3y ago
  Honestly I think in most US cities the driving stress would drive ones BP far higher. I know one time just right before I got to the Drs office some one almost ran into me, I mean just missed, and my BP was way high still.

_ph_ 3y ago

You are so right. Earlier this year I had to spend a week in hospital and they took a variety of measurements every day. It was interesting to see how much variation there was, especially in blood pressure. But one thing was especially interesting, pulse. As I was wearing my Apple watch, I had the values for blood and blood oxygene before they took them. And with pulse, you could clearly see with the graph, how much systematic variation there was. So their single measurement was not great. Best example, the last measurement was taken before I was about to be released, awaiting the doctors sign-off visit. Of course my pulse was off. But the doctor was quite interested to see my pulse for the last couple of hours. People underestimate how valuable a medical tool the Apple watch already is and how game-changing it can get if they manage to extend the sensor suite - as you say, blood pressure, perhaps also body temperature and glucose level. Another fun fact from the visit, they did monitor glucose level and one morning they did so directly after waking me up. Which caused the nurse to run to get me an early breakfast as it was very low. Not as if I hadn't known for decades, that I need a slow start and at least a small bite for breakfast to get into gears...

hedora 3y ago
I recommend Apple Watches, but if money is an issue, or you just dislike Apple, Amazfit has some nice offerings like this band: https://www.amazon.com/Amazfit-Fitness-Monitoring-Tracking-Resistant/dp/B08DKYLK4D https://www.amazon.com/Amazfit-Fitness-Monitoring-Tracking-R... Some of the reports it produces are superior to Apple Health (it measures stress, a proprietary overall health score, and I prefer its sleep monitoring analysis). It’s $39. The 15-25 day battery life claim assumes you disabled most of the functionality. Insert privacy disclaimer here.

inglor_cz 3y ago

There is a device called "holter" that you wear for a day and it measures your BP repeatedly, even during the night. https://my.clevelandclinic.org/health/diagnostics/16330-24-hour-ambulatory-blood-pressure-monitoring https://my.clevelandclinic.org/health/diagnostics/16330-24-h... I have worn a holter several times. I had better results than in a doctor's office. It seems to be a classical case of white coat syndrome.

llm_nerd 3y ago

I suffer from hypertension (which pushed as high as 170/120) and went through a period where I was measuring my blood pressure many times a day to try to essentially hack what the problem was to try to find a natural solution. What I learned is that, for me, -salt intake had zero impact -coffee had no impact -stress level had almost no impact -alcohol had no impact -exercise / activity levels had no impact The single and only controllable factor I could find, short of drugs, was that if I was cold my blood pressure spiked significantly. I had much higher BP in the winter than in the summer, and could improve it by wearing layers, gloves, etc. My body decided to go full ham on blood pressure and it was destroying my kidneys. I would be constantly annoyed by the sound of my own heartbeat doing things like trying to sleep. Telmisartan + Caduet (which is amolodipine + lipitor) and now my blood pressure averages 100/60. And courtesy of the lipitor my cholesterol and triglycerides dropped 60%, from high to normal. Many thanks to the very brilliant people who work in that field and developed those drugs. Anyways, thanks for coming to my TED talk on the magic of modern medicine.

BaculumMeumEst 3y ago
Wow, that sounds like quite an ordeal. Glad you landed okay! I had no idea medication could have that strong of an effect. I also have been checking my levels a little obsessively, unsuccessfully trying to find ways to drop them. And like you, I noticed that I spike during cold weather. I’m probably particularly sensitive because I have very low body fat.
- manmal 3y ago
  You probably tried potassium chloride/bicarbonate already?
  - BaculumMeumEst 3y ago
    I just tried upping dietary potassium with more bananas and avocados and reducing sodium, haven’t looked in to potassium chloride/bicarbonate

Buttons840 3y ago

What you say is true, but at the end of the day blood pressure readings in the flawed doctor's office setting are still correlated with medical outcomes. I just want to speak against a trend people have to dismiss bad medical news by finding excuses. "The blood pressure reading doesn't count because I was nervous in the doctors office"; it's true, but the guidelines have probably accounted for that. "That medical study doesn't apply to me because it was done on the general population, but the general population is overweight and I'm not"; "that study doesn't apply to me because I do yoga, they didn't study people who do yoga"; etc. I know it's hard, I'm in the middle of excusing some bad medical news of my own right now, trying to decide what's best for me. Medicines have risks, untreated conditions have risks, choose your risk, but don't live in denial that the risk exists.

kalensh 3y ago
My issue is that blood pressure is being used by many corporations/health insurance plans to determine your premiums. So adding yet another layer of nervousness - you will be paying extra money over the course of the next year if your blood pressure is a little high (threshold is 120/80).
- pkaye 3y ago
  In the US, your health or medical history can't affect your health insurance premiums. https://www.healthcare.gov/how-plans-set-your-premiums https://www.healthcare.gov/how-plans-set-your-premiums
  - cogogo 3y ago
    It absolutely can affect your life insurance. Understandably that’s a problem of privilege but it’s a truth.
    - pkaye 3y ago
      High blood pressure can be quite manageable with medications for most people and one should qualify for life insurance after that. I know very much about the issue because I had kidney failure due to an autoimmune disease and had to deal with years of dialysis and just recently got a kidney transplant. High blood pressure is a very common issue in kidney failure and even that with the right combination of medications it was mostly manageable. Its much hard to get life insurance after kidney disease. The best shot is through an employer group life insurance plan. And with my last employer I was able to covert it to an individual plan after I left.

serial_dev 3y ago

People mentioned the white coat syndrome, but that's not the only issue. I am not nervous when they measure my blood pressure, but I might have been late to my doctors appointment, so of my 25 min walk to the doctor, I was running half of it. I had non-optimal blood pressure values at the doctor, because I was running not to miss the appointment, and as I arrived, I had to immediately go get my BP checked. After the incident, I religiously measured my BP at home various times a day for a week and my numbers looked okay.

BaculumMeumEst 3y ago
I was late to an optometrist appointment a few weeks back. Sprinted up six flights of stairs and into the office. The literal second I got in they called my name and immediately measured BP. The tech looked like they were going to shit themselves.

ljosifov 3y ago

You are spot on. Random once a year BP measurement is not good enough. Doctors are being asked to provide life altering advice while being effectively blind in this case. I have no idea why we don't try harder to make their (tough) job easier rather than just accepting the current (sorry) state. My cars and my computers have more sensors on them than I have on me! That's crazy - I have to drop nearly dead and only then will I go to doctors' for diagnosis and treatment. My car preventative maintenance is miles better. After being diagnosed with elevated BP, I googled and read what I could and concluded: 1) Cheap "BP monitors" on Amazon just show random readings or the same readings so they are worse than useless: someone may actually use them and believe their readings. 2) There are only few smart watches that have BP measuring function. I am currently using Samsung Watch Active2, and it seems to do the job. There is calibration that is good for 30 days only. After 30 days it expires and I calibrate it again. Calibration involves making 3 measurements in parallel, watch on one hand and manual BP monitor on the other. After each measurement on the manual BP monitor, I tell the watch App what was measured. After each calibration I do another 3 measurements in parallel, again using both the watch and the manual monitor. I compare the watch (post calibration) readings with the manual BP readings. Usually the difference is small within few percent. If it is more than 8-10% I redo the calibration. This has happened 2 times in the 25 odd calibrations I have done. Usually the reason is noise instead of perfect silence (person coming in the room and talking, TV being turned on). I have tried using the watch on Person2 after being calibrated on Person1 - and Person2 got crazy BP readings. So the calibration really does something, it is not nothing. The watch measurements also approximately agreed with measurements taken over 24h period when I wore BP holter (automated BP cuff that inflates every 30 mins and measures and records the BP). Over time I have become more lazy with the re/calibration: now several days pass before I re/do it. So I'm acutely aware that any non-100% automated data collection will eventually be abandoned on long enough time horizon. Redoing the same is boring and becomes more so with time.

atahanacar 3y ago
>I have to drop nearly dead and only then will I go to doctors' for diagnosis and treatment. This is a healthcare issue specific to your country. It is not a problem of "not enough measurements". Regarding using tech like smartwatches for blood pressure measurement, it is currently not possible. They aren't measuring your blood pressure, they are simply correlating optical data like pulse transit time with your blood pressure, which is mostly inaccurate. If you have to calibrate every now and then using actual bp measurements, then you already have enough data and don't need your smartwatch.

redox99 3y ago

At least in my country, to diagnose you with high BP they'd have you wear a holter monitor for 24 hours.

readthenotes1 3y ago
That's standard in the US as well.
- bradknowles 3y ago
  I've worn a holter monitor. It doesn't measure blood pressure at all. It's just two leads measuring your heart rate activity over a period of time. And not even as good as my Kardia 6L.

hwillis 3y ago

> so nobody measures it as frequently as they do their pulse. Once we have the technology to accurately and passively measure blood pressure throughout the day It's surprisingly tricky. The way a BP cuff works (the auscultatory method[1]) is that the pressure is continuously decreased and you listen for the sound of a pulse. When the cuff pressure is higher than your systolic (peak) pulse, bloodflow is blocked and you don't hear a pulse. When the cuff pressure is lower than your diastolic, the cuff is no longer blocking bloodflow at all, and the pulse suddenly becomes much quieter because it's not restricted. It's only between the two pressures that you hear it extra clearly. So the problem with a sensor is that you can't just measure pressure against the skin. At minimum, it really should actually impede a large artery. You can squeeze the arm as tight as you like but if the brachial artery is not affected then your measurement will be very poor. You can do fancy computer vision etc to look at special veins/arteries, and coupled with some demographic assumptions you can infer somewhat accurate measurements- but they really miss out on outliers, which is really a lot of the point of taking measurements. This also generally will require an upper arm strap or something, and be fairly tight. Not great to wear always At some point, I think we will probably see implantable blood pressure monitoring. We do something similar with implantable glucose monitors- which need regular replacement, unfortunately. BP probably wouldn't. Problem is that direct pressure measurement is usually done by tapping off an artery- something that will never be routine. You'd want to do some combination of acoustic and pressure measurement, and it'd need to be calibrated from a base station regularly. [1]: https://en.wikipedia.org/wiki/Blood_pressure_measurement#/media/File:Blood_pressure_measurement_principle.svg https://en.wikipedia.org/wiki/Blood_pressure_measurement#/me...

jkingsman 3y ago
Worth mentioning that BP is about arterial, not venous pressure. Venous pressure is an order of magnitude lower than arterial pressure; usually 0-10mmHg.
- hwillis 3y ago
  ty, edited. oopsies!
3y ago

moffkalast 3y ago

> it would be beneficial to take more frequent blood pressure readings, throughout the day and during typical routines, than it would to only take them every time you visit the doctor It would be, if the most reliable way to get BP data wasn't to apparently violently compress the upper arm until it physically hurts and leave it like that for a minute. How people can do that on any kind of regular basis completely escapes me, and I'm not convinced it's not actively harmful. The wrist monitors are tolerable but seem to be very sensitive to wrist height.

scythe 3y ago

One time a doctor at the on-campus clinic looked at my blood sugar reading said I might be prediabetic. This was an early-morning appointment at a time in my life when I wasn't very used to that and had rushed out of my dorm while scarfing down a bagel that had been hastily topped with the only thing in the cabinet that was in a squeeze bottle — honey! No blood test over the next decade showed even a hint of elevated blood sugar.

atahanacar 3y ago
That is exactly why you need fasting blood glucose for diagnosis of diabetes.

m463 3y ago

I have a garmin watch and one wonderful thing it does is show me my resting heart rate, which is a nice indication of my level of fitness (and correlates with good sleep, sickness, etc) It also does nice things like a detailed check of my sleep, how I'm acclimatizing to altitude when visiting the mountains, the number of steps I walked and pulse-ox. I don't know how these correlate to what blood pressure tells you, but I blood pressure will be directly measured in the same way in a few years.

tguvot 3y ago

take a look at aktiia. tracks blood pressure through the day. currently under trials in usa to get fda approvalm but you can buy it from eu

vonnik 3y ago

Fwiw, OMRON produces high-quality blood-pressure monitors for consumers. https://omronhealthcare.com/blood-pressure/ https://omronhealthcare.com/blood-pressure/ Even these, though, tend to overestimate your actual blood pressure, sometimes by as much as 10 points. But having one in the home makes it easy to take several readings throughout the day, since each one hardly lasts a minute.

smartbit 3y ago
A few years ago their Bluetooth apps didn’t require registration, now the do. So now you’d need to keep track of the measurements yourselves, e.g. using a spreadsheet. Can not recommend Omron anymore.
frereubu 3y ago
Doctors in the UK use Omron monitors.

jliptzin 3y ago

Are you confusing blood pressure and blood sugar? My boyfriend is type 1 diabetic, he measures his blood sugar multiple times a day, but I have never seen him measure his blood pressure.

hwillis 3y ago
No- diabetes can have very negative long term impacts on your small blood vessels, particularly in your kidneys. Changes in blood pressure from vascular damage all over your body can be a signal that nephropathy (kidney disease) is not far away. It takes years to accumulate.
- jliptzin 3y ago
  Thank you. In theory if the diabetic successfully controls their blood sugar for the vast majority of the time does that limit the damage?

Someone 3y ago

> Once we have the technology to accurately and passively measure blood pressure throughout the day, preventive medicine will become much easier How? Do we have any idea what we would do with that data? AFAIK, all treatments we currently have aren’t suited for treating short-duration spikes in blood pressure (do they even need treatment? I wouldn’t know). Also, why would we need preventive medicine for most people with hypertension? https://en.wikipedia.org/wiki/Hypertension#Prevention https://en.wikipedia.org/wiki/Hypertension#Prevention: “The 2004 British Hypertension Society guidelines proposed lifestyle changes consistent with those outlined by the US National High BP Education Program in 2002 for the primary prevention of hypertension: - maintain normal body weight for adults (e.g. body mass index 20–25 kg/m2) - reduce dietary sodium intake to <100 mmol/ day (<6 g of sodium chloride or <2.4 g of sodium per day) - engage in regular aerobic physical activity such as brisk walking (≥30 min per day, most days of the week) - limit alcohol consumption to no more than 3 units/day in men and no more than 2 units/day in women - consume a diet rich in fruit and vegetables (e.g. at least five portions per day); - Stress reduction”

Angostura 3y ago

I'm in the UK with hypertension. My GP surgery sends me a text message every 6 months or so, asking for a week's readings morning and evening, using a home blood pressure monitor - the message includes a link to submit readings. Gets rid of most of my white coat hyper tension

shepherdjerred 3y ago

One easy way to check your blood pressure more regularly is to donate blood! At least in the United States, you'll get your pulse, blood pressure, and iron levels all checked. Additionally, your blood will be tested for some infectious diseases like HIV. Lots of free testing, and you also get to help someone out!

atahanacar 3y ago

Tracking your blood pressure randomly throughout the day will not be meaningful in any way, just like tracking your pulse isn't meaningful. It will only be annoying, as blood pressure measurement is a mechanical process, unlike heart rate measurements which can be done optically or electrically. >right after you've driven to the appointment, made your way through the intake pipeline, and finally sat down in the chair, is not representative of its reading during a typical day in your life. So? It is taught pretty early in med school that before measuring the vitals, you should let the patient rest while you take their story, and ask questions related to things that might change the measurements (did you walk here? did you walk up the stairs? did you drink coffee? did you smoke etc.). And if you still want more measurements throughout the day for various reasons, you can just use holter. >all combine to make blood pressure a fairly variable statistic with limited diagnostic power when it's only measured infrequently. [citation needed] If you are hypertensive, non of the things you've mentioned will matter. Your blood pressure will be high regardless, and it will still be caught. In addition, you can't just diagnose with a single reading anyways. It is funny to read comments regarding medicine on HN.

lm28469 3y ago

> Once we have the technology to accurately and passively measure blood pressure throughout the day, preventive medicine will become much easier, and people will have a better feeling for how their blood pressure responds to small changes in their environment and lifestyle. With 70% of the population being overweight or obese and on a dog shit diet I very much doubt that. We already know what we do is bad, we know how to fix it, virtually no one does it. If people can't be arsed to even walk 30 min a day I don't think they'll care about continuously monitoring their blood pressure. You can track your pulse continuously with ultra cheap gadgets and it'll tell 50%+ of the population their heart is in bad shape, nobody cares The best preventative medicine is your lifestyle, if you wait for symptoms you already failed your body and are 10+ years late to the party