5 ms·

One of the "dirty secrets" in healthcare is similar issues with BP. Things like posture, white-coat syndrome, having to pee, cuff placement, cuff size, arm pos

One of the "dirty secrets" in healthcare is similar issues with BP. Things like posture, white-coat syndrome, having to pee, cuff placement, cuff size, arm position, muscularity, arm diameter, time sitting, and many other variables have a massive influence on blood pressure. BP is kind of like weight - it should be taken at regular intervals during the day, at the same times, and averaged out over time to look at trends. "Snapshot" BP readings are most useful for things like hypertensive crisis, not ongoing BP management. Unfortunately, we see a lot of people put on BP meds where other interventions may be more appropriate based on bad BP measurements. I think there are a lot of things in healthcare like this, where our models are too simplistic and result in flawed understanding and consequently ineffective treatments.

hzay 3y ago
Is it really secret though? It's the first thing you learn when you google "how to take bp". Like I'm not a medical person but when I was pregnant, I was asked to check BP and I asked the doctor "should I like average 3 readings or something?" and she said "just take one, don't stress it". This is well known re thyroid medication as well. Also re weight, progesterone, a bunch of things.
- pc86 3y ago
  It's not a secret. Most of my immediate family is or was in healthcare and nobody is getting put on BP meds because of a single errant reading. They're getting put on meds because of persistent, uncontrolled elevated BPs and with non-pharmaceutical interventions not addressing it. Everyone, especially physicians, know there's a list of 20-30 things that can give you temporarily elevated BP that won't respond to BP meds.
  - importantbrian 3y ago
    Yeah, that's been my experience. Everytime I see my primary my BP is elevated in the office and they send me home with a log and I have to take my BP multiple times a day for 2 weeks and at home it's fine, so I've never been put on meds for it even though it's very high in the office.
  - claytongulick 3y ago
    > nobody is getting put on BP meds because of a single errant reading I'm glad you've had good experiences and relationships with what sound like quality healthcare professionals. Others have had different experiences.
- claytongulick 3y ago
  I suppose "well known" is relative, it may surprise you how little agency some people have over their health. >It's the first thing you learn when you google "how to take bp". The populations that I frequently deal with are not in a life/financial/cognitive place where this is a thing they would think of doing, or be capable of doing. Take a look at this [1] about over treatment of mild hypertension. It's not a new problem, and potentially affects millions [2]. There can be enormous pressure on physicians to treat certain conditions from a population-health standpoint with medications if they fit certain clinical criteria. The recent (2017) change in standards for hypertension [3] have been controversial. It put millions of people into the category of hypertension that weren't previously. Coupled with certain clinical criteria that recommend medication prescription even for mild hypertension, it's concerning that there may be an overprescription issue. Many busy clinics don't have time to have a patient sit for the recommended 5 minutes of rest before taking BP (though I've seen this improving). Many medical assistants are poorly trained in BP measurement, and are overworked - I've seen many cases where a harried MA will do things like sit a patient down, put a cuff on them over-the-sleeve, as the patient slouches in a chair, with the arm in an incorrect position, a poorly fitted cuff, and just write down the number the machine spits out. Of course, a good PCP will double check this and look for a trend. Not all PCP's are good and go to this effort. (I am not a physician, I'm a tech nerd with a clinical background, but I've worked in healthcare for decades) I've also experienced it personally. I went to the doc once about ten years ago for a wellness check. Based on the in-office BP reading and labs, the NP prescribed me five different medications, including BP meds, statins and others. I decided to focus on lifestyle changes instead and that's worked well for me, but that's not an option for everyone. [1] https://www.youtube.com/watch?v=cZCuJheVJA0 https://www.youtube.com/watch?v=cZCuJheVJA0 [2] https://www.umassmed.edu/news/news-archives/2014/11/umms-family-doctors-say-many-take-blood-pressure-meds-not-shown-to-help/ https://www.umassmed.edu/news/news-archives/2014/11/umms-fam... [3] https://www.health.harvard.edu/heart-health/reading-the-new-blood-pressure-guidelines https://www.health.harvard.edu/heart-health/reading-the-new-...
devmor 3y ago
I realized this a couple years ago when I moved and started getting my blood tests done at a new lab that was nearby. My entire life I’ve had perfect blood pressure, but suddenly this lab thinks I have hypertension. After 3-4 visits and checking my own BP during the day, I realized that my blood pressure is just higher in the morning - I never set appointments in the morning previously because I lived too far from a lab to make morning appointments convenient.
- greenish_shores 3y ago
  What makes them think you have hypertension with purely blood laboratory tests? Electrolyte levels ratios? They aren't changed in all types of hypertension (won't be changed in most, probably), but that's just my wild guess.
  - devmor 3y ago
    Just the blood pressure. It wasn’t a diagnosis so much as a “this seems concerning, you should get this checked out”.
nradov 3y ago
Yes, blood pressure measurement is a real mess. Besides the factors you listed, I have found that temperature has a surprisingly large impact. If your hands are cold, then that causes peripheral vasoconstriction and raises BP.
voisin 3y ago
Question, since you seem to know a lot about this: is high blood pressure meant to be a description of a persistent condition (I.e. took a reading at 5, 10, 20 minute intervals at rest and stayed elevated) or is it meant to be a description of something else (after standing up, or after walking, etc etc)?
- claytongulick 3y ago
  Generally, it's referring to a chronic condition, meaning that your blood pressure is elevated as a trend over time. Everyone goes through huge peaks and troughs with BP - at the gym, sleeping, etc... will have massive changes in BP. There are certain conditions where "instant" BP can become a problem, both high and low. Orthostatic hypotension, for example, is a condition where you can get dizzy or black out from changing position too quickly. There's also a condition known as labile hypertension that can cause random high spikes in BP.
importantbrian 3y ago
I have really bad white-coat hypertension. Like 150-90 in the drs. office. So every time I go in they send me home with a chart and I have to dutifully record my blood pressure a couple of times a day for 2 weeks and send it back to them, and when measured at home it's totally fine. Since I have the cuff I check it every so often to make sure it's still fine and it is, but the moment I get in a drs. office boom it spikes. This is even true when I'm there for someone else like my son or my wife. I can feel that my blood pressure is high. I have absolutely no explanation for why except that I had a major surgery when I was 5 and there must be some suppressed trauma from that that comes out physically when I'm in a doctor's office.
- kyleee 3y ago
  To my mind it’s a very natural reaction. We rarely are in situations, like a doctor’s office, where out of the blue you may be told you are dying, etc.
greenish_shores 3y ago
"Cuffless" blood pressure measurements, which could be easily used to measure BP continuously, could easily solve this problem.[0][1] [0] https://www.frontiersin.org/articles/10.3389/fcvm.2019.00040/full https://www.frontiersin.org/articles/10.3389/fcvm.2019.00040... [1] https://www.cnet.com/health/medical/i-have-high-hopes-for-this-cuffless-blood-pressure-monitor-heres-why https://www.cnet.com/health/medical/i-have-high-hopes-for-th...
Zenzero 3y ago
This should be basic knowledge for any provider. I don't really agree that it is a model that is too simplistic. It is a tool that has considerations for accurate use based on physics and physiology.

hzay 3y ago

Is it really secret though? It's the first thing you learn when you google "how to take bp". Like I'm not a medical person but when I was pregnant, I was asked to check BP and I asked the doctor "should I like average 3 readings or something?" and she said "just take one, don't stress it". This is well known re thyroid medication as well. Also re weight, progesterone, a bunch of things.

pc86 3y ago
It's not a secret. Most of my immediate family is or was in healthcare and nobody is getting put on BP meds because of a single errant reading. They're getting put on meds because of persistent, uncontrolled elevated BPs and with non-pharmaceutical interventions not addressing it. Everyone, especially physicians, know there's a list of 20-30 things that can give you temporarily elevated BP that won't respond to BP meds.
- importantbrian 3y ago
  Yeah, that's been my experience. Everytime I see my primary my BP is elevated in the office and they send me home with a log and I have to take my BP multiple times a day for 2 weeks and at home it's fine, so I've never been put on meds for it even though it's very high in the office.
- claytongulick 3y ago
  > nobody is getting put on BP meds because of a single errant reading I'm glad you've had good experiences and relationships with what sound like quality healthcare professionals. Others have had different experiences.
claytongulick 3y ago
I suppose "well known" is relative, it may surprise you how little agency some people have over their health. >It's the first thing you learn when you google "how to take bp". The populations that I frequently deal with are not in a life/financial/cognitive place where this is a thing they would think of doing, or be capable of doing. Take a look at this [1] about over treatment of mild hypertension. It's not a new problem, and potentially affects millions [2]. There can be enormous pressure on physicians to treat certain conditions from a population-health standpoint with medications if they fit certain clinical criteria. The recent (2017) change in standards for hypertension [3] have been controversial. It put millions of people into the category of hypertension that weren't previously. Coupled with certain clinical criteria that recommend medication prescription even for mild hypertension, it's concerning that there may be an overprescription issue. Many busy clinics don't have time to have a patient sit for the recommended 5 minutes of rest before taking BP (though I've seen this improving). Many medical assistants are poorly trained in BP measurement, and are overworked - I've seen many cases where a harried MA will do things like sit a patient down, put a cuff on them over-the-sleeve, as the patient slouches in a chair, with the arm in an incorrect position, a poorly fitted cuff, and just write down the number the machine spits out. Of course, a good PCP will double check this and look for a trend. Not all PCP's are good and go to this effort. (I am not a physician, I'm a tech nerd with a clinical background, but I've worked in healthcare for decades) I've also experienced it personally. I went to the doc once about ten years ago for a wellness check. Based on the in-office BP reading and labs, the NP prescribed me five different medications, including BP meds, statins and others. I decided to focus on lifestyle changes instead and that's worked well for me, but that's not an option for everyone. [1] https://www.youtube.com/watch?v=cZCuJheVJA0 https://www.youtube.com/watch?v=cZCuJheVJA0 [2] https://www.umassmed.edu/news/news-archives/2014/11/umms-family-doctors-say-many-take-blood-pressure-meds-not-shown-to-help/ https://www.umassmed.edu/news/news-archives/2014/11/umms-fam... [3] https://www.health.harvard.edu/heart-health/reading-the-new-blood-pressure-guidelines https://www.health.harvard.edu/heart-health/reading-the-new-...

devmor 3y ago

I realized this a couple years ago when I moved and started getting my blood tests done at a new lab that was nearby. My entire life I’ve had perfect blood pressure, but suddenly this lab thinks I have hypertension. After 3-4 visits and checking my own BP during the day, I realized that my blood pressure is just higher in the morning - I never set appointments in the morning previously because I lived too far from a lab to make morning appointments convenient.

greenish_shores 3y ago
What makes them think you have hypertension with purely blood laboratory tests? Electrolyte levels ratios? They aren't changed in all types of hypertension (won't be changed in most, probably), but that's just my wild guess.
- devmor 3y ago
  Just the blood pressure. It wasn’t a diagnosis so much as a “this seems concerning, you should get this checked out”.

nradov 3y ago

Yes, blood pressure measurement is a real mess. Besides the factors you listed, I have found that temperature has a surprisingly large impact. If your hands are cold, then that causes peripheral vasoconstriction and raises BP.

voisin 3y ago

Question, since you seem to know a lot about this: is high blood pressure meant to be a description of a persistent condition (I.e. took a reading at 5, 10, 20 minute intervals at rest and stayed elevated) or is it meant to be a description of something else (after standing up, or after walking, etc etc)?

claytongulick 3y ago
Generally, it's referring to a chronic condition, meaning that your blood pressure is elevated as a trend over time. Everyone goes through huge peaks and troughs with BP - at the gym, sleeping, etc... will have massive changes in BP. There are certain conditions where "instant" BP can become a problem, both high and low. Orthostatic hypotension, for example, is a condition where you can get dizzy or black out from changing position too quickly. There's also a condition known as labile hypertension that can cause random high spikes in BP.

importantbrian 3y ago

I have really bad white-coat hypertension. Like 150-90 in the drs. office. So every time I go in they send me home with a chart and I have to dutifully record my blood pressure a couple of times a day for 2 weeks and send it back to them, and when measured at home it's totally fine. Since I have the cuff I check it every so often to make sure it's still fine and it is, but the moment I get in a drs. office boom it spikes. This is even true when I'm there for someone else like my son or my wife. I can feel that my blood pressure is high. I have absolutely no explanation for why except that I had a major surgery when I was 5 and there must be some suppressed trauma from that that comes out physically when I'm in a doctor's office.

kyleee 3y ago
To my mind it’s a very natural reaction. We rarely are in situations, like a doctor’s office, where out of the blue you may be told you are dying, etc.

greenish_shores 3y ago

"Cuffless" blood pressure measurements, which could be easily used to measure BP continuously, could easily solve this problem.[0][1] [0] https://www.frontiersin.org/articles/10.3389/fcvm.2019.00040/full https://www.frontiersin.org/articles/10.3389/fcvm.2019.00040... [1] https://www.cnet.com/health/medical/i-have-high-hopes-for-this-cuffless-blood-pressure-monitor-heres-why https://www.cnet.com/health/medical/i-have-high-hopes-for-th...

Zenzero 3y ago

This should be basic knowledge for any provider. I don't really agree that it is a model that is too simplistic. It is a tool that has considerations for accurate use based on physics and physiology.