What is the best way to measure BP

hi guys my name is Sanjay Gupta I'm consultant cardiologist in York I'm actually doing this video from a hotel room in Nairobi I was here in Kenya to visit my dad my dad hasn't very well looked late and I had to rush to see him this is why I didn't do a video last week thankfully he's a lot better and I'm on my way back so I was sat in the same room and I thought I'd do a video on blood pressure and in particular what is the best way to measure blood pressure what is the most accurate way of measuring blood pressure and the truth is that there are a variety of different ways okay there are non-invasive ways which has simply like the blood pressure measurement that your GP does where he puts a cuff around your arm and then he presses a button or he inflates the cuff and listens to hear it manually and then has a listen to your pulse and that is one way or there are invasive ways where you put a catheter in and actually attach it to a manometer and measure the pressure the problem that the invasive ways are obviously far more accurate than non-invasive ways but the problem if they are invasive and they can't it's just practice not practical or safe to offer to everyone who come walks in through the door so largely we have to rely on non-invasive ways to measure the blood pressure now there are three ways you can measure the blood pressure okay the first is off the space readings which is that you go to your doctor the doctor measures your blood pressure or the nurse measures your blood pressure this is in a medical environment a hospital or a clinic or something like that another way is home based measurement which is where you buy a machine and you measure your own blood pressure at home the advantage of that is that it's in your environment you're not in a in a unfamiliar setting and you can do it at different times of the day the third way is to have something called an ambulatory blood pressure monitor which are these automated machines that you can take home and put on for 24 to 48 hours and these machines will automatically make several recordings both during the day and at night and subsequently allow the doctor to calculate an average so these are the three main ways by which we can measure blood pressure non-invasively the question is which is the most accurate and I guess the only way you would know which is the most accurate is to try and correlate it with invasive made readings but more importantly the most accurate recording is that which best correlates with patient outcomes remember the only reason blood pressure is important is either because it causes symptoms or it affects us badly in the long run it affects our outcome adversely the truth is it doesn't cause symptoms in the majority of patients so the only reason blood pressure really is important is that if you have a prolonged if you have prolonged periods of high blood pressure and you're unwell in other ways then that can contribute to something bad happening to you in the future like strokes or heart attacks that's why blood pressure is important so the the best reading the best way to measure blood pressure is the way that correlates best with bad outcomes right and in that sense and what we realize that the 24-hour blood pressure monitoring and delayed rate blood pressure monitoring correlates best with long-term outcomes and therefore is the best way to measure blood pressure this requires you to go to your doctor ask him for a machine the doctor will organise a machine someone straps that machine on you go home you stay with the machine for 24 48 hours you bring the machine back maybe they analyze all the readings taken by the machine it calculates an average and that gives you your average blood pressure and that is perhaps the best indicator of what is likely to happen to you in the future and you should really base treatment decisions and monitoring decisions are based on those readings that is the best way however that is not widely available it's a little bit more expensive so the next best way is home base readings okay home base readings mean you buy a blood-pressure machine you measure your own blood pressure in a situation which is familiar to you where you are at ease and then you calculate your own averages that is the second best way to measure blood pressure the worst way to measure blood pressure is off the spaced blood pressure measurements because with those there is a significant white coat effect which means that because you go to your GP surgery he measures the blood pressure to the familiar environment you're often stressed because you're in a hurry or you've been waiting it's a scary place and anxiety by itself will increase the blood pressure and therefore the blood pressure readings that are made by your GP are rarely ever accurate and correlate very poorly with what is going to happen to you in fact there was some really interesting research which pointed that which showed that actually if you go to your GP once and have a blood pressure reading and then you go back your blood pressure readings will fall by an average of 15 millimeters of mercury the systolic blood pressure will fall by 15 millimeters mercury by the third visit suggesting that that is that white coat effect of 15 millimeters of mercury and actually that continues to happen so if you go by your sixth visit your blood pressure will be even lower partly because of this familiarity partly because you are less anxious so you should never really get too anxious when your GP does your blood pressure so it's high what you want to say is well okay I want two more readings I want to come back and have more readings with you or I'll go home buy a blood pressure machine and make my own readings or best is to have a 24-hour blood pressure monitor and calculate an average in terms of home base readings what is the best way to measure your blood pressure and the answer is that you acquire one of these machines that you can from boots or a health store and the way to measure your blood pressure there is to try and take two readings one or two minutes apart so you basically sit down try and be as calm as possible take a reading ideally first thing in the morning before you take any medications and then about two minutes later repeat a recording and you record those in a diary and then in the evening again ideally before you take any medications in the evening do the same thing again two readings about one or two minutes apart in a sitting position and you do those consistently for seven consecutive days at the same time in the same manner at the end of those seven days what you want to do is ignore the first day's readings and then calculate an average from the remainder of the six days readings and that will give you your average blood pressure and that blood pressure is far more important than that that number is far more important than these isolated numbers that you can have remember the blood pressure changes all day long you know if you're stressed your blood pressure goes up if you've exercised your blood pressure goes up it varies with the time of day we know that the the average blood pressure dips by about fifteen percent when we go to bed at night and when we're asleep so depending on the time of the day depending on how you feel isolated readings will always mislead you and treatment decisions should not be made on isolated readings what you want is some kind of average assessment home based readings are good and be later in blood pressure monitoring is even better so if your doctor turns around to you and says look you have high blood pressure that's what you have to say look I'd like to have more readings okay ultimately your best the best correlates of the the best correlator of outcome as well as effectiveness of treatment is 24-hour blood pressure monitoring so what I would love to do or what I do in my own practice is if someone comes to me and they're you know the suspicion is have they got high blood pressure I would first I would never base it on the reading I've made in my clinic I would always do a 24-hour blood pressure monitor I would calculate an average I would then go back to the patients and say look this is your average it's a little bit on the high side can you work on your lifestyle if there are lifestyle issues to address if despite lifestyle issues does not address are not a lifestyle issue if despite lifestyle issues being addressed the blood pressure numbers are still elevated again on the 24-hour blood pressure monitor then one could contemplate the medication but again I would monitor the effective medication using a 24-hour blood pressure monitor or who based readings not office based readings so I hope you found this useful I would love to hear what you think about this at the later stage I'd like to talk about white coat hypertension and my next video will probably be on white coat hypertension all the best take care bye

Channel: York Cardiology

Views: 132,110

Keywords: Heart palpitations anxiety, Heart palpitations after eating, Heart palpitations causes, Heart palpitations symptoms, Heart palpitations treatment, Heart palpitations cure, Ventricular ectopics, Heart disease symptoms, Heart racing, Heart flutter causes, Heart palpitations at night, blood pressure, hypertension, ambulatory blood pressure

Id: 8-4eB2yZOZA

Length: 9min 40sec (580 seconds)

Published: Thu Feb 28 2019