What blood pressure monitors do doctors recommend and how to measure blood pressure at home

What do you see when you see 9/14? If you see only one date, this note may interest you. If you’re worried about your blood pressure, you might see something else. In that case, it is also advisable to continue reading.

In Argentina, today we commemorate the Hypertension Day. His choice was not by chance: 14/9 (or 140/90 mmHg) represents the maximum value from which a person is considered to have high blood pressure.

The 14 represents the systolic pressure, commonly known as the “maximum”, the pressure exerted by the heart when it contracts. The 9th, the diastolic or “minimum”, which occurs between beats.

Knowing the values ​​is the first step to detect and control hypertension, the main cardiovascular risk factor and premature mortality, since it increases the chances of suffering a heart attack, stroke and kidney damage, among others.

In our country, this is a pending issue for almost half of the people who live with hypertension, which affects more than one in three adults, but 40% of them don’t know and, among those who do have a diagnosis, more than half are treated, but not well controlled.

“Accurate blood pressure measurements are essential for controlling hypertension, because a imprecise determination can significantly affect diagnosis and treatment,” said Joaquín Caputo, member of the Argentine Federation of Cardiology (FAC).

Within the framework of Hypertension Day, the FAC, through a statement, emphasized what it considers “one of the recurring themes in cardiology clinics,” which is what is the best way to measure blood pressure.

Why is it important to make a good measurement? From the FAC they explain that “a overestimation of blood pressure at the individual level can lead to the unnecessary initiation or increase of medication, exposing the person to secondary events. On the contrary, a underestimation “can leave the individual exposed to a risk factor that threatens their health.”

This overestimation (obtaining a higher value than the real one) or underestimation (lower) is not uncommon, notes the FAC statement: “As reported in the Position Statement of the Lancet Commission on Hypertension of the Pan American Health Organization, Health (PAHO), the diagnosis was modified in 50% of patients due to changes in the method of taking blood pressure.

The pressure can be taken in an office, at the pharmacy, or at home. It can be done by a nurse, an aunt, the pharmacist or yourself. But The diagnosis of hypertension is made exclusively by the doctor.

“To make the diagnosis, blood pressure must be measured correctly with an automatic and validated device and perform several measurements. If the average of these measurements is above 135/85, we are almost in a position to say that a person has high blood pressure,” he explained to Clarion Marcos Marin, former president of the Argentine Society of Arterial Hypertension (SAHA).

“Measuring blood pressure in the office is very important, because it represents the entrance door to know the blood pressure values ​​of our patients,” highlights doctor Rocío Martínez, member of the SAHA.

It’s simple, nothing invasive And if a diagnosis of hypertension is reached, the health professional will indicate treatment (which combines healthy habits and antihypertensive drugs), which will help manage the pressure.

But this ideal journey faces several barriers in reality. One of them is that the opportunity to take the blood pressure is often lost when the patient comes into contact with the health system.

Marin, coordinator of the SAHA’s Know and Control Campaign, explains it: “Unfortunately, in an investigation we carried out, we observed that only 14% of patients Those who come to the doctor’s office have their blood pressure measured. “So this is the main scourge, that doctors do not measure blood pressure in the office for different reasons, among others because they do not have any blood pressure monitor.”

Beyond that, and that the diagnosis is always made by the doctor, taking pressure exclusively in the office faces some limitations: poor reproducibility (several measurements are needed at different times), the alarm reaction (what is known such as white coat hypertension, the person can become more nervous in the office and this alters their values), the variability inherent to day and night and rest and exercise.

“That’s why blood pressure taken in the office is not enough to evaluate our patients, that’s why we need measurements outside of his“says Martínez.

For this there are two tools: ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (MDPA).

Is it essential to have a blood pressure monitor at home? No. But some hypertensive people choose to purchase it, and then share the home records with the treating health professional.

“The variability of blood pressure in different situations such as anxiety, stress, physical activity, smoking in the last 30 minutes prior to taking blood pressureposes difficulties,” says Caputo, of the FAC.

As a result, he considers that “being able to have an automatic device is a very interesting option since it allows multiple feedings at different times of the day (before breakfast and dinner are ideal) transforming the automatic blood pressure monitor into an efficient, reliable and valuable tool for the cardiologist.

“Accurate blood pressure measurement is key to the effective diagnosis, prevention and control of hypertension. It can be achieved with the use of validated electronic devicesthe use of a correct measurement protocol and adequate preparation of the patient,” PAHO emphasizes in the guidelines of its HEARTS project.

For years there has been a consensus among health professionals and health authorities that pressure measurement should be carried out with validated automatic devices, which have proven to overcome the limitations of classic aneroids.

“Before there was the mercury one, which was banned in 2013 and many people think that the aneroid is the best device. However, all scientific societies have already agreed that the device to measure pressure in the office and at home has to be an automatic and validated device,” Marin emphasized.

“The use of pressure measurement with automatic blood pressure monitors is supported by numerous prognostic and therapeutic studies fundamental in the field of arterial hypertension,” highlights the FAC statement.

“Its main advantage – he adds – is that it reduces errors related to the observer by automating the measurement process. Another advantage of automatic measurement is that it allows many measurements to be taken outside the office, in the daily environment of each person. The home registry It is ideal for him long-term follow-up of treated hypertensive patients“

The thing is that in aneroids, the manipulation of the equipment is not the responsibility of the patient but of another person, who must manually pump the air to inflate the “cuff” (cuff) and thus, through the stethoscope, hear the heartbeats that indicate the systolic and diastolic pressures.

“Aneroids have the peculiarity that they go out of calibration easily and you have to take them to be calibrated every six months, something that most people do not do,” adds Jessica Barochiner, doctor at the Arterial Hypertension Service of the Italian Hospital, and member of the SAHA.

“In addition, it requires very exhaustive training to master the measurement technique. And many times with this equipment, people measure themselves only once and tend to ’round’ the measurement, which is not correct.”

Automatic digital blood pressure monitors, on the other hand, do not require another person to measure blood pressure: it is the same device that pumps the air to inflate the cuff, with the push of a buttonand deflates when detecting the blood pressure recording, marking the two figures on the digital watch, in addition to the heart rate.

The FAC, in turn, advises against the use of automatic wrist devices. “This is because the cuff is placed over the radial artery, giving inaccurate measurements, especially if the arm is not held at the level of the heart during the measurement and if the radial artery is not compressed evenly.”

PAHO offers a list of validated devices that can be consulted by clicking here.

“The concept should be that every hypertensive patient has to have their blood pressure controlled. With every change of season“The ideal would be for the patient to go to the doctor and have his blood pressure measured in two or three measurements in the same consultation,” Marin responded.

Home monitoring of blood pressure “is correct to do four days in a row, two doses in the morning and two at night and take an average,” he said.

“This should be repeated every three months and the patient’s pressure should always be below 135/85. That is the best way to know if a hypertensive patient is well controlled,” he concluded.

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