A Reference for Patients Managing Their Hypertension at Home
The majority of patients who need to manage their hypertension now do so from the comfort of their homes. Recent advancements in blood pressure monitors have made it easy to obtain accurate readings.
Many doctors now encourage their patients to check their blood pressure outside of a clinic, allowing them to obtain multiple readings between office visits. This has led to better diagnosis and faster treatment - ultimately culminating in a healthier patient.
At Surgo, we've created this helpful guide for patients in need of hypertension home management and physicians that need to refer their patients to the proper at-home bp monitor.
What to Look for When Choosing a Home Blood Pressure Monitor
- Accuracy Rating
- Doctor's Referral
- Cuff Type
- Ease of Use
- Multiple Readings
- Customer Reviews
What to Avoid When Choosing a Home Blood Pressure Monitor
- Non-Rated Monitors
- Finger Monitors
Blood Pressure Monitor History
How was the modern-day blood pressure monitor invented? Believe it or not, a horse deserves some of the credit.
In 1733, Reverend Stephen Hales was the first to record a blood pressure measurement. He did so on his horse, inserting a long glass tube into an artery and observing the pressure increase as blood was forced into the tube.
The first sphygmomanometer was invented by Samuel Siegfried Karl Ritter von Basch in 1881. His device contained a rubber bulb filled with water. This bulb would restrict blood flow in the artery while being connected to a mercury column. The mercury column would translate the pressure required to obscure the patient's pulse.
Later in 1896, Scipione Riva-Rocci improved on the device by adding a cuff that would apply even pressure to the patient's limb. This new design became the standard.
The medical field saw a breakthrough in 1905. Dr. Nikolai Korotkoff discovered the difference between systolic blood pressure, the pressure in your arteries when your heart beats, and diastolic blood pressure, the pressure in your arteries when your heart rests between beats. When a medical professional states two different numbers after taking your blood pressure, for example "180 over 80", they're referring to your systolic (180) and diastolic (80) blood pressure.
Blood pressure monitors developed slowly at first, but have rapidly been improved with new technology. Advancements have been made with non-cuff monitors - like photoplethysmograph (PTG), which measures pulsatile changes in index finger blood volume derived from a photodetector opposing a light-emitting diode. If that sounds like a lot of science, it is. Other new forms of hypertension management include portable bp monitors that are wearable.
Now that we're caught up on the history of blood pressure monitors, let's discuss the different types.
Blood Pressure Monitor Types
There are two primary types of blood pressure monitors: manual and digital. Both have their advantages and disadvantages and best use may be determined by the patient's needs. There are also two different types of blood pressure cuffs: arm-cuffs and wrist-cuffs.
Manual blood pressure monitors are still used today because of their accuracy. They include an inflatable cuff that collapses and releases the artery under the cuff. A mercury or aneroid manometer is then used to measure the pressure. When a manual bp device is used, trained medical professionals will place a stethoscope on the patient's arm to listen to the blood pulsing through the artery, a process known as auscultation.
Manual blood pressure monitors take various forms, including mercury monitors, Baumanometers, and aneroid meters.
Mercury column blood pressure monitors indicate pressure using a column of mercury. These columns do not require recalibration and are widely considered the most accurate form of measuring blood pressure.
These monitors are often used in clinical trials or with high-risk patients because of their accuracy. However, they require a trained professional to accurately conduct a blood pressure test and are difficult to transport. As a result, they are generally not recommended for at-home use.
Baumanometers are wall-mounted versions of a mercury column blood pressure monitor. They're often used in hospitals and exam rooms. Since they're fixed units, they are not portable and shouldn't be used at home.
Aneroid blood pressure monitors are a mechanical type of monitor that includes a dial. They're lightweight, making them portable. Some come with a stethoscope attached to the cuff and are considered safer than mercury column monitors.
These monitors do require recalibration and patients using these monitors at home should regularly test them for accuracy. The simplest way to tell if an aneroid monitor needs to be recalibrated is to lay the cuff completely deflated on a table or flat surface. If the needle rests outside of the box, then it's time to recalibrate.
Digital blood pressure monitors use oscillometric measurements and employ electronic calculations instead of auscultation. This means that a stethoscope is not required.
Many digital blood pressure monitors can inflate the cuff with the push of a button. It will read the patient's blood pressure and deflate on its own. After a short rest period (usually 15 to 30 seconds) patients can run another test. Some monitors will even take multiple readings on their own.
Digital blood pressure monitors are also portable and often use large, digital numbers to display a patient's systolic and diastolic blood pressure numbers, making it easy to read the testing results. Their ease of use makes them ideal for at-home hypertension management.
One of the drawbacks of digital blood pressure monitors is that they are not as accurate as manual monitors. They're also not recommended for patients with the following conditions:
- Arrhythmia or irregular heartbeats
- Pulsus alternans or alternating strong and weak heartbeats
- Pulsus paradoxus
Arm-Cuff monitors contain a cuff that's placed on the patient's upper-arm or bicep area. These cuff types are considered more accurate and are commonly used in hospitals and clinics.
Some patients do find arm-cuff monitors to be uncomfortable, especially patients with large arms. There are options for those who might find an arm cuff to be painful.
Wrist-cuff monitors contain a cuff that's placed on the patient's wrist just above their hand. Many patients prefer this cuff type because of its comfortable feel and portability.
The primary drawback to wrist cuffs is that they are not as accurate as arm cuffs. The arteries in your wrist are more narrow and closer to the surface of your skin compared to those in your bicep. This tends to result in higher and more inaccurate blood pressure readings.
Who Can Benefit from Home Blood Pressure Monitoring?
Patients of all kinds can benefit from the use of a home blood pressure monitor. The American Heart Association recommends at-home blood pressure monitoring for all patients with hypertension. There are several other patient types that can benefit from checking their blood pressure outside of their doctor's office.
Patients with Elevated Blood Pressure
According to Canadian government statistics, 43% of citizens 65 years and older are reported to have high blood pressure. Patients 50 to 64 years old see 24.3% of their age group diagnosed with high blood pressure among both men and women. However, many individuals are not aware that they even have high blood pressure, meaning these figures are likely lower than the actual percentages.
Those with hypertension should be continuously monitoring their blood pressure to avoid developing issues. Monitoring your blood pressure at home can assist patients in identifying trends for both increasing and decreasing blood pressure before they become serious enough for hospitalization.
Patients Who Have Recently Started Blood Pressure Medication
When starting a new blood pressure medication, it's critical to measure its effectiveness. To avoid multiple trips to the clinic to check on the progress of these medications, many patients can take regular readings at home and report them to their medical provider.
As noted previously, 43% of Canadians over the age of 65 have been diagnosed with high blood pressure. This percentage has seen a slight decline since 2015 (44.7%) - good news for doctors and patients alike.
Elderly patients are generally at a higher risk for hypertension or other chronic health conditions, so continual monitoring of blood pressure can improve long-term health.
The primary hypertension concern during pregnancy is preeclampsia, a dangerous pregnancy-related complication. Preeclampsia usually begins after 20 weeks of pregnancy and may include symptoms such as high blood pressure, high levels of protein in the urine that can indicate kidney damage, or other signs of organ damage. In some cases, women can develop postpartum preeclampsia after the delivery of their baby.
Both the life of the mother and baby can be threatened if preeclampsia remains untreated. Since this condition can be fatal and hypertension is a common symptom, it's advisable for pregnant patients to check their blood pressure at home and alert their doctor of any noticeable changes.
Other high blood pressure issues that can affect patients during pregnancy include:
- Gestational hypertension
- Chronic hypertension
- Chronic hypertension with superimposed preeclampsia
Patients with diabetes are generally at a higher risk for hypertension. Over time, diabetes actually damages small blood vessels. This results in the walls of blood vessels to stiffen. The stiffening of blood vessel walls leads to high blood pressure.
Patients with both high blood pressure and type 2 diabetes are at an increased risk of heart attack or stroke. Regular, accurate blood pressure readings can help healthcare providers track blood pressure more accurately.
Patients with Cardiovascular Issues
Heart disease and stroke continue to be the leading causes of death and hospitalizations in Canada. Hypertension issues are closely connected to the development of cardiovascular diseases.
There's even a correlation between cardiovascular mortality and elevated blood pressure. Cardiovascular mortality doubles with each 20/10 mmHg increase in blood pressure. Having high blood pressure and leaving it untreated increases the risk of stroke, ischemic heart disease, peripheral vascular disease, and heart failure.
Checking blood pressure at home creates a repeatable system for monitoring blood pressure in high-risk patients.
Patients with Potential "White Coat Syndrome"
White coat syndrome, sometimes referred to as white coat hypertension, is high blood pressure that appears to develop when patients are around doctors (in white coats) or other medical professionals. There have been cases of individuals who have normal blood pressure when compared to their readings in a doctor's office.
The leading theory is that this syndrome is caused by anxiety resulting from a clinic, hospital, or healthcare visit. White coat syndrome is more common in women, elderly patients, nonsmokers, people with a recent diagnosis of mild hypertension, and patients who are pregnant.
The easiest way to tell if a patient has white coat syndrome is by having them take their own blood pressure at home. Multiple readings at home can help healthcare workers determine if a patient's hypertension is affected by the location of the reading.
Patients Wanting to Monitor Their Health
The truth is that hypertension and its effects come with staggering statistics that all patients should note:
- Hypertension affects more than one in five people
- Hypertension is the most common reason patients visit a doctor
- Hypertension is the top reason for taking medication
- The lifetime risk for developing hypertension among adults aged 55 to 65 years with normal blood pressure is 90%
- An estimated 30% of hypertension can be attributed to excess dietary sodium
Checking blood pressure at home is a wise decision for any person wanting to maintain a healthy lifestyle.
How to Choose a Home Blood Pressure Monitor
When choosing a home blood pressure monitor, there are several factors to consider.
When choosing a home bp unit, it's essential to select one that is accurate. Inaccurate readings can lead to misdiagnosis and may have implications for the long-term treatment of hypertension. Ensure the monitor you're looking to purchase has been validated by various studies for its accuracy.
A great resource to utilize when searching for a home blood pressure monitor is Hypertension Canada. They've curated a list of recommended blood pressure devices that include a Gold or Silver rating. Both levels are considered accurate.
If you're still wary of a device's accuracy, you can ask your doctor or pharmacist to check your home bp monitor for you.
If your doctor has asked you to monitor your blood pressure at home, it's a good idea to ask them if they have any recommendations. Doctors may be aware of popular devices that work well for other patients and can sometimes guide you to the best value.
The other benefit is that your doctor may know which monitor type is best for your current treatment plan. Ask and see if they'll offer a referral for your home bp device.
Fit should be considered not only for your comfort, but also for accuracy. If the blood pressure cuff doesn't fit properly it can often lead to inaccurate readings.
Most home bp units have a cuff that can be adjusted to fit different arm or wrist sizes. Choose a home blood pressure monitor with a cuff that properly fits your upper arm or wrist.
The 2017 High Blood Pressure Clinical Practice Guidelines recommend the following cuff sizes:
- Adult Small | Arm circumference of 22 to 26 centimeters or ~ 8.5 to 10 inches
- Adult Average | Arm circumference of 27 to 34 centimeters or ~ 10.5 to 13 inches
- Adult Large | Arm circumference of 35 to 44 centimeters or ~ 13.5 to 17 inches
Cuff types are very important when managing your hypertension at home. The American Heart Association does not recommend wrist or finger monitors because they "yield less reliable readings." However, Hypertension Canada does list several wrist cuffs as either Gold Level or Silver Level recommended.
Many arm cuff monitors have multiple user memories which allow more than one person to take their blood pressure on the device. They're also generally considered more accurate, but can be difficult to take on the go.
Wrist monitors are lightweight and easy to transport. Many patients find them more comfortable than an arm cuff monitor. However, they are usually considered less accurate and require a specific body position to get a proper reading.
Whichever cuff type you select, make sure it:
- Has been approved by your doctor for use
- Has been verified for accuracy
- Fits your arm or wrist properly
Monitors that are difficult to use or read can lead patients to defer testing on a regular basis. When selecting your monitor make sure the display is easy to read. Many modern home bp units come with an enlarged digital display.
The buttons should be large, easy to locate, and easy to understand. There should be a clear indication of how and where to place your cuff. The monitor should come with detailed instructions on how to place your cuff, obtain a reading, and operate additional features.
The easier it is to use, the more likely you are to use it.
Many modern blood pressure monitors do much more than provide a reading. Popular features to look for include:
- Multiple cuffs
- Irregular heartbeat detection
- Medication reminders
- One-touch operation
- Hypertension classification indicator
- Multiple measurement modes
- Reading memory storage
- Multiple user memories
- Memory download capability
- Large display
Many monitors come with a combination of these capabilities. Make a list of the features you need and features you want. Locate websites that allow you to compare monitors. See which monitor ticks the most boxes on your list.
Blood pressure monitors come with a wide variety of options and as a result, also come with a wide variety of prices.
Refer back to your list of needs and wants in a bp unit. Find monitors that have the features you need. These could include requirements from your healthcare provider. The cost of these monitors should be your minimum budget. Now locate monitors with the features you need AND want. From there you can determine whether the cost justifies the features.
Most home blood pressure units will cost anywhere from $40 to $200 in Canada. More expensive does not necessarily mean more accurate. The additional cost can usually be attributed to additional features.
Some home blood pressure monitors will automatically take three different readings. The unit will take a reading every 30 to 60 seconds. It then averages the three readings to provide you with a number that most closely reflects your actual blood pressure.
Having a monitor with this built-in feature adds convenience to taking your blood pressure at home. If you don't opt for a monitor that automatically takes multiple readings, it is still recommended that you take an average of two to three readings every time you measure.
Before making a purchase, check to see what others are saying about the monitor you have in your cart. Getting feedback from someone who's already used the monitor is invaluable. It helps you cut through the noise of retailers advertising the latest and greatest new technology.
Check the bad reviews along with the good. What are the primary complaints? What do past buyers say about the quality of the product, ease of use, and accuracy? Has anyone dealt with a broken or malfunctioning monitor?
All of the answers to these questions will help with your decision. You can even ask your doctor what other patients have been saying about their home bp monitors.
How to Accurately Measure Your Blood Pressure from Home
When measuring your blood pressure at home, there are several tips recommended by Hypertension Canada and healthcare providers:
- Don't smoke or drink caffeine 30 minutes before measuring your blood pressure
- Empty your bladder prior to taking your blood pressure
- Rest and relax 5 minutes before starting
- Use a dining chair instead of a sofa when selecting a place to site
- Ensure you are sitting down with your feet flat on the floor with both your back and your arm supported
- Keep your arm at heart level
- Apply your blood pressure cuff onto a bare arm - sleeves or other clothing can lead to inaccurate measurements
- If you're using an arm cuff, ensure the cuff is placed securely on your bicep (upper arm)
- If you're using a wrist cuff, ensure you place the cuff on the correct spot of your wrist based on the monitor's instructions
- Take multiple measurements (at least two) in the morning and in the evening for 7 days prior to your doctor's appointment
- Take multiple measurements (at least two) in the morning and in the evening for two weeks after a change in medication
- Measure at the same time each day
- Try not to speak while measuring your blood pressure
- Record your results after every measurement
- Remember to provide results to your doctor
Monitoring your blood pressure at home can help improve your long-term health by providing your doctor with important data outside of your office visits. With accurate readings, health care providers can make adjustments to your treatment plan and can monitor and stay ahead of future hypertension-related issues.
At Surgo, we've partnered with BIOS Medical to provide patients with quality, affordable at-home blood pressure monitors. All of the BIOS Medical Blood Pressure Monitors we sell are recommended by Hypertension Canada.
Our team is here to assist doctors and medical professionals in guiding their patients to the right home bp unit. Shop our selection of Patient Self-Taking BP Units or contact us with any questions.