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CLICK ON THE GRAPHIC TO READ IT. IT’S IMPORTANT!

By Paul Goldfinger, MD, FACC  June 28, 2020

The latest guideline from the American Heart Association and the American College of Cardiology says the target for treatment “has been lowered to 130/80mm Hg.”

I have advocated home BP checks for years, but now the process has an official name:  SMBP  (“self-measured blood pressure.”)

Experts say, “Compared with routine blood pressure measurements obtained in an office setting, SMBP measurements are a better predictor of cardiovascular disease and premature death.”

SMBP can help with a variety of hypertension issues:

a. Use it to confirm a suspected diagnosis of hypertension based on office BP readings.

b. Use SMBP to assess the effectiveness of treatment for patients who have hypertension.

c. Use SMBP to identify white coat and masked hypertension. Masked hypertension is defined as a normal blood pressure (BP) in the clinic or office (<140/90 mmHg), but an elevated BP out of the clinic (ambulatory daytime BP or home BP>135/85 mmHg).

d. SMBP devices should be used which are validated for clinical accuracy. Also patients need to be educated on how to accurately measure their blood pressure.

See the graphic above and bring your home machine with you to the doctor’s office to compare to his readings.

e.  Keep a written record with readings, time and date.  Don’t take a reading if you just had a very stressful moment or just finished strenuous exercise.

Do not write down the first reading. Wait 5 minutes and repeat; use the second reading.

f.  “Cointerventions” can help affect better BP control. This includes education sessions, telehealth visits, discussions with nurses or pharmacists, counseling for weight reduction, and psychological evaluation for stress reduction.

g.  Effective management guided by SMBP readings can help prevent over-treatment, frequency of doctor visits, avoidance of cardiovascular complications, and improved quality of life.

Reminders:

There are many drugs available to treat hypertension, and they all have side effects, so be aware.

If you are older, for example over 60, you may be more sensitive to drug side effects.  Be especially aware of lightheadedness which can be postural  (more noticeable when standing.)  It could mean that your BP readings may be too low for you.

And there is the risk of interaction with other drugs.  For example, if you take Viagra, it can combine with your BP meds to cause risky dizziness or fainting. Consult with your doctor and don’t buy Viagra or generics over the counter.

Many older patients take 5-10 meds, so your doctor and pharmacist have to watch for drug interactions.

As for aerobic exercise, if you are over 50 or if you have worrisome risk factors such as early heart disease in the family, smoking, overweight and high cholesterol, consult with a cardiologist and have a stress test.

Blogfinger contains a number of posts about hypertension. Use the search box at the top right of this page to find them.