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41 PRACTICAL QUESTIONS AND ANSWERS ABOUT HYPERTENSION AND HYPERCHOLESTEROLEMIA - 2008

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General information

  • Blood pressure measurement at home is necessary for the evaluation of pressure and the diagnosis of hypertension but also for the longterm observation of pressure.
  • For the right evaluation of pressure at home the patient must be trained in the technique of measurement and the device must be checked periodically (once per year).
  • Reliable measurements may be performed with a mercury or a mechanical sphygmomanometer (it is like a clock with a revolving indicating needle) and a stethoscope (see the figure) after the patient's meticulous training in the technique of measurement (see "What is the right way of blood pressure measurement?") or more easily with an automatic electronic device (see "Which devices are appropriate for blood pressure measurement at home?").
  • The measurements may be performed by the hypertensive person himself or by another person at home.
  • Patients usually change their drug treatment (more pills or avoidance of a regular dose) based on an isolated measurement. This is a wrong strategy and must be avoided.

How many measurements are needed

  • For the evaluation of pressure at home many measurements must be performed on different days in resting conditions and the average must be assessed.
  • Isolated measurements are of low value because they may not represent the true pressure at home.
  • The measurement of pressure in a state of agitation, stress, discomfort, panic, headache, dizziness etc must be avoided because it will be misleading.
  • For the long-term home monitoring of blood pressure, 1-2 measurements per week are usually enough.
  • For the evaluation of blood pressure by patients at home it is recommended to monitor blood pressure for at least 3 and preferably 7 routine working days before each visit to the doctor.
  • Duplicate morning (before drug intake if treated for hypertension) and evening measurements should be taken after 5 minutes sitting rest and with 1 minute between measurements.
  • The total of measurements should be averaged to give a single number for systolic and diastolic blood pressure after discarding measurements of the first day.
  • All measurements must be recorded, as in figure 2. You must not choose which measurement you record. You must not choose which measurements you will show to your doctor. But you may record if you had any problem during the measurement.
  • In general, blood pressure is lower at home than at the doctor's office. Blood pressure is recorded as normal at home when the average of measurements is lower than 130 mmHg for the systolic and lower than 80 mmHg for the diastolic.

WRITING GROUP
G. Stergiou, Chairman
A. Achimastos
E. Andreadis
I. Avramopoulos
M. Elissaf
N. Karatzas
T. Mountokalakis
D. Papadogiannis
K. Siamopoulos
E. Varsamis
K. Vemmos
D. Vlahakos