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Variable Or Fluctuating Blood Pressure

Some fluctuation or variation in blood pressure is normal. Variations in pressure that are significantly greater than the norm are associated with increased risk of cardiovascular disease brain small vessel disease, and dementia independent of the average blood pressure level. Recent evidence from clinical trials has also linked variation in blood pressure to stroke, heart failure, and cardiac changes that may give rise to heart failure. These data have prompted discussion of whether excessive variation in blood pressure should be treated, even among normotensive older adults. Older individuals and those who had received blood pressure medications are more likely to exhibit larger fluctuations in pressure, and there is some evidence that different antihypertensive agents have different effects on blood pressure variability whether these differences translate to benefits in outcome is uncertain.

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Understanding Your Blood Pressure Reading

Blood pressure is measured in millimetres of mercury and is given as 2 numbers:

• systolic pressure the pressure when your heart pushes blood out
• diastolic pressure the pressure when your heart rests between beats

The highest number is always the systolic pressure and it’s always given first. For example, a blood pressure given as “120 over 80” or 120/80mmHg means a systolic pressure of 120mmHg and a diastolic pressure of 80mmHg.

As a general guide:

• normal blood pressure is considered to be between 90/60mmHg and 120/80mmHg
• high blood pressure is considered to be 140/90mmHg or higher
• low blood pressure is considered to be 90/60mmHg or lower

If your reading is between 120/80mmHg and 140/90mmHg, you may be at risk of developing high blood pressure. There are things you can do to help prevent high blood pressure.

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D Typing Of Hypertension

About 90% of hypertension is essential hypertension. The diagnosis of essential hypertension is made by the exclusion of secondary hypertension. Essential hypertension includes white coat hypertension , in which hypertension is observed only in a medical setting . The diagnosis of white coat hypertension is made by home blood pressure measurement and ABPM, as well as by measurement of blood pressure at the clinic. The frequency of isolated systolic hypertension increases in elderly people, because systolic blood pressure increases whereas diastolic blood pressure often decreases due to a reduced compliance of the aorta caused by atherosclerosis. Several studies, including the Framingham Study, Ohasama Study and Hisayama Study,54,109,110,115,116 showed that isolated systolic hypertension is a strong risk factor for cerebral and myocardial infarction in elderly people. Isolated systolic hypertension in the elderly is classified into the burned-out type, caused by a decrease in diastolic blood pressure in essential hypertension, and the de novo type, caused by a novel elevation of systolic blood pressure in old age.

Myth: As Long As I Dont Add Too Much Salt To My Food I Can Eat What I Want

Fact: Its not just table salt you have to worry about.

You may already know that salt causes high blood pressure. But, salt isnt just what you add to your food from the saltshaker. According to Garg, some of the most common sources of dietary sodium also include:

• Breads and rolls
• Cheese
• Snack foods, like potato chips and pretzels

It helps to reduce your dietary sodium intake to less than 2,400 mg a day and to follow the DASH eating plan, which consists of a diet rich in fruits, vegetables and low-fat dairy products, he says. Following the DASH diet may reduce your systolic blood pressure by 8 to 14 mm Hg.

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B Blood Pressure Measurement In A Non

ABPM and self-measurement of blood pressure at home are methods for blood pressure measurement in a non-clinical setting. Ambulatory and home blood pressures are often considered to have clinical values comparable to, or greater than, that of clinic blood pressure. These blood pressure measurements also have value as blood pressure information differing in nature .

Table 2 Characteristics of each type of blood pressure measurement

Home blood pressure measurement

Table 3 Measurement of home blood pressure

The finger-cuff device for blood pressure measurement is inaccurate. The wrist-cuff device for blood pressure measurement is easy to use, but often provides inaccurate measurements because of the difficulty in correcting the difference of hydrostatic pressure between heart level and wrist level, and because of the difficulty in completely compressing arteries due to anatomical issues with the wrist.51 At present, therefore, a blood-pressure-measuring device with an upper-arm cuff is used for home blood pressure measurement. The accuracy of upper-arm-cuff devices for home blood pressure measurement using the cuff-oscillometric method is generally acceptable as long as they are the products of Japanese companies. The results of tests of the accuracy of various home blood-pressure-measuring devices are provided at www.dableducational.org or .

Table 4 Criteria for hypertension in different measurement methods

What Are The Different Types Of High Blood Pressure

There are two main types of high blood pressure: primary and secondary high blood pressure.:

• Primary, or essential, high blood pressure is the most common type of high blood pressure. For most people who get this kind of blood pressure, it develops over time as you get older.
• Secondary high blood pressure is caused by another medical condition or use of certain medicines. It usually gets better after you treat that condition or stop taking the medicines that are causing it.

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How Can I Measure My Blood Pressure At Home

Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure monitoring.

SMBP means you regularly use a personal blood pressure measurement device away from a doctors office or hospitalusually at home. These blood pressure monitors are easy and safe to use. A health care team member can show you how to use one if you need help.

Evidence shows that people with high blood pressure are more likely to lower their blood pressure if they use SMBP combined with support from their health care team than if they dont use SMBP.3

Use these additional tips for SMBP:4

• Use a blood pressure log pdf icon to record your blood pressure measurements.
• Take your blood pressure at the same time every day.
• Take at least two readings, 1 or 2 minutes apart.

Myth: Theres Nothing I Can Do To Prevent High Blood Pressure If It Runs In My Family

Fact: Lifestyle changes can reduce your risk.

High blood pressure can run in families if your parents or close blood relatives have had high blood pressure, you are more likely to develop it, too, Garg says. However, lifestyle choices have allowed many people with a family history of high blood pressure to avoid it themselves.

In addition to following a healthy diet, maintaining a healthy weight and regular exercise can have a large impact on reducing blood pressure, according to Garg.

Significant weight loss can decrease systolic blood pressure by 5 to 20 mm Hg, he says. Exercising for 30 minutes every day can reduce systolic blood pressure by 4 to 9 mm Hg.

Its also important to reduce stress and make sure that you are getting enough shut-eye.

Chronically high levels of stress and inadequate sleep can both contribute to high blood pressure, Garg says. Managing stress and ensuring you get adequate sleep can help reduce your blood pressure.

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Is There Anything Else I Need To Know About A Blood Pressure Measurement

If you were diagnosed with high blood pressure, your provider may recommend one or more of the following lifestyle changes.

• Exercise regularly. Staying active can help lower your blood pressure and also help manage your weight. Most adults should aim for 150 minutes of physical activity per week. Check with your provider before beginning an exercise program.
• Keep a healthy weight. If you are overweight, losing as little as 5 pounds can lower your blood pressure.
• Eat a healthy diet that includes fruits, vegetable, and whole grains. Limit foods high in saturated fat and total fat.
• Reduce salt in your diet. Most adults should have less than 1500 mg of salt per day.
• Limit alcohol use. If you choose to drink, limit yourself to one drink a day if you are a woman two drinks a day if you’re a man.
• Don’t smoke.

Myth: The Risk Of High Blood Pressure Is The Same For People Of All Races

Fact: Black adults have an increased risk of developing high blood pressure.

Although the reasons why arent completely clear, hypertension is more common among Black adults than adults of other races and ethnicities, Garg says.

High blood pressure may also develop at a younger age, be more severe and be more likely to lead to hospitalization. Experts think this may be because obesity and diabetes are more common among African Americans. There may also be genetic and socioeconomic components.

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Testing Your Blood Pressure At Home

Your GP may suggest 24-hour or ambulatory blood pressure monitoring if they think you may have high blood pressure .

ABPM tests your blood pressure regularly over 24 hours, by using a cuff attached to a portable device that’s worn on your waist.

You can continue with your daily activities during this time.

If you want to regularly check your blood pressure at home, you can buy a machine.

When And Where To Get Your Blood Pressure Tested

You should have a blood pressure test if you’re worried about your blood pressure at any time.

If you’re over 40, you can have this test done as part of an NHS Health Check, which is offered to adults in England aged 40 to 74 every 5 years.

If you have been diagnosed with high or low blood pressure, or you have a high risk of developing either, you may need more frequent checks of your blood pressure.

You can get your blood pressure tested at a number of places, including:

• your local GP surgery
• some workplaces

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What Is Blood Pressure

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is called diastolic pressure.

Your blood pressure reading uses these two numbers. Usually the systolic number comes before or above the diastolic number. For example, 120/80 means a systolic of 120 and a diastolic of 80.

What Are The Treatments For High Blood Pressure

Treatments for high blood pressure include heart-healthy lifestyle changes and medicines.

You will work with your provider to come up with a treatment plan. It may include only the lifestyle changes. These changes, such as heart-healthy eating and exercise, can be very effective. But sometimes the changes do not control or lower your high blood pressure. Then you may need to take medicine. There are different types of blood pressure medicines. Some people need to take more than one type.

If your high blood pressure is caused by another medical condition or medicine, treating that condition or stopping the medicine may lower your blood pressure.

NIH: National Heart, Lung, and Blood Institute

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A Classification Of Blood Pressure Levels

Although a positive correlation is observed between blood pressure and risk of cardiovascular disease, blood pressure values are distributed continuously and hypertension is defined artificially. In the 1999 WHO/ISH Guidelines,62 the diagnostic criteria for hypertension were combined, in principle, with the JNC VI diagnostic criteria to avoid confusion.60 Thereafter, the guidelines were revised in the JNC7 in 2003,38 2003 ESH-ESC Guidelines,61 2003 WHO/ISH Statement119 and 2007 ESH-ESC Guidelines,66 all of which defined a blood pressure of 140/90mmHg as indicative of hypertension.

In the Hisayama Study in Japan, the cumulative mortality rate due to cardiovascular disease was lowest when the systolic and diastolic blood pressures were < 120mmHg and < 80mmHg, respectively, and the risk of cardiovascular disease increased significantly when the systolic blood pressure was 140mmHg compared with < 120mmHg, and when the diastolic blood pressure was 90mmHg compared with < 80mmHg, including in elderly individuals.109 Moreover, according to the Tanno/Sobetsu Study, an 18-year prospective epidemiological study in Hokkaido, Japan, a systolic blood pressure of 140mmHg and a diastolic blood pressure of 90mmHg were considered significant risk factors for cardiovascular and total mortality.120 Similarly, in NIPPON DATA 80, a significant increase in mortality rate due to cardiovascular disease was observed at a blood pressure of 140/90mmHg.6

How Blood Pressure Is Tested

Blood pressure machines vary, but they’re all a type of measuring device, which often have an arm cuff attached to it.

The cuff is usually wrapped around your upper arm and filled with air until it feels tight. This can feel uncomfortable but it only lasts a few seconds.

It’s important to relax and not talk during this time, because this is when your blood pressure is measured.

If a healthcare professional is doing this for you, they may also use a stethoscope to record your blood pressure.

An automatic device usually picks up the measurements from sensors in the arm cuff, which are sent to a digital display.

You should get the results straight away.

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Aha Issues Scientific Statement On Accurate Blood Pressure Readings

The American Heart Association has issued recommendations to help clinicians obtain the most accurate blood pressure measurements possible, according to a statement published in Hypertension.

Accurate BP measurement is integral to the diagnosis and management of hypertension. In order to ensure the most accurate measurement, the AHA has issued the following recommendations.

Training in BP Measurement

• Assess the physical and cognitive competencies needed to perform auscultatory BP measurement:
• Clinician must be able to see the dial of the manometer at eye level without strain, and they must be able to read the sphygmomanometer no further than 3 feet away.
• Clinician must be able to hear the Korotkoff sounds.
• Clinician must be able to deflate cuff, listen to Korotkoff sounds, and read the sphygmomanometer at the same time.

• Assess the knowledge required:

• Media Coverage of Expanded Definition of Hypertension Unbalanced

Body Position and BP Measurement

Regulation Of Blood Pressure

The endogenous, homeostatic regulation of arterial pressure is not completely understood, but the following mechanisms of regulating arterial pressure have been well-characterized:

These different mechanisms are not necessarily independent of each other, as indicated by the link between the RAS and aldosterone release. When blood pressure falls many physiological cascades commence in order to return the blood pressure to a more appropriate level.

The blood pressure fall is detected by a decrease in blood flow and thus a decrease in glomerular filtration rate .

Decrease in GFR is sensed as a decrease in Na+ levels by the macula densa.

The macula densa causes an increase in Na+ reabsorption, which causes water to follow in via osmosis and leads to an ultimate increase in plasma volume. Further, the macula densa releases adenosine which causes constriction of the afferent arterioles.

At the same time, the juxtaglomerular cells sense the decrease in blood pressure and release renin.

Renin converts angiotensinogen to angiotensin I .

Angiotensin I flows in the bloodstream until it reaches the capillaries of the lungs where angiotensin-converting enzyme acts on it to convert it into angiotensin II.

Angiotensin II is a vasoconstrictor that will increase blood flow to the heart and subsequently the preload, ultimately increasing the cardiac output.

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What Affects A Blood Pressure Reading

Many things can affect a blood pressure reading, including:

• Nervousness about having your blood pressure taken. This is called white coat syndrome. As many as 1 in 3 people who have a high blood pressure reading at the doctors office may have normal blood pressure readings outside of it.1
• What you ate, drank, or did before your reading. If you smoked, drank alcohol or caffeine, or exercised within 30 minutes of having your blood pressure measured, your reading might be higher.2
• How you are sitting. Crossing your legs and letting your arm droop at your side rather than rest on a table at chest height can make your blood pressure go up.2

Its important to get an accurate blood pressure reading so that you have a clearer picture of your risk for heart disease and stroke.

A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. A reading that says your blood pressure is higher than it actually is may lead to treatment you dont need.