Blood pressure monitoring

Lowering blood pressure in patients who are hypertensive has been shown to reduce the relative risk of stroke, both ischemic and hemorrhagic, by 35% to 45%.23 Also, the more blood pressure is lowered, the greater the reduction in stroke risk.24 All patients should have their blood pressure monitored and controlled appropriately based on current guidelines for blood pressure management. However, no one agent has been clearly shown to be more beneficial than any other for preventing stroke. 

Blood pressure monitoring Annually or change of treatment (if hypertensive)... 

A home medical box in the bathroom could be introduced, comprising simple medical tools, such as a wrist blood pressure monitor or a (non-contacting) electronic thermometer, and a stethoscope microphone. Additionally an interactive medical encyclopedia could be accessible, with in depth explanations and animated models. Also a connection to a medical doctor could be integrated with wireless video links. 

All CHC users should have at least annual blood pressure monitoring. 

Patients on DMPA also should be weighed, have their blood pressure monitored, and have a physical exam, and Papanicolaou smear annually, as well as mammogram as indicated based on the patient s age. 

Patients given venlafaxine should have blood pressure monitored regularly. 

Koopmans, R., Oosterhuis, B., Karemaker, J.M., Werner, J., and van Boxtel, C.J., Pharmacokinetic-pharmacodynamic modeling of oxprenolol in man using continuous non-invasive blood pressure monitoring, Eur.. Clin. Pharmacol., 34, 395-400,1988. 

Concomitant administration of diuretics and angiotensin-converting enzyme (ACE) inhibitors results in enhanced hypotensive effect. Blood pressure monitoring is required, therefore, if patients who are on diuretics are started on ACE inhibitors. The ACE inhibitor should be initiated in the evening to avoid falls d ue to hypotension. 

Parenteral (supraventricular tachyarrhythmias) - For IV use only. Give as slow IV injection over at least 2 minutes under continuous EGG and blood pressure monitoring. An IV infusion has been used (5 mg/hour) precede the infusion... 

With its prominent noradrenergic activity at higher doses, and with reports of associated hypertension, blood pressure monitoring and EKGs should be considered for some patients. 

Thus, the physician must establish with certainty that hypertension is persistent and requires treatment and must exclude secondary causes of hypertension that might be treated by definitive surgical procedures. Persistence of hypertension, particularly in persons with mild elevation of blood pressure, should be established by finding an elevated blood pressure on at least three different office visits. Ambulatory blood pressure monitoring may be the best predictor of risk and therefore of need for therapy in mild hypertension. Isolated systolic hypertension and hypertension in the elderly also benefit from therapy. 

Gerin W, Schwartz AR, Schwartz JE, et al, Limitations of current validation protocols for home blood pressure monitors for individual patients, Blood Press Monit 2002 7(6) 3 13—3 18. 

Continue antihypertensives as dictated by blood pressure monitoring. Treatment may need to continue for up to three months. 

No proteinuria Monitor blood pressure Monitor blood glucose Screen for microalbuminuria if type 1 diabetes for >5 years or type 2 diabetes Aim for <130/80 mmHg Aim for <120/70 mmHg if type 1 diabetes Aim for HbAlc <7% Dietary advice for sugar and fat STOP SMOKING... 

Ten years ago, doctors scoffed at the idea of measuring and monitoring blood pressure at home rather than in the medical office. Today many physicians, at least those in the know, recognize that modern home blood pressure monitors are as good as, or perhaps even better than, clinical testing. That trend is worldwide. 

Late in 2004, the American Heart Association advocated home monitoring in its revised guidelines for blood pressure measurements, published in the February 2005 issue of the journal Hypertension. The lead author of that report. Dr. Thomas Pickering of Columbia University in New York, said, We ve found that blood pressure measurements taken by doctors in their offices may actually be unreliable in many patients. For that reason, there is wider acceptance of blood pressure readings taken by patients in their homes, and of ambulatory blood pressure monitoring. ... 

You ll find many brands of blood pressure monitors in the marketplace. Two excellent choices are Omron and LifeSource, both certified accurate by the British Hypertensive Society, internationally recognized for evaluating blood pressure monitoring devices. Omron is more widely distributed and is very respected. LifeSource has some extra features, including an indicator of cardiac arrhythmias, or heartbeat disturbances, on certain models. You can find Omron in pharmacies, discount stores, and online. Check out LifeSource as well at www.lifesourceonline.com. You ll be happy with either product. 

Here s an experiment to try when you get a home blood pressure monitor, which I really hope you will do. Put the cuff around your arm and measure your pressure. Note the reading. Now think about something that happened in your life either recently or a while back that really made you angry. Dwell on that negative experience for two or three minutes. Then measure your blood pressure again. Almost certainly the numbers will be higher. 

So try this experiment for yourself. Sit down with the blood pressure monitor in place, the cuff around your upper arm. Push the button, take your blood pressure reading, and make a note of it. Now close your eyes for two to three minutes, and concentrate on breathing in and out, slowly and deeply. Imagine your chest as an inflating and deflating balloon. After that two- to three-minute breathing exercise, take your blood pressure again. You ll be amazed at the improvement. 

If you have decided to purchase a blood pressure monitor, which I discussed in chapter 2, try this simple test. Walk rapidly to wherever the device is, sit down, start it up, and measure your blood pressure. Jot down the numbers. Then close your eyes and spend two or three minutes concentrating on your breathing. Very deliberately breathe in deeply, feeling your lungs expanding to the... 

---