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November 6, 2018

Monitoring Blood Pressure Outside of the Doctor’s Office

JAMA. 2018;320(17):1830. doi:10.1001/jama.2018.11644

If your blood pressure is suspected to be high, it is important to know your blood pressure measurement pattern outside the doctor’s office.

If you are taking medication to control your blood pressure, regular blood pressure monitoring could help your doctor decide how to adjust your medication, if necessary.

There are 2 different ways to monitor blood pressure outside the doctor’s office: at home and by ambulatory blood pressure monitoring, also called 24-hour blood pressure monitoring. Talk with your doctor about the approach most appropriate for your situation.

At-home vs 24-Hour Blood Pressure Monitoring

The advantage of both at-home and 24-hour monitoring is that they are done in a familiar environment rather than in a doctor’s office or clinic and they provide a truer average of a person’s usual blood pressure. At-home monitoring involves many fewer measurements in one day but is convenient enough to be performed over the course of several days, so that an accurate average blood pressure can be calculated. Twenty-four-hour monitoring takes many measurements at set intervals during the day and at night but only during a single 24-hour time span.

How to Prepare for and What to Expect During 24-Hour Blood Pressure Monitoring

  1. Arrange with your doctor a day to wear the upper arm cuff for 24 hours.

  2. You may feel nervous, although most people quickly get used to wearing the cuff. Some people experience slight arm soreness or achiness from repeated inflation and deflation of the cuff.

  3. Shower and dress comfortably because you will be wearing the device for 24 hours without exposing it to water. Wear a comfortable shirt from which you can remove one arm. The cuff will be placed on your bare arm and your arm will go back into your sleeve. You will be given a waist belt or shoulder sling to put the device in to carry with you. It weighs about twice as much as a cellular phone.

  4. The cuff will inflate at set intervals during the day and at night. Try to continue with your usual daily activities as much as possible. If you are a light sleeper, your sleep quality might be affected by the cuff inflation and deflation.

  5. When the cuff starts to inflate, if you are in a situation in which it is safe to do so, keep your arm still and relaxed straight down at the side of your body whether you are seated, standing, or lying down. If a measurement fails, the device will repeat the measurement shortly thereafter.

  6. Try to avoid looking at the blood pressure readings on the screen of the device.

  7. Write down on the log sheet given to you by your doctor the times that you go to sleep and wake, the time medication is taken, and physical activities.

  8. After the 24-hour period, go back to your doctor’s office or clinic to remove the cuff and return it. Your doctor should let you know the results and what they mean for treatment of your blood pressure.

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Ms Melville reported receipt of funding from the New Brunswick Health Research Foundation to her supervisors. Dr Byrd reported funding from NHLBI.

Sources: Jin J. Checking blood pressure at home. JAMA. 2017;318(3):310.

Byrd JB, Brook RD. Arm position during ambulatory blood pressure monitoring: a review of the evidence and clinical guidelines. J Clin Hypertens. 2014;16(3):225-230.