Blood Pressure

So how many of us have gone to the doctor’s office and thought that cannot be right when they take our blood pressure with a machine? I know I have. So I have 2 primary care doctors (pcp) one that is civilian and one through the VA. Every time I go to the VA they always read my b/p by a machine that puts my b/p through the roof. However, at my civilian pcp my b/p is always spot on and no issues. Problem with this is the VA labels me with high blood pressure and wants to start me on medication. I cannot see being put on medication that is not warranted so I fought that.

Recently at an RE appointment they too used a machine to do my b/p and it came back high. I tried to explain that normally my b/p is spot on, however, they stated that when my labs were faxed from the VA the doctor had me labeled with hypertension. This makes me angry as I don’t have this, and do understand the ramifications of having high b/p especially untreated when trying to get pregnant.

This led me to do some research into accuracy of machine b/p readings. In doing so I learn some things…..not so much on accuracy of machines but proper ways to take a blood pressure…..which often does not occur and never has through the VA for me. Needless to say I decided to share these findings.

It is important to first look at the site in which blood pressure is taken from. For most this is from the upper arm, however, in some clinics this has to come from the forearm due to the clinic not having a large enough cuff to fit the upper arm. While taking it from the forearm may seem like that best solution, research has shown that doing so will result in a higher b/p reading thus making this site not reliable (Ng & Lang, 2014).

Next lets look at cuff size. If the cuff is to large, this will cause the reading to be lower than it actual is (Ringrose, Millay, Badwick, Langkaas, & Padwal, 2015). Whereas too small produces a b/p reading that is higher (Smith, 2005).

As an obese patient I often find that clinics do not have the right size cuff to fit me (even at the VA) which results in them using cuffs that are too small. This was and is the case for the pcp at the VA and the RE I recently seen. When I said something about the size of the cuff, they stated it was fine as long as the cuff went around the arm. However, there are reasons for the cut off lines on the b/p cuffs.

Smith (2005) reported that a cuff needs to fit the persons arm within the lines shown on the cuff and for most obese individuals this means using a much larger cuff sometimes even a thigh cuff in order to get an accurate reading. Without an accurate reading we could be getting labeled and treated for things we do not have and when talking about the heart this can have huge health implications.

Another area Smith (2005) reported as being over looked is the fact that while your blood pressure is being taken, you should not be talking. Doing so falsely raises your b/p. How many of us have been to the doctor’s office and had them asking questions while the machine is reading for our blood pressure. So combine that with the wrong size cuff, how much is your blood pressure being over estimated? Sad but true many clinics do not follow the American heart association guidelines for taking a b/p (Smith, 2005).

As patients I think we need to demand that they start doing so in order to be given the best care needed for us. If you are looking to become pregnant, as am I, having accurate b/p readings is essential in care as being obese puts us at a higher risk for mischarge due to a number of reasons one being high b/p (preeclampsia) (retrieved from http://www.acog.org/Patients/FAQs/Obesity-and-Pregnancy ).

I have said something in the past about the size of cuff to the nurse at the doctor’s office and was told it wasn’t an issue, however, after doing this research I do believe that the next time I go to the VA or any new doctor’s office I will be taking a copy of the American heart association guidelines for taking blood pressure so that I can show them that what they say is fine, is actually not so.

Furthermore, due to the fact that I know the VA clinics use the welch b/p machine in my local area, the guidelines for those machines are listed on line and for my arm it states that I should be using a thigh cuff as their large cuff cut off limit does not go high enough despite being able to just barely wrap it around my arm (and while pumping up starts to come apart causing the nurse to hold it on). It is sad when we have to fight for the most basic care standards, but am finding this seems to be the way when you are obese.

If your doctor has told you to start taking your blood pressure at home make sure you also follow the guidelines. If you are having a hard time finding a b/p cuff that fits your arm try amplestuff.com they have a few options for obese individuals for b/p cuffs. If you find one of the right size for you may even want to take it with you to your doctors office if they refuse to fit you with the right size cuff, and tell them to use your meter as the cuff is the right size. Doing so will insure that you are getting accurate b/p readings.

One last thing to note about taking your b/p is that the cuff should not go over top of clothing. Putting the cuff over top of clothing, including thin shirts can cause a higher reading (Smith, 2005). So when you go to the Doctor's office be sure to wear clothing that does not cover your arm or is easily movable without cutting into your arm.

References

Ng, I. H. L, & Lang, D. (2014). Clinical comparison of non-invasive blood pressure measurement at different sites:  A systematic review protocol. Home, 12(4). Retrieved from http://www.joannabriggslibrary.org/jbilibrary/index.php/jbisrir/article/view/936/1919



Ringrose, J., Millay, J., Badwick, S. A., Neil, M., Langkaas, L. A., & Padwal, R. (2015). Effect of overcuffing on the accuracy of oscillometric blood pressure measurements. Journal of the American Society of Hypertension, 9(7), 563-568. doi:10.1016/j.jash.2015.04.007.



Smith, L. (2005). New aha recommendations for blood pressure measurement. American Family Physician, 72(7), 1391-1398.