World Hypertension Day 2021: Steps To Follow While Checking Blood Pressure At Home

Hypertension is a major preventable cause of cardiovascular disease (CVD). About 2 out of every 5 adults have Hypertension, as per reports. Hypertension is diagnosed when a person's systolic blood pressure (SBP) is more than or equal to 140 mm Hg and/or their diastolic blood pressure (DBP) is more than or equal to 90 mm Hg following repeated examination. Home BP measurement (HBPM) is often necessary for the accurate diagnosis of hypertension, and for treatment decisions. On World Hypertension Day, here are some tips to measure blood pressure at home.

World Hypertension Day 2021: All about home BP monitoring

Blood pressure can be reliably measured at home, provided the right steps are followed.

1. The BP Device: A Validated electronic (oscillometric) upper-arm cuff device should be used. In general, wrist monitors are not recommended due to inferior accuracy to upper-arm devices in practice.
2. The BP Cuff: Size should be according to the individual's arm circumference (smaller cuff overestimates and larger cuff underestimates BP).
3. The Room: Home BP should be measured in a quiet room at a comfortable temperature.
4. The Conditions: Before measurement, avoid smoking, caffeine and exercise for 30 min. Empty your bladder and remain seated and relaxed for 3 - 5 min.
5. The Position: Sit with back supported on chair. The legs should be uncrossed, and feet kept flat on the floor. The arm should be resting on a table with mid-arm at heart level.
6. The Protocol: Take 3 measurements with about 1 min between them. Calculate the average of the last 2 measurements. If BP of first reading is less than 130/85 mm Hg, no further measurement is required.

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The frequency of monitoring:

Before each visit to the doctor or hospital:

• Monitor for 3 to 7 days in the morning (before drug intake, if on treatment) and the evening.
• Two measurements on each occasion after 5 min sitting rest and 1 min between measurements. (Exclude readings from day 1 for the purpose of interpretation)

Long-term follow-up of treated hypertension:

1 to 2 measurements per week or month.

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The interpretation:

Average home BP (after excluding readings of the first day) more than or equal to 135 and / or more than or equal to 85mm Hg indicates a diagnosis of hypertension, or inadequately controlled Hypertension (if already on treatment).

Lifestyle changes for hypertension

The management of hypertension includes non-pharmacological interventions (lifestyle changes) and medications. Lifestyle changes are indicated in all patients, irrespective of whether medications are required or not.

Healthy lifestyle choices can prevent or delay the onset of hypertension and can reduce cardiovascular risk. Lifestyle modification is also the first line of antihypertensive treatment. In addition, modifications in lifestyle can also enhance the effects of antihypertensive treatment.

Salt reduction: Reduce salt added when preparing foods, and at the table. Avoid or limit consumption of high salt foods such as fast foods and processed foods.

Healthy diet: Eat a diet that is rich in whole grains, fruits, vegetables, polyunsaturated fats and dairy products. Reduce food high in sugar, saturated fat and trans fats. Increase intake of vegetables high in nitrates known to reduce BP, such as leafy vegetables and beetroot. Other beneficial foods and nutrients include those high in magnesium, calcium and potassium such as avocados, nuts, seeds, and legumes.

Healthy drinks: Moderate consumption of coffee, green and black tea.

Moderation of alcohol consumption: Avoid / reduce alcohol consumption. Avoid binge drinking.

Weight reduction: Achieving and maintenance of a healthy body weight and waist circumference is recommended for non-hypertensive individuals to prevent hypertension, and for hypertensive patients to reduce BP.

Smoking cessation: Smoking is a major risk factor for CVD, COPD and cancer. Smoking cessation is advised.

Regular physical activity: Regular aerobic and resistance exercise is beneficial for both the prevention and treatment of hypertension. Moderate intensity aerobic exercise (walking, jogging, cycling, or swimming) for 30 minutes on 5-7 days per week is recommended. In addition, performance of resistance / strength exercises on 2-3 days per week also can help reduce BP.

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Reduce stress and induce mindfulness: Chronic stress has been associated to high blood pressure later in life. The practice of transcendental meditation/mindfulness as a daily routine also lowers blood pressure.

(Dr Girish Godbole, Consultant Cardiologist at Vikram Hospital, Bangalore)

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