The People's Perspective on Medicine

Home Blood Pressure May Be Better Than Clinic

Home blood pressure measurement predicts complications of hypertension more accurately than clinic measurements.

Do you take your blood pressure at home? Home blood pressure monitoring can be extremely helpful. Measuring your own blood pressure in the privacy of your home can help sidestep the nerves that lead to white coat hypertension for susceptible individuals.

African-Americans Get Extra Benefit from Home Blood Pressure Measurement:

While this practice can be helpful for anyone, the Dallas Heart Study has found it is especially useful for African-American adults (Hypertension, Sept 16, 2019). In this study, blood pressure measurements made at home were more accurate than those made in the clinic. In particular, blood pressure readings obtained by research associates out of the office were better for predicting a serious complication.

The condition, left ventricular hypertrophy, occurs when the lower left chamber of the heart develops thickened walls. This is probably a result of the heart muscle having to work harder against the resistance of high blood pressure. In a normal muscle, this extra exercise might produce additional strength. That could be a good thing. However, overdeveloped muscle in the heart means that a person is at higher risk for strokes or heart attacks.

The authors conclude:

“Our results underscore the importance of hypertension management programs outside the medical office to prevent hypertensive heart disease, especially in high-risk black adults.”

Measuring Blood Pressure Correctly:

Notice that the scientists conducting the Dallas Heart Study made sure that trained professionals made the out-of-office blood pressure measurements. They probably weren’t sure that volunteers could do this accurately. We think, however, that you should be able to do a very good job with your home blood pressure measurement if you are alert to the details. Unfortunately, blood pressure readings are often taken incorrectly. That’s in the doctor’s office, clinic and hospital. We suspect that few health professionals are familiar with the guidelines set up by the American Heart Association (AHA). In fact, we have observed technicians in a highly rated hospital make mistakes. Measuring blood pressure is important enough to get it right. This reader points out a couple of common errors.

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Three Bad Mistakes to Avoid When Measuring Blood Pressure:

Q. The instructions for my home blood pressure machine make it clear that you should be sitting for five minutes at least, with your arm supported at just below heart height.

In the doctor’s office, you hop off the scale, climb on a stool and seat yourself with your legs dangling. Then the nurse takes your BP with your arm hanging down, nowhere near the level of your heart. How can that be accurate?

A. We too have been shocked to observe how often blood pressure measurements in the clinic are performed incorrectly. We do not understand why the people who are charged with measuring blood pressure are not instructed in the AHA recommendations:

Checklist Prior to Measuring Blood Pressure:

  1. Did you get time to relax? Whether you take your BP yourself at home or have it measured in a clinic setting, always take 5 to 10 minutes to sit and relax prior to any reading.
  2. Did you sit in a comfortable chair with back support and an arm rest? Were your feet flat on the floor? Never allow any health professional to take your blood pressure while you sit on an exam table with your feet dangling and no back rest or arm support!
  3. Did someone measure your arm circumference to make sure the BP cuff is the right size? We have NEVER seen a technician do this. If your arm is smaller or larger than average the wrong sized cuff will lead to misleading BP readings.
  4. Was your arm supported at heart level while someone was measuring blood pressure? This is critical to an accurate reading. We are constantly dismayed to see people having their blood pressure read with their arm dangling at their side.
  5. Did the technician, nurse or doctor talk to you or ask you a question while measuring blood pressure? If you responded, the chances are very good that your blood pressure was falsely elevated. NEVER speak during the minute or two it takes to pump up the cuff and let the air all the way out!
  6. Did you get to go to the bathroom prior to a BP measurement? A full bladder can impact your readings.
  7. Did the doctor, nurse or technician take your BP at least twice during your visit? One single reading is not adequate. It is recommended that two measurements be made some time apart. The two readings can then be averaged to get a better sense of your true blood pressure.

Measuring Blood Pressure At Home:

We have been advocating home blood pressure measurements for more than 40 years. Because of all the mistakes that can be made in the clinic we think regular home readings may be more reliable. They also lead to better blood pressure control (Lancet, March 10, 2018).

For more information on the proper technique for measurement as well as nondrug strategies for controlling BP, we offer this link:

https://www.peoplespharmacy.com/2017/11/23/why-lower-your-blood-pressure-if-it-was-measured-incorrectly/

You may also be interested in our eGuide to Blood Pressure Treatment.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Citations
  • Rader F et al, "Superiority of out-of-office blood pressure for predicting hypertensive heart disease in non-Hispanic black adults." Hypertension, Sept 16, 2019. https://doi.org/10.1161/HYPERTENSIONAHA.119.13542
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Excellent review. Overtreatment leading to low blood pressure can actually be more deadly than undertreatment. At the doctor’s office, stepping on the scale is often stressful and contentious. Taking blood pressure right away often leads to a false high.

For home use, there are studies suggesting that the new wrist units can be very accurate if held at the level of the heart. Wrist units are also more consistent for people whose arms have different geometries.

I think it would be a great idea to send this to all doctors’ offices. Your descriptions of measurements is right on target. In fact, I am considering changing providers due to those very reasons.

I have to say it’s more like moving cattle when at the doctor’s office or clinic…even in a hospital setting. You’re lying down and stressed out. At home I’ll have to do some correcting, as I do not always follow those BP guidelines while measuring. In measuring there is quite a difference with feet flat on floor compared to elevated in a recliner, some as much as 20 points. I usually run it 4 times but find that I did not give a 5 or 10 minute relaxing period before the first measurement.

I don’t recall any time that a blood pressure reading for me was done correctly in a doctor’s office.

I am 68 years old and have never had high blood pressure but I do have white coat syndrome. I get some very high readings in the doctors office but the doctor always takes it again before I leave which shows it has gone back down. I monitor my blood pressure at home at different times of the day. I also think arthritis inflammation can raise my blood pressure at times too.

I have white coat syndrome as evidenced by my much lower bp readings at home. I am retired from the medical field and follow the guidelines stated here when taking my bp at home. Only once in over 20 years in a doctor’s office have I had my bp taken correctly, and I complimented the person.

I am one who always has high blood pressure when I go to the doctor. I make sure they take it again toward the end of the visit, and it is always normal. I would never accept medication or a “diagnosis” based on a single reading.

Another common error: They put the blood pressure cuff over the sleeve of your shirt or even thick sweater!

Think very true what was said. At home I sit in a chair, feet flat and arms elevated at heart level for 10 minutes, then take my blood pressure.
When I go to the heart doctor recently I was put on the scale, then went right to a chair, and they took my blood pressure right away with arm dangling down. I was not told tone quiet.

After the results of that the nurse practitioner wanted to increase the blood pressure medications and sent a new prescription to my pharmacy.Then that’s more money out of my pocket and into the pharmacy’s pocket.

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