Hah -- remember, half of all doctors graduated in the bottom half of their class.
I'll offer a few more BP observations.
Many doctors don't know how to measure BP, or are unwilling to follow the protocol, which is noted in earlier posts: at least 5 minutes sitting, upright in chair, legs uncrossed and feet on the floor. Nurses and PAs do it better, yet almost always the nurse is talking to me while listening for the pulse to return, and I think they release the pressure too fast, which increases the possible error.
At my former cardiology office, the person fetching a patient would walk us the 75 feet from the waiting room, make us stand on the Scale of Shame, walk us farther to the exam room, and within a minute begin to take BP.
I asked the doctor how long it takes most people's BP to return to baseline after that kind of exercise. He had no idea. I found one study online that suggested about 80% of people will return to baseline in 5 minutes, and almost all in 8 minutes. I require about 7.
Finally, I was diagnosed earlier this year (I'm 73 and overweight) with obstructive sleep apnea (58 events per hour, yike!) and started CPAP two months ago. My BP has eased down since then and is now 120/65-ish and occasionally lower. My resting heart rate has slowed a bit too. I hope these are expected results -- I talk to the sleep doc soon and cardio in November.
Cuffs should always be aligned properly on the arm such that the arrow on the cuff is aligned with the crook of your elbow (along the artery); no crossed legs, sitting, head aligned with your shoulders, patient relaxed and breathing comfortably. The cuff needs to be the proper size and the inflation should squeeze your arm properly. If you have a high reading it may deflate and re-inflate to a higher cuff pressure.
Stress and nervousness do affect your BP reading; when I lived in AZ, just walking in from over 100 degree heat to an air conditioned room would cause stress and significant changes in BP as your body is constantly adjusting to the environment.
Tracking over a longer time is the best indication of your BP as many have noted. However, it is the range and the endpoints of that range that should be of concern to the clinician as each vendor may have some variation in the accuracy of their medical devices' sensors.
If you have the BP done in a clinic or hospital they are *supposed* to check the machine yearly for electrical issues and accuracy as per JCAHO guidelines and the Environment of Care rules; if they do not do that they will be dinged on the assessment and possibly suffer reimbursement issues from CMMS and probably insurance companies who tie their reimbursement policies to JCAHO findings and the CMMS determinations. This is a bit cynical, but if the facility has recently been through their JCAHO inspection, there is a higher probability the medical equipment has been recently calibrated and validated.
With regard to the clinical therapy decisions a clinician might make based on the readings, posters here are correct that the ranges used for clinical intervention have been lowered recently. That being said, as always it is a personal decision to heed your clinician's advice and if you are not sure of their advice, a second or even third opinion is warranted. Again, not to be cynical, 50% of MDs graduated in the lower half of their class and clinicians have to pay their bills, too. Most go into medicine for noble reasons, but not all.
Lastly, genetic proclivities aside, as with most of life, prevention is worth and ounce of cure. Many times there are things one can do to limit or stave off for a longer time the need for clinical intervention. We all age and wear out and most will need some type of help or another. Nevertheless, the more you can defer that, the better as I'm sure most here know
By the way, I am a biomedical/clinical engineer and have worked in many biomedical engineering shops in many different hospitals and clinics; I also teach about these types of systems at the graduate engineering level. The main point I stress to my students and my staff are ensuring the veracity of the sensors on the medical devices which includes correct calibration of the devices, correct use of the devices and proper environments for the use of the devices and/or context information added to the data collected for an assessment of the user/environment/sensor accuracy of the device for the clinician to use; those sensor readings and data are used by clinicians to make decisions and if the data is not accurate or trustable, the clinician may make a correct decision on bad data resulting in no intervention when needed or intervention when not needed. The rules put in place by the JCAHO and CMMS regarding medical device maintenance are there to mitigate the risk of the clinical intervention dilemma.
