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Home blood pressure monitoring is important in the diagnosis and management of high blood pressure (hypertension). Self monitoring helps monitor your blood pressure within a comfortable and familiar setting.

This allows your physician and you to know whether your blood pressure is under control or how well your blood pressure medication is working.

Home blood pressure monitoring helps in the early prevention of potential health complications.

Who needs to be doing this?

Home blood pressure monitoring is particularly useful in clinical situations including:

  • Borderline hypertension
  • Newly diagnosed hypertension
  • Variable blood pressure readings in the office or wide blood pressure discrepancy between home and doctors office (white coat hypertension)
  • Apparentresistance to blood pressure medication
  • Hypotensive symptoms from medications
  • Suspected autonomic dysfunction
  • Episodic hypertension
  • Prognostic data

Why do I need it?

Since blood pressure fluctuates throughout the day, multiple recordings need to be taken. Readings can vary throughout the day and can be triggered by emotions, diet, or medications. Multiple blood pressure readings give a more accurate range of what your actual blood pressure is oppose to your clinical office visits.

Blood pressure recording in a comfortable and familiar surrounding helps to eliminate emotional stress or anxiety some patients may have after walking into a doctor’s office.

Blood pressure monitoring can help in a personal self improvement for controlling blood pressure. Most patients become encouraged and better motivated about their own health with a home monitoring system.

Who should not be doing this?

For patients with an irregular heartbeat (arrhythmia), home blood pressure monitoring is not advised.

This is because home monitoring does not give accurate readings in these patients.

What is the risk?

There are no known risks associated with home blood pressure monitoring.

A temporary and brief squeezing or sensation of tingling and numbness may be felt during the inflation of the cuff.

How is it done?BPcuff

For the diagnosis of hypertension, multiple readings should be taken at various times throughout a patient’s day in addition to regular monitoring at the physicians office.

Blood pressure should be measured twice daily, at the same time everyday. Blood pressure should be measured once in the morning about one hour after waking and before taking your medications or foods. An evening blood pressure can be taken before dinner and before your evening medications.

Avoid caffeine, tobacco, and food 30 minutes before recording your blood pressure. Make sure to be seated, comfortable, and relaxed before taking your blood pressure. Avoid speaking while taking your blood pressure.

The correct method to check blood pressure is to place the cuff over your Left arm about 2cms above the elbow. Place the lined marking on the cuff against the artery of the inner arm, on the inside area of the biceps muscle. The cuff should not be too tight or too loose. Two fingers should be able to pass beneath the cuff. Turn the machine on and the cuff will automatically inflate.

It is important to make a diary of your activities. Normal daily activities including exercise, eating, sleeping, and even when you take your daily medications must be noted. Record the time of day or any symptoms you may feel accurately in your diary.

Bring your diary with you to your next appointment so your physician can assess how well your blood pressure is controlled.

Interpretation:

Interpreting your blood pressure readings may be confusing. The top number, Systolic pressure is the pressure in the arteries during contraction of the heart when arteries are being filled with blood.  The bottom number is the Diastolic pressure which measures the pressure within the arteries during the relaxation of the heart resulting in a lower value than the top number.

Normal blood pressure ranges up to 120/80, but blood pressure can rise and fall with exercise, rest, or emotions.

  Systolic Pressure Diastolic Pressure
Normal <120 <80
Prehypertension >120-139 80-89
Essential (primary) Hypertension 140-159 90-99
Secondary Hypertension >160 >100

If the presence of hypertension has been made, the following information should be assessed:

  • The presence and extent of target organ damage
  • The cardiovascular risk status
  • Rule out other possible and reversible causes of hypertension

What are the benefits?

Several benefits of home blood pressure monitoring include:

  • Establishment of true vs. false hypertension (i.e. White coat hypertension)
  • Assess the response to blood pressure medications
  • Patient compliance improvement
  • Possible reduction in health care costs

Hypertension (High Blood Pressure)

What is high blood pressure?

High blood pressure is also known as hypertension. In this condition, the force of the blood pressing against your artery walls is high. High blood pressure is important to control because it can lead to serious health problems including heart attack, stroke, and heart failure.

Hypertension can be asymptomatic and therefore dangerous. High blood pressure is easily detected and should be routinely monitored.

What are the causes of high blood pressure?

There are 2 types of hypertension, each having different causes:

  • Essential (primary) hypertension

Accounts for 85% of cases and influenced by diet, lifestyle, or family history of high blood pressure.

  • Secondary hypertension

Accounts for 15% of cases as a sudden cause of high blood pressure due to involvement of other organs or medications including:

–  Congenital defects

–  Sleep Apnea

–  Kidney diseases

–  Adrenal gland tumors

–  Thyroid disorders

–  Birth control pills, pain relievers, and cold remedies.

What are the risk factors?HighBP
  • Sex- Men are more likely to develop hypertension. Women are more likely to develop high blood pressure after menopause.
  • Old age
  • Race- more common amongst African Americans than Caucasians.
  • Family history of high blood pressure
  • Smoking
  • Alcohol
  • Being overweight or obese
  • Lack of physical activity
  • Too much salt in your diet
  • Stress
  • Chronic conditions may increase the risk of high blood pressure including high cholesterol levels, diabetes, adrenal and thyroid disorders, and sleep apnea.

What are the symptoms?

Some people may have NO signs or symptoms and can be surprised when diagnosed.

Symptoms include:

  • Headache
  • Dizziness
  • Blurring of vision
  • Nausea and vomiting
  • Chest pain
  • Shortness of breath

How do I know if I have high blood pressure?

Blood pressure is recorded at your routine doctor’s visit. If you are not diagnosed with hypertension, check your blood pressure at least twice a year. For patients already diagnosed with high blood pressure should check their blood pressure more frequently. Blood pressure does not only have to be recorded at your doctor’s appointment. You can check at any local grocery store or at home if you have your own blood pressure monitor. Take your blood pressure when you are calm and relaxed. Home blood pressure monitors are a great way to get accurate readings while you are at rest. 24 hour blood pressure recording is better than office recordings.

The correct method to check blood pressure is to place the cuff over your Left arm about 2cms above the elbow. Not too tight or too loose, you should be able to pass 2 fingers in the cuff.

Once you have recorded your blood pressure you will be left with 2 numbers. The top number, Systolic pressure is the pressure in the arteries during contraction of the heart when arteries are being filled with blood.  The bottom number is the Diastolic pressure which measures the pressure within the arteries during the relaxation of the heart resulting in a lower value than the top number.  Normal blood pressure ranges up to 120/80, but blood pressure can rise and fall with exercise, rest, or emotions.

  Systolic Pressure Diastolic Pressure
Normal <120 <80
Prehypertension >120-139 80-89
Essential (primary) Hypertension 140-159 (may be higher) 90-99
Secondary Hypertension >160 >100

What happens in my blood pressure is not controlled?

You are at risk of having:

  • Heart attack
  • Atherosclerosis i.e.: hardening of the arteries
  • Angina i.e.: chest pain
  • Stroke
  • Congestive Heart failure, weak heart muscle
  • Peripheral vascular disease
  • Kidney failure- need for renal dialysis
  • Aortic aneurysm
  • Vascular dementia
  • Blindness

How can I prevent this?

  • Check your blood pressure routinely.
  • Diet modification: cut back on salty and buttery foods. Be sure to eat plenty of fruits, vegetables, and foods rich in potassium.
  • Certain supplements can help lower cholesterol including Cod liver oil, Coenzyme Q10, and Omega 3 fatty acids.
  • Follow a diet. Try using the “No Whites Diet”, “DASH diet”, or the “Paleolithic diet”. Ask Dr. Jamnadas about which diet plan is best for you.
  • Maintain a healthy weight with a body mass index <25. This will minimize the pressure in your arteries.
  • Get a comprehensive nutritional evaluation. Certain elements and vitamin deficiencies can cause high blood pressure. I.e. Vitamin D deficiency affects an enzyme produced by your kidneys that affects blood pressure.
  • A full endocrine evaluation may be recommended to rule out secondary causes of hypertension.
  • Be more physically active. Try going for a walk, jog, bike ride, or swim.
  • Quit smoking
  • Limit alcohol: if you choose to drink alcohol, limit it to no more than 2 drinks a day.
  • Keep stress levels to a minimum.

Treatment of high blood pressure:

Diet modification, weight loss, and active lifestyle all help in lowering blood pressure.

Medical treatment varies in each patient.

Dr. Jamnadas will prescribe a single low dose medication to lower the blood pressure first.

If not controlled with just one, a combination of 2 or more medications may be advised for best results.

The category of medication Dr. Jamnadas prescribes depends on the stage of high blood pressure and whether you have other medical problems.

Blood pressure lowing drugs include:

  • Diuretics– sometimes referred to as “water pills”. These reduce sodium and water to lower blood volume.
  • Beta Blockers– act by lowering the heart rate to decrease the work load of the heart and help dilate the blood vessels.
  • ACE Inhibitors– lower blood pressure by preventing some of your natural chemicals to be made that constrict blood vessels and promote dilatation.
  • Angiotensin II Receptor Blockers (ARBs) – block the action of the natural chemicals that narrow blood vessels.
  • Calcium Channel Blockers– relax the muscles within the blood vessels by selectively blocking excess calcium and slow the heart rate. This increases the oxygen supply to the heart, increases blood flow, lowers resistance within the vessel, and prevents coronary artery spasm.
  • Vasodilators– directly act on the muscles within the walls of the blood vessels, promoting dilatation and decreases blood pressure.

Once your blood pressure is under control, Dr. Jamnadas may have you take a daily aspirin to reduce your risk of cardiovascular disorders.

*RESPeRATE: Resperate is a portable FDA approved device that lowers your blood pressure by altering your breathing patterns. This uses chest sensors to measure breathing to synchronize you to a breathing pattern with longer expirations. This is recommended to be used for 15 minutes a day, 3- 4 days a week. A reduction in stress levels will be noticed.  This device is available for purchase in our office.

Don’t Forget!

Schedule routine visits to Dr. Jamnadas to monitor your blood pressure.

Take your medications regularly, exactly as prescribed.

If you are having any side effects or the costs of medications are posing problems please do NOT discontinue your medications on your own. Ask Dr. Jamnadas about other options.

Ensure good nutrition and get regular exercise.

Quit smoking

Manage stress: stay positive, optimistic, and most of all calm.

 *The single most important parameter to treat in your life is your blood pressure*

What is it?

White coat syndrome (WCS) is a temporary elevation of blood pressure caused by excitement or anxiety that does not necessarily constitute hypertensive disease, but may indicate an inclination towards its development.

White coat syndrome occurs in a patient whose blood pressure is consistently higher at a physician’s office than when measured at home. Patients may or may not have an existing diagnosis of hypertension.

Patients with white coat syndrome have an increased risk of cardiovascular disease, although the risk is greater in a true hypertensive patient.

Ambulatory 24-hour blood pressure monitoring is useful in the evaluation of these patients.

What are the causes?

The causes of white coat syndrome are usually always caused by:WhiteCoat

  • Fear
  • Dread
  • Worry
  • Excitement
  • Anxiety

These emotions stimulate the fright or flight response.

This stimulates hormones (i.e. adrenaline) and the nervous system to constrict the blood vessels causing a temporary increase in blood pressure.

What are the symptoms?

There are no symptoms of white coat syndrome.

Patients are generally asymptomatic.

How is it diagnosed?

The goal in diagnosis is to avoid unnecessary drug therapy, provide a better diagnostic and prognostic assessment, and reduce costs.

A good way to overcome white coat syndrome is by multiple office blood pressure readings done in a routine fashion, to minimize anxiety.

Blood pressure may also be recorded outside the physician’s office at home or at a local grocery store. This is referred to as blood pressure self-monitoring.

The best way to diagnose white coat syndrome is with a 24 hour ambulatory blood pressure monitor, which is provided here at CVI. This is a small portable monitor that takes regular readings of your blood pressure over the day and night. A 24 hour ambulatory blood pressure monitor allows the physician to assess blood pressure under the conditions of a typical day. Blood pressure will also be monitored during sleep. Obtaining recordings during sleep is beneficial as normal blood pressure decreases or “dips” during sleep. With the lack of this “dip” during sleep, the diagnosis of true hypertension can be clarified.

If you have been diagnosed with white coat syndrome, the risk of developing heart disease is greater and many patients go on to develop hypertension (high blood pressure) in the future.

It is essential to have your blood pressure recorded on a regular basis to ensure that if blood pressure escalates, action can be taken promptly to bring blood pressure down and minimize the risk of heart disease.

Lifestyle modifications are reinforced in patients with white coat syndrome.

How is it prevented?

Lifestyle modifications are highly recommended in patients with white coat syndrome.

This includes:

  • Quit smoking
  • Limiting alcohol
  • Controlling cholesterol and diabetes
  • Eating a healthy diet
  • Reducing your salt intake
  • Keep physically active with the right kind of exercise
  • Maintain a healthy weight with a BMI <25
  • Manage stress: stay positive, optimistic, and most of all calm

What is it?

RESPeRATE is a portable FDA approved drug free device used to lower blood pressure by altering breathing patterns. RESPeRATE uses chest sensors to measure breathing to help synchronize you to a breathing pattern with longer expirations. RESPeRATE has been shown to reduce blood pressure, stress, and depression.

What are the indications?

RESPeRATE is used as a relaxation treatment for the reduction of stress using guided and monitored breathing exercises. The device is indicated for use only as an adjunctive treatment for high blood pressure, together with other pharmacological and/or non-pharmacological interventions.

Who benefits from RESPeRATE?

RESPeRATE has been shown to be particularly helpful in the following clinical situations:

  • White coat syndrome or labile hypertensive patients who might benefit from reducing stress and sympathetic activity
  • Patients with isolated systolic hypertension
  • Resistant hypertensive patients (uncontrolled BP despite the use of a diuretic and at least 2 other medications at maximum dosage).

How do I use it?

  1. Place respiration sensor belt around your abdomen or upper chest.
  2. Resperate analyses your breathing pattern to create a personalized guiding melody.
  3. Synchronize your breathing with the melody tones. Inhale when tone goes up, exhale when tone goes down.
  4. Resperate guides you to slow breathing and reach the ‘therapeutic zone’ which is just under 10 breaths per minute.

How does it work?

Interactive slow breathing affects the neural system by relaxing the small blood vessels which results in improved blood circulation.

When do I use RESPeRATE?

Patients are instructed to use the RESPeRATE device routinely at rest, in 15 minute daily sessions, aiming to accumulate at least 45 minutes of slow breathing per week (10 breaths per minute or less). The weekly accumulated effective time (minutes of slow breathing) appears on the device display momentarily each time the device is turned on. Patients should be made aware that results, just like physical conditioning, may take a few weeks to become fully manifested and that without continued device use, any achieved benefits would likely be diminished. Studies show that the bulk of the reduction in BP occurs within 4 to 6 weeks of routine use.