About the Program: Blood Pressure Monitoring

Twenty-Four-Hour Blood Pressure Monitoring

The blood pressure that your doctor records in the office is generally assumed to be representative of your "true" blood pressure, or the average level over prolonged periods of time. But this isn't necessarily always the case: many people get nervous when they're seeing their doctor, so their blood pressure goes up. This phenomenon is called "white coat hypertension." 24-hour (or ambulatory ) monitoring is a technique that enables blood pressure to be measured outside the rather artificial setting of the doctor's office while you go about your normal daily activities. The monitor is about the size of a Walkman radio, and it is worn on a belt around the waist. Connected by a thin tube to a blood pressure cuff on the upper arm, it is relatively unobtrusive. It can be pre-programmed to take readings at regular intervals, typically every 15 to 30 minutes throughout the day and night, and it is fully automatic, which means that it pumps up the cuff, deflates it, and stores the reading in its memory. All you have to do is to hold your arm still while the reading is being taken and record what you were doing at the time. At the end of the 24 hours you have the monitor disconnected, and the readings are transferred into a personal computer. Up to 100 readings may be taken, so it's possible to get a much better idea of what your true blood pressure really is.

We have been using this procedure for many years, particularly in patients in whom it's unclear whether or not their blood pressure is really high. However, there are a lot of doctors who still regard it as experimental, and many insurance companies do not reimburse for it. Medicare should start to reimburse for it in 2002. The cost is $200.

Home (Self) Monitoring

You may be advised to start monitoring your blood pressure at home. This is a very convenient way of measuring blood pressure changes over time, particularly when treatment is being started or changed. There are now a number of easy-to-use devices that are available in drug stores and electronics suppliers that cost about $70. A typical monitor is battery-operated and has a cuff that you wrap around the upper arm. You press a button on the device, which pumps up the cuff and takes a reading. This reading is displayed on a screen, so all you have to do is to write down the numbers, typically systolic pressure, diastolic pressure, and the pulse rate. There are also monitors that record blood pressure from the wrist or the finger, but these readings are not as reliable. Most of our patients now monitor their own pressure, and when they start we advise them to bring the monitor in so that it can be checked for accuracy. The readings recorded at home are nearly always lower than the ones we obtain in the clinic and may be useful for diagnosing white coat hypertension.