Commonly used arm positions can overestimate blood pressure readings: study

I'm convinced most people take BP wrong.

Here's how:

Lie down on a bed on your back, and put the cuff on your arm and get the 'button' within reach of your finger to turn it on. Then completely relax (and DO NOT move) with soft music or whatever. Then without moving your body at all, after 10 minutes (at least) push the button to start the pressurization and reading.

This gives an accurate reading and is often DRAMATICALLY lower than if you don't do it this way. I was convinced I had super high potentially life-threatening BP until I learned this.

Now if you want to see I'm right, get up and walk around some and then sit back down and take another reading. It will be noticeably higher, because your heart starts pumping harder even from minimal movement.

I don't disagree, but wouldn't the counterargument be that the 120/80 and 140/90 thresholds (or whatever they've redefined hypertension as) apply precisely to sitting rather than lying, and after only a minute's stillness, rather than ten? And also that you spend 16 hours out of 24 not lying down?

You don’t live your day to day life listening to soft music, lying down ready to doze. If your BP is elevated due to stress throughout the day it’s elevated, you will accumulate the harms. Idealizing conditions also gives a misleading reading.

> Now if you want to see I'm right, get up and walk around some and then sit back down and take another reading.

This doesn’t prove you’re right, just demonstrates normal physiology. Kind of like saying when you dyno an engine you should do it at idle. That is a valid measurement, just not the one that’s interesting.

In a healthy adult you will see a more significant increase in systolic pressure, but mean pressure shouldn’t rise nearly as greatly.

What you’re trying to observe is not the minimum ideal (your method) nor the short term maximums but an average of normal activity.

There’s a reason why ambulatory BP monitoring is the gold standard for diagnosing hypertension.

>This gives an accurate reading and is often DRAMATICALLY lower

Just because it gives lower results doesn't mean it's more accurate. I can raise my arm during measurement or use a tourniquet above the cuff and get a lower result. That doesn't mean the measurement is accurate at all.

There are standardized procedures on how to measure BP. Your "accurate" method is not one of them.

I've heard that for some people it's exactly the opposite. Standard procedure, IIRC, is to have the arm resting in a position that puts the cuff right about even with your heart. But some people get really big jumps in BP when supine, and I've heard it suggested that doctors might want to start doing their BP tests in that position because those people may not get diagnosed correctly despite spending a third of every day with high blood pressure.

The word "accurate" was the wrong choice of words. The machine itself is always going to be "accurate" if it's working correctly, and cuff is used right. Perhaps "proper" was a better word, since we're not talking about the accuracy of a measurement.

Since you'll get a higher readout after exercise, or even moderate daily activities, it's recommended that the person be perfectly relaxed for a few minutes before taking the reading. What I described is just my way of being perfectly relaxed, and what I know for a fact doctors do if they suspect an actual BP problem, and want to "scrutinize" it to find the true lowest resting reading.

If you go to an emergency room and say you've taken your BP and it's high, they'll do basically what I said. Lay you down, let you relax 10 min, and then take a reading. If the reading comes up 120/80 they'll say go home, you're fine, whatever you did to take the BP yourself was wrong. I've seen this happen to someone. That's how I know.

I think the main point is not necessarily the laying down part, but it's just that you need to be perfectly still for 10 min. Your BP will still be dropping more even after 5 min. This is just how to get the lowest resting reading. Of course others on this thread have balked about whether this lowest readout has value on it's own.

You are confusing the assessment of an acute condition with a chronic one.

There is a huge difference between assessing and treating an acute elevated BP and chronic hypertension. ERs don’t treat or admit to the hospital for chronic hypertension.

As I said, you can’t assess chronic hypertension by only evaluating in idealized circumstances, however this is a fine enough way for ruling out hypertensive emergency which is all an ER cares to do. And yes, you want to idealize conditions if you’re considering aggressive emergent treatment protocols that can have serious side effects.

Like I said, the best option for evaluating chronic hypertension is 24 hour ambulatory BP (which of course would include quite a bit of resting time) - usually 15 to 30 minute intervals. Why? I think the first two sentences of the prior comment are pretty intuitive.

And truth be told if the reading comes up 160/100 they’ll still send you home and tell you to follow-up with your PCP. There are of course other factors (like say having heart failure, symptoms other than headache), but usually it’s BP north of 180/120 where the ER starts getting concerned, and even then you will likely be released for outpatient follow-up +/- some oral medication.

In the public, hypertension is primarily a chronic condition and a slow killer. There are only a few circumstances where rapid control of blood pressure is not counterproductive since over time your body compensates while your organs (primarily kidneys, heart, and brain/eyes) slowly worsen in function.

No I'm not confusing anything with anything else. You've just gotten offended over something -- probably the word "wrong" in my original post, which made you then decide to take it over literally.

I think people will get 90% of the way to lowest BP reading simply by being still and silent for 10 mins. I doubt the lying down part is that important. I just originally didn't know that. I'd be doing something active (or just worked out), then decide to take BP and get a high reading. I think you probably assumed every word of my initial post was meant to be an absolute thing, rather than a general idea of the necessity to be relaxed not only during the reading but for several minutes before.

Anyone can look that up and find out I'm right.

> No I'm not confusing anything with anything else.

Yes you are, since you are the one that brought up an anecdote about an emergency visit, and I am explaining why that is not relevant.

> probably the word "wrong"

I wasn’t offended, those were your words, that I took at face value. People actually can’t read your mind, apparently you think you can read mine.

> I think people will get 90% of the way to lowest BP reading

And I’m explaining to you why just getting the “lowest” BP reading is not the overarching goal in evaluating chronic blood pressure.

> I think you probably assumed every word…

I wasn’t the only one that criticized your wording, perhaps that should be a sign to you rather than a prompt to assess my psyche.

> Anyone can look that up and find out I'm right.

On that note, is there anything specific I have said that is inaccurate? Look it up if you wish. If not, what is the purpose of your bickering?

Yeah, I'm not even reading your latest list of grievances and pedantic nit-picking. If you don't think people should be relaxed when taking a BP reading, I only have two words for you "Google it."

If you're actually interested in learning something new, here you go: https://my.clevelandclinic.org/health/diagnostics/16330-24-h...

You managed to spout enough crap about the history of Javascript that it summoned Brendan Eich himself, and you even then continued to double down. It really seems like you might get some benefit by taking a deep breath and not letting every correction or even just piece of added information enrage you. That may also likely help your blood pressure.

I was pretty sure there was a grievance under the surface. So now it comes out.

Did you enjoy your stroll thru the graveyard of past debate participants? lol.

No grievance. We've never interacted before (nice edit, btw). Yes, the outsized defensiveness did prompt to see what I was dealing with.

After rereading my initial reply I am still puzzled as to why pointing out that ambulatory measurements matter got you bent out of shape. I can concede that "Idealizing conditions also gives a misleading reading." could probably be better worded as "gives a misleading picture", but I don't think that warranted such defensiveness and hostility, you seem to have ignored the overall point made in that comment.

I think it's pretty easy to see, on this thread, which person got "bent out of shape"