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Commonly used arm positions can overestimate blood pressure readings: study

(medicalxpress.com)
330 points wglb | 1 comments | 14 Oct 24 17:57 UTC | HN request time: 0.204s | source
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crazygringo ◴[14 Oct 24 19:30 UTC] No.41841006[source]▶
There's definitely a huge variance in blood pressure readings depending on posture, relaxation, arm position, recent activity, etc. If you buy a blood pressure monitor, it's really interesting to see how "random" a single reading at the doctors' is, and how large your fluctuation throughout the day is.

That being said, it really makes me wonder about studies that correlate blood pressure with other things. Is the blood pressure really being measured "correctly" in all those studies? Or not?

In other words, if your "true correct" blood pressure is lower than what the doctor normally takes, but then a lot of the studies are based on real-life "incorrect" higher blood pressures, then don't you similarly want an "incorrect" higher reading for consistency? Or are the studies always really done with far more accurate blood pressure readings, where the patient sits still for 5 min beforehand, keeps their legs uncrossed, is totally free of stress and anxiety, didn't exercise beforehand, etc.?

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arcticbull ◴[14 Oct 24 22:46 UTC] No.41842987[source]▶
Also doctors and nurses are known to do an abject awful job of measuring bp according to the defined procedure. It’s usually way off when taken clinically.

Ars article here but there’s plenty in pubmed too.

https://arstechnica.com/health/2024/10/your-doctors-office-c...

[edit] The prep guidance is…

> You must not eat, drink, exercise, or smoke within 30 minutes of a reading. You must have an empty bladder. You must sit straight up in a chair with back support. Your legs must be uncrossed and your feet must be flat on the ground. The arm to be measured must be rested on a flat surface so that it is at the same level as your heart, not lower, not higher. You must sit calmly, without talking for five minutes to relax before the reading. When it's time, an appropriately sized cuff should be wrapped around your bare upper arm, right above the elbow; it should never be wrapped over clothing. At least two readings should be taken, with the average recorded. Ideally, readings should be taken in both arms, with the highest readings recorded.

When was the last time you got it measured properly? Literally never for me in a clinical setting. I don’t know why they bother honestly.

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ttymck ◴[14 Oct 24 23:54 UTC] No.41843506[source]▶
And what's the typical variance (from "actual") for a "usual" reading?
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1. bonoboTP ◴[15 Oct 24 12:15 UTC] No.41847747[source]▶
For me, the first reading is usually higher (by 20-30, even after a long rest period) and subsequent ones get lower and lower as I calm down from the initial worry about whether I will get a high reading or not.

At the doctor's office / hospital I try to tell them this, but they tend not to care. I think they know it varies a lot, they know about psychological effects, but i) they anyway take it much less seriously than overthinkers like me and some fellow HN-ers would imagine and ii) they may prescribe something and anyway expect it not to do much, and also expect the patient not to follow through with taking it properly etc. Honestly, the whole thing is quite a farce. The painful truth is that generic lifestyle improvements are the biggest bang for your buck, instead of worrying about getting exact and precise blood pressure readings.

The other similar big thing is routine blood tests for deficiencies and cholesterol, iron etc. It can also have huge variance over the year, and often people only do it every one or two years and take it as this extremely solid evidence that you need to take this or that medicine. If we were truly serious about this, we would do several tests, separated by weeks, done with different kit manufacturers at different labs etc.

I think the reason for not doing more thorough testing is implicitly admitting that the results aren't really all that actionable and improved precision doesn't really improve treatments because we have no idea what to really do with the results. There are studies showing correlations/causations of certain interventions on specific markers, and those markers are in turn correlated to some outcomes, but often the "evidence-based medicine" doesn't follow the full chain towards the actual outcome.

The other big reason for not measuring more times is the same that a man with a watch knows the time, but a man with two watches is never quite sure about it. In other words, if you got a test and had a result, you can document this and all is fine.