Regarding white coat hypertension, the shot isn’t always necessary. Some people’s blood pressure just goes up from the stress of the clinical setting.
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It also never helps to explain that this has happened many times before and that I have a reasonably high quality BP measurement device at home (most recently the exact same Braun model) that gives me decent measurements when I'm at rest/relaxed. They just look at me like I'm an idiot. How could a civilian conceivably perform such a complex measurement?
Then I get the predictably insanely high measurement and they look satisfied. Gotcha!
Please bring on the AI doctors.
This often isn't possible, but it's a reason doctor visits usually drop you in a room by yourself with a machine that will take multiple measurements with a lengthy delay between. Though that's where the white coat thing comes into play and people are stressed about a doctor coming in, etc.
I have to take daily BP measurements during titration for ADHD medication. (Using an _A&D UA-611 Plus_ machine at home.)
I can put the cuff on my arm and sit at my desk for 20 minutes to be nicely rested and calm, and then take 5 different measurements with a few minutes between each one. They'll vary quite wildly (anything from, say, 115/75 to 135/90) despite not moving between measurements or having any reason to be more or less agitated. I generally just ignore the low/high outliers and average the others. There's no pattern either, sometimes the outliers are first, sometimes last.
Also it's not just the monitor I have at home, the same is true of a probably more trustworthy machine in a clinical setting. I mentioned this to my doctor when I last visited and we saw the same thing with multiple measurements using a more sophisticated machine at the clinic.
* the position of both of your arms, and the angle your elbows are bent at matters. make sure the edge of your desk isn't pushing into your forearm.
* same goes for both of your legs. make sure you're sitting with legs uncrossed, relaxed angles, make sure the edge of your chair isn't pushing into the back of your thighs excessively.
* control your posture. slouching seems to have an effect too, but I'm unclear on the mechanism.
Anecdotally, the nurses at the doctor's offices I go to rarely (~never) bother to control for any of this other than telling me not to cross my legs. So while I fully believe white coat hypertension is a thing, I also think there's a lot of poor control of variables here. If you look up the AMA/AHA guidelines for blood pressure, the ranges they offer are predicated on some very prescriptive protocols for measurement.. which I virtually never see adhered to.
[0] https://www.garmin.com/en-US/p/716808/ [1] https://www.withings.com/us/en/bpm-connect
It really amazes me how people whose job it is to take blood pressure don’t recognize the stress situations that people are in might result in abnormal readings.
Doesn't it take more than a few minutes for one's circulation to return to normal after a BP measurement?
It was kind of interesting watching my blood pressure tick down back to normal over the course of about 4 days though.
I guess the lesson is don't rip your bicep off, it will transiently elevate your BP. ;)
AKA - the government might pay your eye clinic more if they screen you for high blood pressure. (Among other things).
Edit: Well, it will stop bleeding… once you lose enough blood.
It took me a minute to understand (and neither of us think this is 100% true) but it's both funny and a good point.
It’s not the cuff position as I used multiple positions, cuffs, and sensors. All 140/90. Plus I feel it.
It’s wild. My BP/HR fluctuates alot outside of clinical, but inside clinical it drops.
This prompted me to do some research, and it turns out there's very strict guidelines for how to 'accurately' measure blood pressure, almost none of which were followed by most specialists. There's a laundry list of things that can each increase your blood pressure by 10-15mmHg (eg. drinking water, sitting cross legged, recent physical exercise, not sitting with the right posture, not sitting for at least 15 minutes).
Given this lackadaisical approach to measurement, I seriously question the diagnostic validity of blood pressure tests 'in the wild'.
I've had a doctor measure my heart rate right after remarking on my "elevated HR during intake" (I walked there and I was running late), after telling me some slightly distressing news on what was already a very stressful day, knowing about my white coat anxiety, and right around the time of peak effects of stimulant medication which they also know about. Wouldn't you believe it, my heart rate was high (110)!
Then I got a front seat to watch their confirmation bias kick in, and have them make some really faulty assumptions based on this bad information. They were quite sure that I had developed a certain medical condition but the lab tests quickly proved them completely wrong.
Doctor ends up telling him that he was hoping it was just the attractive nurse, but no. He'd be starting medication today.
https://my.clevelandclinic.org/health/diseases/25100-hyperte...
It was apparently the lack of control and the whizzing motor. Having direct fine control over the pump is downright relaxing in comparison.
Once, I had to give my spouse an injection, and I almost passed out and threw up, once when they took the cap off the syringe and accidentally poked themselves in the finger, and then when I actually had to administer the injection.
I know I'd get used to it, but there's a decent chance that if I had to give myself insulin shots, I'd just fucking die.
Blood pressure is highly variable even moment by moment. A single data point at your yearly visit is basically meaningless. Even your posture can shift it. Legs in a different position? Too much tension in one arm over the other? Seated awkward? Have gas? Unfortunately, it's also very difficult to get a 24 hour monitor unless you have another suspected condition (such as kidney problems).