Take control of high blood pressure in 2 weeks

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Discover this secret and catch what your doctor may be missing

Do you really have high blood pressure? If your doctor only knows what your blood pressure is when you're sitting in her office, then she's only telling you part of the story. This month, Prevention reveals one of the easiest, most convenient ways to find out for sure if you have this leading risk factor for stroke and heart attack. Read on and discover how you can easily take control of your blood pressure in just two weeks.

When High Isn't Really High
You have high blood pressure, or hypertension, when your blood pressure is equal to or greater than 140/90 most of the time. The important phrase here is most of the time. Studies have shown that approximately 20% of people with high blood pressure in the doctor's office have normal blood pressure at home. A reading may simply be high because you're anxious about having a medical exam. There's no way to know if it's high the rest of the time from that single reading.

You can make sure there's no mistake by taking your blood pressure at home. While home blood pressure monitors have been available for years, many doctors have underestimated their lifesaving potential. This month, Prevention consulted leading hypertension experts to create a plan that lets you take advantage of one of modern medicine's best-kept secrets. Now you can team up with your doctor to avoid being treated for a condition you don't have-and to be treated appropriately and promptly if you do.

The Plan
Before you start, ask your doctor if she'll partner with you on home monitoring. It won't do you much good to get your own readings when she prefers to go by her own measures. If your doctor won't work with you, consider finding one who will by visiting the Hypertension Network Web site at www.bloodpressure.com and searching their list of more than 1,500 doctors specializing in treating hypertension.

Select a blood pressure monitor. The gold standard is the mercury monitor, the one your doctor most likely uses and the device against which all others are compared. But for home use, mercury monitors are clumsy and expensive. Pick up a more convenient unit for your upper arm instead. (See "Check Out These Home Monitors...Our 3 Best Bets," on p 105.)

Get some training. Since your measurements will be used to make decisions about your treatment, ask your doctor to show you how to get the most accurate readings. Don't rely solely on the instructions that come with your home unit.

Take your monitor for a test drive. While you're at the doctor's office, test your monitor alongside the mercury one to make sure your readings are on target. The monitor you use at home should be checked for accuracy right out of the box and then once every year thereafter.

Record your numbers. Work with your doctor to determine how often you should check your blood pressure. Taking three readings twice a day (once in the morning and once in the evening) three days a week for about two weeks is what hypertension expert Thomas G. Pickering, MD, DPhil, professor of medicine at New York Hospital-Cornell Medical Center in New York City, recommends.

In a notebook or calendar, jot down your numbers and the date and time they were taken. Also note what you had just been doing prior to taking the reading and how you're feeling. "If you've just exercised, eaten a meal, or are feeling extremely stressed, that may influence the readings, so it's helpful to know," says Dr. Pickering.

What Your Readings Mean
Once you've collected two weeks' worth of home readings, review them with your doctor. Here's a preview of what she may say:

If your home readings are always less than 135/85, chances are you don't have hypertension. But if your office readings are equal to or greater than 140/90 while your home readings are normal, you might have something called "white coat hypertension." Doctors once thought that this phenomenon was nothing to worry about, but new research has them thinking differently.

"People whose blood pressure is only up when they see the doctor are not within the norm," says Sheldon G. Sheps, MD, emeritus professor of medicine at the Mayo Clinic in Rochester, MN. "These people are at increased risk of future high blood pressure, so we manage them with lifestyle modification. It's just that they don't need drugs to lower their blood pressure." To find out if you truly have white coat hypertension, your doctor will have to take some more office readings or review past readings in your chart.

If your home readings are usually less than 135/85, but one or two occasionally jump above that level, review your measurement notebook with your doctor. What was going on at the time you had these high readings? You may have had what's called a temporary spike. Such high readings, like a fever, can be a symptom of something else, not hypertension.

If your home readings are almost always more than 135/85, your doctor can be pretty certain you have hypertension. She may recommend medication and aggressive lifestyle changes. But hold onto that home monitor! You can still help your doctor fine-tune your treatment by continuing to monitor your pressure on your own.

Is It Working?
Use your home monitor to find out if your blood pressure lowering strategies are working. Your doctor can also use your readings to zero in on the most effective dose of your medication.

Once you and your doctor see that your home readings are down in a healthy range, you can safely reduce the frequency of your measurements to about two or three per month. These spot checks will help make sure you stay on track. If you get a high reading, take another reading the following day. If you see your pressure climbing and staying high, call your doctor. Caution: Don't make any changes in your medication on your own.

On the Horizon
In the next few years, most people with hypertension will be monitoring their own blood pressures at home under doctor's orders. "Home monitoring is akin to people with diabetes checking their own blood sugar," says Dr. Sheps.

In fact, next to a healthy lifestyle, listening to your heart may be the best thing you can do to make sure it stays healthy.

Check Out These Home Monitors... Our 3 Best Bets

Aneroid unit
What it is: a cuff you inflate manually; a small needle gauge from which you read your pressure; and a stethoscope to listen to your arterial sounds

Why you should buy one: When it comes to accuracy, it's the next best thing to a mercury monitor.

Drawbacks: Using one correctly by yourself can be challenging. (You'll wish you had an extra hand to hold all the components!) These units are also very delicate and can easily lose accuracy if bumped or dropped.

Buying tips: Look for one with a built-in stethoscope and something called a D-ring cuff, which makes putting it on a bit easier.

Cost: about $20

PHOTO (COLOR): Aneroid unit

Electronic blood pressure monitor (manual inflation)
What it is: a small, portable, battery-operated unit with an attached cuff and easy-to-read digital screen

Why you should buy one: It's easy to use, especially if you have vision or hearing problems. You don't need a stethoscope since the arm cuff will "listen" to your blood pressure sounds for you.

Drawbacks: Not as accurate as a mercury or aneroid unit but still a good choice. Some models are designed for use on the left arm only.

Buying tips: To make record keeping even easier, consider a unit that will record your readings or allow you to print them out.

Cost: about $35 to $40

PHOTO (COLOR): Electronic blood pressure monitor

Electronic blood pressure monitor (autoinflation)
What it is: a step up from the manual inflation model. Put on the cuff, push a button, and the machine does the rest: inflates the cuff and displays your numbers on an easy-to-read digital screen.

Why you should buy one: Easy to use, just like the manual inflation monitor. It is especially good for people who have arthritis or weakness in their hands that makes it difficult to inflate the cuff manually.

Drawbacks: same as the manual inflation model

Cost: about $70 to $90

PHOTO (COLOR): Electronic blood pressure monitor

10 Tips for Perfect Pressure

You've got your monitor. Now make your readings count. To keep them accurate, remember the following:
Steer clear of caffeine for at least 30 minutes before taking your blood pressure. Sources to watch for are coffee, nonherbal tea, soda, chocolate, and some pain relievers. (Check labels to be certain.)
Refrain from smoking for at least 30 minutes before your measurement. Smoking increases your blood pressure and your overall risk for heart disease. Our best advice: Get help and quit.
Always use the same arm. To keep your readings consistent, use the same arm-preferably your nondominant one-every time you measure. If you're a "rightie," measuring your left arm leaves your right one free to handle your monitor properly.
Check the cuff fit. Refer to the monitor's instructions to make sure the cuff is the right size for your arm.
Check the cuff placement. On a bare upper arm, the bottom of the cuff should be positioned about 1 inch above the elbow. Some units have markings on their cuffs to make alignment even easier.
Use the "two finger" test. If you can't slide two fingers side by side under the uninflated cuff while it's on your arm, the cuff is too tight.
Sit next to a desk or table so that the arm you're measuring is level with your heart. Keep your back supported.
Relax for at least 5 minutes before taking your pressure. Don't talk during the reading.
Follow your measurement plan. Blood pressure readings vary a lot, so take multiple readings at one sitting and average them.
Write down all your readings. Sometimes people don't record a high reading because they think it's a "fluke." But it's important to share every measurement with your doctor. Don't worry that one high reading may affect your diagnosis. All your readings should be taken into account.
Read Your Blood Pressure Like a Pro
Ask your doctor what your blood pressure is and she'll give you two numbers, something like "120 over 80," written as 120/80, measured in millimeters of mercury (mm Hg). The larger, top number is called systolic pressure. It indicates how hard your heart is working to pump your blood with every heartbeat. The smaller, bottom number-the diastolic pressure-is the pressure in your arteries between beats.

Quick Tip
What is hypertension? Blood pressure readings taken in the doctor's office of 140/90 or higher or home readings greater than 135/85 for extended periods.

PHOTO (COLOR): Exercise is a natural way to lower high blood pressure.

PHOTO (COLOR): Stay in the game: Home monitoring helps keep blood pressure under control.

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By Susan C. Smith

Susan C. Smith is the research manager at Prevention and the staff specialist on heart health.

WHO'S GOING TO PAY?
You-until insurance companies and Medicare start covering the cost of home blood pressure monitors. But things could change. There's a movement afoot to convince insurers that reimbursing for these monitors is worthwhile, both healthwise and moneywise. What to do in the meantime? Pay for a home monitor out-of-pocket, recommends hypertension expert Thomas G. Pickering, MD, DPhil, professor of medicine at New York Hospital-Cornell Medical Center in New York City. "The electronic ones can often be purchased for less than $100. There's also the potential to save money on office visits and medication. It's a good investment in terms of people's health and well-being."

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