Q: I am a 71-year-old female in very good health I take a lot of vitamins and a 75 mg Voltaren daily for shoulder arthritis. My problem, though not truly medical, is one that I’m sure affects more people than just me. Whenever I visit the doctor, they take my blood pressure. I have extremely large upper arms (20” in diameter) plus my upper arm is very short. The nurse has to use an extra large cuff for me and during the inflation process, I am in EXTREME pain. Since the new procedure for BP is to inflate the cuff, deflate it and then re-inflate it a few minutes later, I get a double dose of pain. I have a high pain tolerance but this is something else. Consequently, my BP shows up in the doctor’s office as 190-195/90-95 which is a very high reading. Whenever I take my pressure at home with a wrist cuff that I have had checked for accuracy, my BP is 115-125/62-74.
Is there any other method that can be used in a medical office for someone like me that would be more humane and give a more accurate reading without the pain? Thank you.
A: According to a Consumer Reports article from three years ago, wrist monitors were easier to deal with then because of the bulk of a regular cuff but readings were less accurate than those taken at the upper arm. Advances, however, have been made, leading to more accurate readings than were previously available. The report went on to say that of all the wrist models on the market at the time, two were found to be more accurate than the others – the Omron and the Rite Aid units. Since then, numerous other brand names have joined the ranks of better rated devices. The reason for this may be that the individual sat in a chair and held his or her arm across the chest as if saluting the flag, whereas most units recommend holding your arm out from the body with the elbow facing downward. And, despite every technician’s efforts to assure proper alignment, the models available couldn’t equal the top-rated wrist models with across-the-chest positioning.
Units in local pharmacies today are relatively simple and commonly involve placing a finger only into a device, pushing the appropriate buttons, and obtaining a reading. Those monitoring units that are available for home use may be slightly more complicated with more bells and whistles, including wrist bands, upper arm units, battery operated devices, semi-automatic or automatic inflation units and more.
Approximately one in three adults in our country have been diagnosed with hypertension, a condition that may have no signs or symptoms. This is unfortunate in some respects, since the condition may go undiagnosed indefinitely and cause damage to the kidneys, heart, blood vessels, and other parts of the body. This makes annual or timely examinations (if there are other medical conditions or a family history of hypertension) with a physician an important part of health care. Readings will not remain the same for an individual all the time. If we are nervous, anxious or physically active, our levels may rise. On the opposite spectrum, readings will lower when we are at rest or asleep. And, readings tend to elevate with age. Following a healthy lifestyle will help some patients at least delay if not prevent unwanted rises in blood pressure.
You indicate your wrist unit has been checked for accuracy. There are instances when a device will require recalibration because of several reasons. Therefore, I recommend you bring your unit to your physician’s office the next time you have an appointment. Begin by checking (or having the nurse check) your numbers using your wrist unit. Promptly thereafter, have her use the arm cuff that causes you so much pain only once. If the numbers are compatible, you should be able to continue with them using your wrist unit. If they aren’t, you might jot down both sets of numbers, repeat the process on your following visit, and compare them to determine if there is continuity of the arm unit being, say, 10 or 15 points higher. If this is the case, perhaps you can use your unit, add the differential, and have the nurse make a notation in your chart that the reading was with your personal unit and not theirs. As a point of information, the journal Circulation suggests that an arm greater than 17.3 inches in circumference requires that the BP be checked with a thigh cuff. Should your physician’s office have such a unit, it would be the way to go.
You shouldn’t have to experience pain each time you visit your physician. Ask them to work with you in a way that is satisfactory to all involved.
