How NOT to Take Care of High Blood Pressure

People try to remember a lot of numbers that pertain to their health, but none is more important than blood pressure. High blood pressure raises your risk of heart attack, stroke, and kidney disease — diseases that for most people pose a much greater risk than cancer. Controlling high blood pressure can reduce these risks dramatically.

So why is it that most people with high blood pressure (also known as hypertension) do not have good control over it? One reason is the way most people with hypertension receive care:

• They get their blood pressure measured two to three times per year, when they visit their doctor.
• At those visits, they climb onto the examination table, and a doctor or aide measures their blood pressure.
• Decisions about whether to adjust their medications are made on the basis of that measurement.

 And little if anything happens until the next visit. There is a better way to care for your hypertension — a MUCH better way. Here are the main principles:

• The more data, the better. Blood pressure jumps around from minute to minute. People are often under stress when they visit the doctor, and any one or two readings can be misleading. I tell my patients with hypertension to get a home blood pressure monitoring device or find a gym or drug store where they can get their blood pressure measured as often as they like – but at least every month. Discuss your target with your physician (getting the top number under 140 is a good goal for most people, and getting under 130 is even better), and let him or her know how you are doing.  For people with well-controlled blood pressure, there is no need to measure their pressure every day, but I do encourage patients to check their pressure daily when they are not yet under control or we are changing medications. But the fact is that you cannot have too much data, and relying upon office visits to measure pressure is just not enough.

• Measure your pressure correctly.
• • You should be sitting with your feet resting on the ground. If your legs are hanging (as they often are when you sit on an examination table) or if you are standing, your reading may be misleadingly low.
  • You should be sure to use a blood pressure cuff that is big enough for your arm, because a cuff that is too small will give a misleadingly high set of numbers. The inflatable part of the cuff should enclose 80% of your arm. Most blood pressure cuffs come with marks that allow you to know if the cuff is fitting properly.
  • Ideally, you should sit quietly for a few minutes before the measurement, and your arm should be resting on a table so that the cuff is at about the same height off the ground as your heart.
• Take good care of your hypertension between doctor visits. Key elements include:
• • As stated above, you should keep track of your own blood pressure data, so that you can alert your physician if the numbers are too high.
  • If you develop side effects to your medications, let your doctor know. DON'T just stop your drugs and wait until your next visit to mention it.  During that time, your high blood pressure will be untreated, doing damage to your blood vessels.
  • Develop a routine in which you can be sure to take your blood pressure drugs every day. Patients who only remember to take their pills some days are never going to get good control. And that could mean less protection from complications of hypertension, such as heart attack or stroke.
  • Be open to new models of care that enhance your visit to your doctor. For example, some people now use home monitors that transmit their blood pressure via the Internet to a doctor, nurse, or pharmacist, who helps them manage their hypertension. A study just published in the Journal of the American Medical Association (June 25, 2008, pages 2857 to 2867) showed that this model led to good blood pressure control in 56% of patients, compared with 31% treated in the conventional manner.
  • Follow your doctor's recommendations about diet, loss of excess weight, and moderation of alcohol intake.

In summary, if you have hypertension, your blood pressure is high all the time. You shouldn't just take care of it during doctor visits. You should be taking care of it throughout the year by taking your medications every day, measuring your pressure frequently, and acting promptly if you are having side effects or poor blood pressure control. The result can be a longer, healthier life, plus a sense of control over your health.

Have you had trouble getting your blood pressure under control? What has worked well for you? What are the biggest challenges you've faced in lowering your blood pressure?

Thomas H. Lee, M.D., is an internist and cardiologist who is a Professor of Medicine at Harvard Medical School. He is also the Network President of Partners Healthcare System, the integrated delivery system founded by Brigham and Women's Hospital and Massachusetts General Hospital.

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