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Reason and treatment for fluctuating BLOOD PRESSURE.

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Hi there,

I have some blood pressure questions and am looking for some help interpreting my readings. I'm a 34 year old, slightly overweight, exercising regularly and on several supplements (approved by my doctor) for overall and heart health.

I previously was diagnosed with borderline hypertension and have taken some steps to bring that down (trying to eat healthier, exercise more, the right supplements, fewer stimulants, moderating alcohol, etc.). I believe I have brought it down and all my readings fall into either normal or prehypertension now generally speaking, but I'd still like to get it to 120/80 or under as much as possible.

I use an Omron BP652 blood pressure monitor as I find it very convenient. I know wrist blood pressure models have been controversial in the past, but this one seems pretty well-reviewed for accuracy. Also, I tried to buy a cuff model (a higher end Omron) and had many problems getting it to read and not error out (improper cuff fit/air leakage error), so I returned it. (I may try again at some point, but the experience was frustrating).

I'm trying to get an accurate picture of my blood pressure, and it's especially difficult as I have anxiety/panic when it's being taken, especially at a doctor's office, so my readings there always seem high. This I believe leads to inflated readings, but I also don't feel 100% sure of that.

Onto my questions:

1.) I generally take three readings and average them together. First I do left wrist, then right wrist, then left wrist again. I do these in fairly quick succession as unfortunately, waiting between readings for me tends to boost my anxiety (the waiting and anticipation). For whatever reason, my first reading is almost always quite a bit higher than the other two, with the right wrist reading almost always being the lowest.

For example, a few minutes ago, I tookreadings. First reading on the left wrist was 127/81 with a pulse of 74. Then I did the right wrist and got 118/73 with a pulse of 69. Finally on the left wrist again I got 118/76 with a pulse of 67.

Another example of a previous reading with even more variation is the first, left wrist reading at 130/75 with a 78 pulse, right wrist 111/69 with a 67 pulse, then right wrist again 120/76 with a 69 pulse.

Is the first reading being so much higher attributable to anxiety? Or is it because I'm doing the second left wrist reading too soon after (~1 minute or less) and my arteries are still compressed?

2.) I've read >10mm of difference between left and right readings can be concerning, and this worries me a bit. Readings are often near 10mm off and sometimes above, though not always, and usually that second and third reading are much closer together than, say, the first and second. How concerned should I be?

3.) My blood pressure is almost always <120/80 for both systolic and diastolic soon after waking (sometimes quite a bit lower)...the higher readings tend to happen later on in the day. Is this significant? If I take 3 readings a day, 3 measurements (Left-Right-Left) each reading, and average them, I tend to come out at 120/80 or less lately (something that didn't used to happen, so I know I'm getting there), but is this a fair way to do it?

4.) How often should blood pressure machines be replaced? The one I have is from 2011, but has only gotten heavy usage the last year or so.

Thanks for your help! High blood pressure scares me and I just don't want to put myself at future increased risk of heart attack and stroke.

Category: Cardiologist

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Category: Cardiologist
 32 Doctors Online

Thank you for your query at

Your bp is well controlled. It doesnt matter if your bp is occasionally 130/80 mm hg. Given your good lifestyle diet and exercise and absence of any other risk factors except for overweight you are low risk for heart attacks. Anxiety seems to be a major issue here. If there js so much anxiety that you have to rush though the bp measurements then you need some pharmacological treatment for anxiety. The bp difference of 10 in upper limbs is fine. You can confirm if the bp machine is accurate by simultaneously asking a physician to take bp. There is no life span of bp machine. You can use it toll it is accurate compared to a physician. The guideline is to take three readings in the same limb rather than alternating like you have doing. Taking bp within a minute can underestimate the bp rather than overestimate
Feel free to discuss further,
Dr Vivek Mahajan
DM Cardiology

Patient replied :

Thanks very much for your detailed reply!
From what you're saying, you're not too concerned my blood pressure occasionally gets a bit higher. Would you say stroke risk is also low in addition to heart attack risk? And does this apply if, say, instead of systolic being a tad high, diastolic is a tad high, as that sometimes happens too (mid-80's to just under 90). But again, not all the time - sometimes it's great, and shortly after waking it's almost always great.
Sometimes the difference between that left and right reading is almost 20, but then, as I mentioned, if I take another reading on the left, it's usually more like the right reading was (lower). So you're saying you're still unconcerned by the difference there?
So you'd recommend not taking my BP more than once in a minute. Does it need to be three minutes or so, or is anytime over a minute sufficient?
I just started seeing a therapist for anxiety last week. I'm hoping to avoid medications, but I'll seriously consider it if I can't learn to do a bit better with it.
I did take my BP machine (a while ago) to the doc and she felt it was decently accurate I think. But I may take it again next visit. In your opinion are wrist machines at this point trustworthy enough?
Thanks very much!

Thank you for writing to us again.
Your bp control seems fine. Diastolic 80 to 90 falls in pre hypertension range and only thing that you need to do is continue your healthy lifestyle. As far as risk of stroke and mi is concerned all you need to do is to take precautions in diet and exercise properly.
Bp recordings with the machine should be taken 5 min apart.
If the readings of right and left come close to each other later that means there is no serious issue.the difference in bp should be consistent to be significant.
Any machine including wrist machine is useful only if it matches the physician taken bp on multiple occasions.
Feel free to discuss further,
Dr Vivek Mahajan

Patient replied :

Thanks much! So I tried spacing the readings apart a few minutes (playing a game on my phone to distract me in between but not moving position, which helps with the anxiety) and my readings appear to actually be lower and in general closer together. (I also discovered with the right wrist I might not have been aligned perfectly, and that brought the readings a bit closer as well). Good to know arm difference is only significant if consistant all the time.
I'm assuming if you are measuring different arms, it's not necessary to wait between readings since the cuff isn't over the same place? You only need to wait when taking the same arm twice? (I do realize in general, you want to measure the same [highest, which is my left] arm most of the time, but I like to do the other for comparison occasionally]).
Thanks again for all the help. I think after this, that resolves my questions.

Hello. Yes. The guidelines are for measurement of BP in the same arm over 10 minutes, 3 readings. Of course it does not affect in anyway that you take blood pressure in the other arm too. The problem is with checking BP in the same arm too quickly. And the other problem is anxiety.
I am sorry for this exceptional delay in my response.
Regards, Dr Vivek Mahajan.

Patient replied :

Thank you for the amazing responses! =)

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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