I think the bigger issue with measuring blood pressure is that, aside from diagnosed diabetics, it's a measurement done infrequently and at mostly arbitrary times. Your blood pressure reading on the day of a doctor's appointment, right after you've driven to the appointment, made your way through the intake pipeline, and finally sat down in the chair, is not representative of its reading during a typical day in your life. Other factors like recency of coffee or alcohol consumption, exercise and sleep, all combine to make blood pressure a fairly variable statistic with limited diagnostic power when it's only measured infrequently.
Regardless of whether you're lying down, standing up, or sitting in a chair, it would be beneficial to take more frequent blood pressure readings, throughout the day and during typical routines, than it would to only take them every time you visit the doctor. This seems like common sense, and you can even buy blood pressure sensors for $20 on Amazon, but how many people take their blood pressure on a regular basis? Once you're a diagnosed diabetic, then maybe you start measuring it every day - but wouldn't it be better to start such a habit before you become diabetic? After all, if you're continuously measuring a variable then you can notice patterns and anomalies, and take steps to mitigate them - possibly avoiding becoming diabetic before it's too late.
It seems the limiting factor is sensor technology, which is obviously lacking compared to wearable sensors for tracking heart rate. Any health-conscious person with an Apple Watch or similar wearable device can easily track their pulse throughout the day. But no similarly accurate and seamless sensor exists for measuring blood pressure (as far as I know?), so nobody measures it as frequently as they do their pulse. Once we have the technology to accurately and passively measure blood pressure throughout the day, preventive medicine will become much easier, and people will have a better feeling for how their blood pressure responds to small changes in their environment and lifestyle.
I suffer from hypertension (which pushed as high as 170/120) and went through a period where I was measuring my blood pressure many times a day to try to essentially hack what the problem was to try to find a natural solution.
What I learned is that, for me,
-salt intake had zero impact
-coffee had no impact
-stress level had almost no impact
-alcohol had no impact
-exercise / activity levels had no impact
The single and only controllable factor I could find, short of drugs, was that if I was cold my blood pressure spiked significantly. I had much higher BP in the winter than in the summer, and could improve it by wearing layers, gloves, etc.
My body decided to go full ham on blood pressure and it was destroying my kidneys. I would be constantly annoyed by the sound of my own heartbeat doing things like trying to sleep.
Telmisartan + Caduet (which is amolodipine + lipitor) and now my blood pressure averages 100/60. And courtesy of the lipitor my cholesterol and triglycerides dropped 60%, from high to normal. Many thanks to the very brilliant people who work in that field and developed those drugs.
Anyways, thanks for coming to my TED talk on the magic of modern medicine.
Mmm.. I have been measuring my blood pressure for 5 years, twice a day, and I can't say I agree with you.
- Coffee increases systolic by 15 mmHg for 6 hours, so does smoking.
- Lisdexamphetamine (I am diagnosed ADHD) decreases BP by 10 mmHg
- Good sleep for 5+ consecutive days decreases BP. One day isn't enough.
- Rebound hypertension when forgetting my BP meds is a thing. +10 mmHg the next day.
- Low carb diet decreases BP steadily after the first week or so, especially if your metabolism is out of whack (understandable due to the deleterious effect of fructose on nitric oxide production)
- Amateur BP readings (wrong time of day, single measurement, not relaxed enough) can add 30 mmHg easily. Readings taken at the GP's office are worthless for this reason. My advice is measure every 3 minutes until your BP measurement stabilises. The correct reading is the lowest. Sometimes you need 15 minutes to reset to baseline.
- Also important is the delta between systolic and diastolic. Mine is around 40 mmHg, if it's higher than that, it's an indicator of a stress peak (bad sleep, bad day, overwhelmed) that usually resolves after a couple days.
Thanks for sharing publicly. May I ask if the Caduet has any side effects? I'm going through a similar issue. I know that my problem is alcohol, being overweight and middle age (40+). I'm also on Telmisartan which takes it down from 170/100 to about 135/85 on a good day which is still too high for my liking. I might try asking the doc for dual therapy on my next visit and Caduet sounds like a good candidate. My cholesterol also on the high side just outside of normal range! I know I need to lose 20-25lbs but I can't see it happening because of a combo of dad/work life.
Hydration is a big part too:
I have venesections done every two week or so as a treatment for hemochromatosis. I.e. They take 450ml blood and dump it.
If my blood pressure is low before hand, the nurses get me to drink two jugs of water, blood pressure goes up to normal range with in minutes. Same before they let me drive home.
This has turned out to be a really useful tip for me life in general. If I'm feeling shit, I now suspect low blood pressure and force myself to drink two or three pints of water. It usually results in me feeling much better
Myself being someone who suspects that they have high blood pressure (based on infrequent measurement), would you mind sharing if you had any recurring symptoms (outside of hearing heartbeat) when your blood pressure was at its peak?
Wow, that sounds like quite an ordeal. Glad you landed okay! I had no idea medication could have that strong of an effect.
I also have been checking my levels a little obsessively, unsuccessfully trying to find ways to drop them. And like you, I noticed that I spike during cold weather. I’m probably particularly sensitive because I have very low body fat.
> so nobody measures it as frequently as they do their pulse. Once we have the technology to accurately and passively measure blood pressure throughout the day
It's surprisingly tricky. The way a BP cuff works (the auscultatory method[1]) is that the pressure is continuously decreased and you listen for the sound of a pulse. When the cuff pressure is higher than your systolic (peak) pulse, bloodflow is blocked and you don't hear a pulse. When the cuff pressure is lower than your diastolic, the cuff is no longer blocking bloodflow at all, and the pulse suddenly becomes much quieter because it's not restricted. It's only between the two pressures that you hear it extra clearly.
So the problem with a sensor is that you can't just measure pressure against the skin. At minimum, it really should actually impede a large artery. You can squeeze the arm as tight as you like but if the brachial artery is not affected then your measurement will be very poor.
You can do fancy computer vision etc to look at special veins/arteries, and coupled with some demographic assumptions you can infer somewhat accurate measurements- but they really miss out on outliers, which is really a lot of the point of taking measurements. This also generally will require an upper arm strap or something, and be fairly tight. Not great to wear always
At some point, I think we will probably see implantable blood pressure monitoring. We do something similar with implantable glucose monitors- which need regular replacement, unfortunately. BP probably wouldn't. Problem is that direct pressure measurement is usually done by tapping off an artery- something that will never be routine. You'd want to do some combination of acoustic and pressure measurement, and it'd need to be calibrated from a base station regularly.
I wonder if there are methods that could take advantage of natural movements throughout the day, where your body naturally emulates what the cuff forces it to do. For example, when you transition suddenly from sitting to standing, is it possible for a sensor to measure some proxy metric that, combined with an accelerometer, can be used to infer blood pressure? If there is some method like this, even if it has large margins of error, maybe cumulative measurements could converge on a fairly accurate reading?
(I'm not a medical professional nor do I know much about sensing, or even really the basics of how blood pressure is measured or what it indicates.)
Worth mentioning that BP is about arterial, not venous pressure. Venous pressure is an order of magnitude lower than arterial pressure; usually 0-10mmHg.
Maybe a related question, but how good a proxy is cuff pressure for a gold standard method that measures inside an artery? Whenever I've had BP measured for clinical studies (not focused on BP specifically) they used a mix of cuff and continuous fingertip sensors depending on the activity.
What you say is true, but at the end of the day blood pressure readings in the flawed doctor's office setting are still correlated with medical outcomes.
I just want to speak against a trend people have to dismiss bad medical news by finding excuses. "The blood pressure reading doesn't count because I was nervous in the doctors office"; it's true, but the guidelines have probably accounted for that. "That medical study doesn't apply to me because it was done on the general population, but the general population is overweight and I'm not"; "that study doesn't apply to me because I do yoga, they didn't study people who do yoga"; etc.
I know it's hard, I'm in the middle of excusing some bad medical news of my own right now, trying to decide what's best for me.
Medicines have risks, untreated conditions have risks, choose your risk, but don't live in denial that the risk exists.
>but the guidelines have probably accounted for that
They have not. The guidelines are against controlled studies with strict protocols on how to take the measurement.
To know your blood pressure relative to the guidelines, you want to be as close to the guideline protocols and possible. That can be a 20/10 point difference or more.
The average physicians office doesn’t follow those protocols unless you deviate significantly. e.g you walk in with 140/90 and they aren’t going to bother. 160/95 and they will recheck you with more care given to the proper measurement technique.
This isn’t to say one should dismiss the numbers when taken properly; I’m just pointing out that calibration is necessary.
I think the purpose of taking BP in a regular doctor's visit is also just screening, not to make a final diagnostic decision. If it's normal they can move on, if not they can do some followups to determine whether it's genuinely an issue. Very many basic screening tests work like that: they're effective at determining something is not an issue, but not at definitively saying it is.
Personally I definitely have some degree of "white coat" syndrome, doctors offices just put me on edge for whatever reason. Several years ago as a healthy 30 year old at a routine office visit, the doctor found my blood pressure to be right on the upper bound of normal. She didn't immediately take any action on it, she just told me to stop by a local pharmacy and use their automatic machine a few times over the following weeks, and to enter the numbers in her organization's medical chart app. I did, it was normal, she sent me an email "thanks, looks good!". Case closed.
I was specifically told, by my doctor, to take my BP first thing I wake up and have sat down for a while.
My Withings BPM Connect takes 3 measurements automatically at intervals and takes the average of those + saves them to Apple Health.
Before I was taking my BP when I was feeling "weird" and of course it was through the roof, by taking it in the mornings my BP is still a bit high, but not Hypertension Level 2 high.
My issue is that blood pressure is being used by many corporations/health insurance plans to determine your premiums. So adding yet another layer of nervousness - you will be paying extra money over the course of the next year if your blood pressure is a little high (threshold is 120/80).
You are so right. Earlier this year I had to spend a week in hospital and they took a variety of measurements every day. It was interesting to see how much variation there was, especially in blood pressure. But one thing was especially interesting, pulse. As I was wearing my Apple watch, I had the values for blood and blood oxygene before they took them. And with pulse, you could clearly see with the graph, how much systematic variation there was. So their single measurement was not great. Best example, the last measurement was taken before I was about to be released, awaiting the doctors sign-off visit. Of course my pulse was off. But the doctor was quite interested to see my pulse for the last couple of hours.
People underestimate how valuable a medical tool the Apple watch already is and how game-changing it can get if they manage to extend the sensor suite - as you say, blood pressure, perhaps also body temperature and glucose level.
Another fun fact from the visit, they did monitor glucose level and one morning they did so directly after waking me up. Which caused the nurse to run to get me an early breakfast as it was very low. Not as if I hadn't known for decades, that I need a slow start and at least a small bite for breakfast to get into gears...
Some of the reports it produces are superior to Apple Health (it measures stress, a proprietary overall health score, and I prefer its sleep monitoring analysis).
It’s $39. The 15-25 day battery life claim assumes you disabled most of the functionality.
> Your blood pressure reading on the day of a doctor's appointment, right after you've driven to the appointment, made your way through the intake pipeline, and finally sat down in the chair, is not representative of its reading during a typical day in your life.
That's actually different. The stress of being at the doctors causes blood pressure to elevate vs more mundane things like running, walking, driving stress. The difference is someone without white coat syndrome will have a lower blood pressure reading at the end of the doctors visit.
Tracking your blood pressure randomly throughout the day will not be meaningful in any way, just like tracking your pulse isn't meaningful. It will only be annoying, as blood pressure measurement is a mechanical process, unlike heart rate measurements which can be done optically or electrically.
>right after you've driven to the appointment, made your way through the intake pipeline, and finally sat down in the chair, is not representative of its reading during a typical day in your life.
So? It is taught pretty early in med school that before measuring the vitals, you should let the patient rest while you take their story, and ask questions related to things that might change the measurements (did you walk here? did you walk up the stairs? did you drink coffee? did you smoke etc.). And if you still want more measurements throughout the day for various reasons, you can just use holter.
>all combine to make blood pressure a fairly variable statistic with limited diagnostic power when it's only measured infrequently.
[citation needed]
If you are hypertensive, non of the things you've mentioned will matter. Your blood pressure will be high regardless, and it will still be caught. In addition, you can't just diagnose with a single reading anyways.
It is funny to read comments regarding medicine on HN.
A few years ago their Bluetooth apps didn’t require registration, now the do. So now you’d need to keep track of the measurements yourselves, e.g. using a spreadsheet. Can not recommend Omron anymore.
Yeah, I have a machine and unless I take measurements very frequently (different times of day, etc.) it's really hard to make sense of the numbers. You really need to get a long term chart to weed out the noise.
I've been getting much better readings at the doctors but then I realized I always ride my bike there, sit in the waiting room for a while and then get a low reading. Not representative!
I've been using Google Fit to track my blood pressure over time. I've been measuring every other day. The charts really are helpful.
The biggest correlation with my blood pressure is how regular my sleep is. Once I started militantly waking and sleeping on a set schedule, the numbers came down. They seem to spike for a few days if my sleep gets messed up badly somehow.
I also have been trying to standardize my measurement: same time of day, after sitting quietly alone for five minutes.
I am not sure, while the values obtained this way might require calibration, it sounds like very controlled conditions to me. The exercise should bring your body into a very controlled state, beyond the physical load very relaxed. So after a short rest, this should be a good time to get reliable readings. But I am not a doctor.
You are spot on. Random once a year BP measurement is not good enough. Doctors are being asked to provide life altering advice while being effectively blind in this case. I have no idea why we don't try harder to make their (tough) job easier rather than just accepting the current (sorry) state. My cars and my computers have more sensors on them than I have on me! That's crazy - I have to drop nearly dead and only then will I go to doctors' for diagnosis and treatment. My car preventative maintenance is miles better.
After being diagnosed with elevated BP, I googled and read what I could and concluded: 1) Cheap "BP monitors" on Amazon just show random readings or the same readings so they are worse than useless: someone may actually use them and believe their readings. 2) There are only few smart watches that have BP measuring function.
I am currently using Samsung Watch Active2, and it seems to do the job. There is calibration that is good for 30 days only. After 30 days it expires and I calibrate it again. Calibration involves making 3 measurements in parallel, watch on one hand and manual BP monitor on the other. After each measurement on the manual BP monitor, I tell the watch App what was measured.
After each calibration I do another 3 measurements in parallel, again using both the watch and the manual monitor. I compare the watch (post calibration) readings with the manual BP readings. Usually the difference is small within few percent. If it is more than 8-10% I redo the calibration. This has happened 2 times in the 25 odd calibrations I have done. Usually the reason is noise instead of perfect silence (person coming in the room and talking, TV being turned on).
I have tried using the watch on Person2 after being calibrated on Person1 - and Person2 got crazy BP readings. So the calibration really does something, it is not nothing.
The watch measurements also approximately agreed with measurements taken over 24h period when I wore BP holter (automated BP cuff that inflates every 30 mins and measures and records the BP).
Over time I have become more lazy with the re/calibration: now several days pass before I re/do it. So I'm acutely aware that any non-100% automated data collection will eventually be abandoned on long enough time horizon. Redoing the same is boring and becomes more so with time.
>I have to drop nearly dead and only then will I go to doctors' for diagnosis and treatment.
This is a healthcare issue specific to your country. It is not a problem of "not enough measurements".
Regarding using tech like smartwatches for blood pressure measurement, it is currently not possible. They aren't measuring your blood pressure, they are simply correlating optical data like pulse transit time with your blood pressure, which is mostly inaccurate. If you have to calibrate every now and then using actual bp measurements, then you already have enough data and don't need your smartwatch.
> Once we have the technology to accurately and passively measure blood pressure throughout the day, preventive medicine will become much easier
How? Do we have any idea what we would do with that data? AFAIK, all treatments we currently have aren’t suited for treating short-duration spikes in blood pressure (do they even need treatment? I wouldn’t know).
“The 2004 British Hypertension Society guidelines proposed lifestyle changes consistent with those outlined by the US National High BP Education Program in 2002 for the primary prevention of hypertension:
- maintain normal body weight for adults (e.g. body mass index 20–25 kg/m2)
- reduce dietary sodium intake to <100 mmol/ day (<6 g of sodium chloride or <2.4 g of sodium per day)
- engage in regular aerobic physical activity such as brisk walking (≥30 min per day, most days of the week)
- limit alcohol consumption to no more than 3 units/day in men and no more than 2 units/day in women
- consume a diet rich in fruit and vegetables (e.g. at least five portions per day);
> Once we have the technology to accurately and passively measure blood pressure throughout the day, preventive medicine will become much easier, and people will have a better feeling for how their blood pressure responds to small changes in their environment and lifestyle.
With 70% of the population being overweight or obese and on a dog shit diet I very much doubt that.
We already know what we do is bad, we know how to fix it, virtually no one does it. If people can't be arsed to even walk 30 min a day I don't think they'll care about continuously monitoring their blood pressure. You can track your pulse continuously with ultra cheap gadgets and it'll tell 50%+ of the population their heart is in bad shape, nobody cares
The best preventative medicine is your lifestyle, if you wait for symptoms you already failed your body and are 10+ years late to the party
> it would be beneficial to take more frequent blood pressure readings, throughout the day and during typical routines, than it would to only take them every time you visit the doctor
It would be, if the most reliable way to get BP data wasn't to apparently violently compress the upper arm until it physically hurts and leave it like that for a minute. How people can do that on any kind of regular basis completely escapes me, and I'm not convinced it's not actively harmful. The wrist monitors are tolerable but seem to be very sensitive to wrist height.
Are you confusing blood pressure and blood sugar? My boyfriend is type 1 diabetic, he measures his blood sugar multiple times a day, but I have never seen him measure his blood pressure.
No- diabetes can have very negative long term impacts on your small blood vessels, particularly in your kidneys. Changes in blood pressure from vascular damage all over your body can be a signal that nephropathy (kidney disease) is not far away. It takes years to accumulate.
People mentioned the white coat syndrome, but that's not the only issue.
I am not nervous when they measure my blood pressure, but I might have been late to my doctors appointment, so of my 25 min walk to the doctor, I was running half of it. I had non-optimal blood pressure values at the doctor, because I was running not to miss the appointment, and as I arrived, I had to immediately go get my BP checked.
After the incident, I religiously measured my BP at home various times a day for a week and my numbers looked okay.
I was late to an optometrist appointment a few weeks back. Sprinted up six flights of stairs and into the office. The literal second I got in they called my name and immediately measured BP. The tech looked like they were going to shit themselves.
I have a garmin watch and one wonderful thing it does is show me my resting heart rate, which is a nice indication of my level of fitness (and correlates with good sleep, sickness, etc)
It also does nice things like a detailed check of my sleep, how I'm acclimatizing to altitude when visiting the mountains, the number of steps I walked and pulse-ox.
I don't know how these correlate to what blood pressure tells you, but I blood pressure will be directly measured in the same way in a few years.
One time a doctor at the on-campus clinic looked at my blood sugar reading said I might be prediabetic. This was an early-morning appointment at a time in my life when I wasn't very used to that and had rushed out of my dorm while scarfing down a bagel that had been hastily topped with the only thing in the cabinet that was in a squeeze bottle — honey!
No blood test over the next decade showed even a hint of elevated blood sugar.
One easy way to check your blood pressure more regularly is to donate blood!
At least in the United States, you'll get your pulse, blood pressure, and iron levels all checked. Additionally, your blood will be tested for some infectious diseases like HIV.
Lots of free testing, and you also get to help someone out!
I'm in the UK with hypertension. My GP surgery sends me a text message every 6 months or so, asking for a week's readings morning and evening, using a home blood pressure monitor - the message includes a link to submit readings.
The original media release[^1] is much clearer, with a 3 points abstract followed by a detailed summary. I don't know if this derived article was written by a human or by an AI, but I think it's junk like this that contributes to makes the web a mess of noise and echo.
I have white coat hypertension and probably also some borderline hypertension, and my readings are off the chart (or used to be). I really hated the first doctor who diagnosed it, he straightaway gave me prescription (don't get me started on the whole prescription business in the US). I never picked the prescription.
I decided to work on it and see if I can "fix it naturally". I did 2 main things : first one was extremely easy (for me), I dropped more than 29kgs (approx 60lbs) which was 34% of my body weight over more than 15 years (techinally the first 20 kg was pretty quick, last 9 kg took a few years and experimenting with food and eating habits). Secondly, I started practising meditation. That's a hard one, takes me a lot of effort but I'm doing it quite consistently now.
Anyway, I barely check my blood pressure now and last I checked it was 118/75. I can't emphasize how important it is to eat well and live a stress free life to keep your heart healthy. Of course it worked for me because mine was just borderline high (on the best days it used to be 135/85), it won't work if you have severe hypertension but there's no harm in trying, it will definitely drop a few points on the meter and your heart will thank you.
Most people though, even being technically capable of similar feats, are not in a position to do so, because of the time and attention expenditures required. Rebuilding large chunks of your life to accommodate for a new lifestyle is the harder the more other people depend on you. Keeping your resolution for many years also.becomes harder.
What is preventing most people from losing weight? Eating less calories than what is expended during the day will result in weight loss (caloric deficit). Walking around the house, breathing, and sleeping consumes 1500-2000 calories/day. Eat less than that. No medication required.
Caloric deficit is the only way to lose weight. If you hear someone say, “No! You need to exercise and reduce calories!” That’s just burning the candle from both ends - increasing caloric requirements and decreasing caloric intake (e.g. caloric deficit). There are good reasons to do exercise, but it’s not strictly required for weight loss.
(Consult a medical professional before beginning any weight loss routine, etc., etc.)
Meditation is accessible to anyone willing to try. Five minutes a day is enough. Free resources abound for guided meditations and arbitrarily in-depth instruction.
Congratulations on this accomplishment! Having attempted and regained some weight back during the pandemic, I appreciate how hard it is to make lifestyle changes.
Question: what kind of meditation has helped you the most?
I vary my style. I don't really prefer guided meditations because then it is one more thing I need to rely on.
That said, what works for me is : I have been a gym rat for many years now, I never skip my gym and I am there 6 days a week. I recognized that the only way I can stick to meditation is by including it in my gym routine. So I always do my meditation after working out. Minimum 10 minutes and on good days 20 to 30 minutes. But I never leave the gym without doing it.
I try different meditation on different days. Some days I do simple focus on breathing type meditation, other days I imagine myself circling some random star/planet and focus on it, then sometimes I just imagine waves coming in going out (I try to think of waves as thoughts that pop in and out from my mind), I have also tried chanting meditation - that can be extremely useful in the beginning - I don't do it much though. Finally on days when I have my headphones with me I also try guided meditation (generally I prefer Sam Harris or someone like him who guides through as a non-religious practice).
I really think the key is to try a few styles and experiment with them. I won't trust all the "self-proclaimed experts" who say "this is the only way", just find one that you can relate to and understand the basics of it and come up with your own style - meditation is an art and not a science. I would also recommend that you include it in your routine that you never break (it could be as simple as saying I will meditate before I brush my teeth assuming you brush your teeth everyday :-)). Some days are better others not so much. On some days, the thoughts just keep popping in and out, and other days I feel in a zen mode.
It is incredibly powerful practice, the biggest improvement I noticed is that you become aware of your emotions before they take control of you. For instance, I am short tempered, (and although I am still working on it) these days I notice right before when I am going to loose it and then I think of my "zen state" and suddenly the anger can't take control of me. It is almost like magic.
We also need people who are knowledgeable on how to take blood pressure. Seems like half the time the nurse uses a machine and has that thing cranked up to 200mm so they don't have to redo it if the patient is high. No shit my blood pressure is elevate - I can feel my pulse get stronger because my arm isn't getting any blood flow.
Similar thing with my petite old grandma. Always measured high if an unknown person did it because they would overinflate. But when someone would just put it 20 over her previous known good reading, then her blood pressure was fine.
> Sixteen percent did not have high blood pressure — a reading greater than 130/80 mm Hg — while seated. However, these same people did show high blood pressure when researchers measured their BP while lying flat on their backs.
I don't know about you but getting somewhat concise readings for my blood pressure at several facilities has been difficult in here.
When I went to the medical exams to get my drivingllicense one year ago I was told my blood pressure was a bit high - maybe due to the nervousness of being checked, but it was better to ask my doctor - both of my parents suffer from high blood pressure.
So I did. He told me my blood pressure was high and gave me that famous table to fill up with daily readings for two weeks.
My sister (physiotherapist) has a sphygmomanometer at home but she will scream at me to be perfectly still and seated for at least 5 minutes before doing the reading - and it _always_ was 120/80.
Went several days to a nearby pharmacy and they gave me a little chair to be sat for 10 minutes before standing up and going to a small cubicle where they did the measurement with an electronic sphygmomanometer. Measurements there always were fairly inconsistent and above 131/87 - going up to 150/87.
Also went to several other points to get my blood pressure measured and they always had a different method and (unsurprisingly) yielded different results. But for some reason when they measured with analogic/traditional sphygmomanometers, the measurements always were lower compared with electronic ones.
Fortunately could afford a decent electronic sphygmomanometer for myself and started doing my own measurements, which are fluctuating between 117/77 and 122/82.
This is an interesting point. I know for sure that I have been taught in school to never trust the electronic BP machines, since they can be pretty far off for some (but not all) people.
Instead, using a sphygmomanometer is much more likely to give accurate results.
Anecdotally, I always have a super weird initial blood pressure reading when I go to the doctor and they use the electric machine (one time it was 112/95), but when it is rechecked with a sphygmomanometer it tends to level out at somewhere around 130/85.
The way a manual sphigmomanometer works is different from the way the electronic ones do[1], I would not be surprised if for a few people something else affects the reading of the pressure in the arm band.
Any disparity between interarm BP—especially when large and persistent—should prompt consideration of diseases known to be the cause: coarctation, dissection, or aneurysm of the thoracic aorta; Takayasu (pulseless) disease; and various types of intra- and extra-arterial obstruction in an upper extremity.1,9,11,23,24 These diagnostic considerations become much more likely if the arm with the lower BP also has a grossly diminished radial pulse.
When I first stared measuring at home, I'd get these crazy variations. The first time I measured, I was <- this -> close to driving to the ER, as I had something like 150/110 3-4 times in a row. "Fortunately" the measurements were done pretty poorly - I was sitting in a slouched chair, my arm / measurement point was way too low, and a bunch of other things.
I redid the measurements after reading the manual, sitting straight up, feet on ground, measuring at heart level, etc. Suddenly I got 100/110 over 80/85, and while that wasn't ideal, it obviously calmed me down a good bit.
Readit News
Regardless of whether you're lying down, standing up, or sitting in a chair, it would be beneficial to take more frequent blood pressure readings, throughout the day and during typical routines, than it would to only take them every time you visit the doctor. This seems like common sense, and you can even buy blood pressure sensors for $20 on Amazon, but how many people take their blood pressure on a regular basis? Once you're a diagnosed diabetic, then maybe you start measuring it every day - but wouldn't it be better to start such a habit before you become diabetic? After all, if you're continuously measuring a variable then you can notice patterns and anomalies, and take steps to mitigate them - possibly avoiding becoming diabetic before it's too late.
It seems the limiting factor is sensor technology, which is obviously lacking compared to wearable sensors for tracking heart rate. Any health-conscious person with an Apple Watch or similar wearable device can easily track their pulse throughout the day. But no similarly accurate and seamless sensor exists for measuring blood pressure (as far as I know?), so nobody measures it as frequently as they do their pulse. Once we have the technology to accurately and passively measure blood pressure throughout the day, preventive medicine will become much easier, and people will have a better feeling for how their blood pressure responds to small changes in their environment and lifestyle.
What I learned is that, for me,
-salt intake had zero impact
-coffee had no impact
-stress level had almost no impact
-alcohol had no impact
-exercise / activity levels had no impact
The single and only controllable factor I could find, short of drugs, was that if I was cold my blood pressure spiked significantly. I had much higher BP in the winter than in the summer, and could improve it by wearing layers, gloves, etc.
My body decided to go full ham on blood pressure and it was destroying my kidneys. I would be constantly annoyed by the sound of my own heartbeat doing things like trying to sleep.
Telmisartan + Caduet (which is amolodipine + lipitor) and now my blood pressure averages 100/60. And courtesy of the lipitor my cholesterol and triglycerides dropped 60%, from high to normal. Many thanks to the very brilliant people who work in that field and developed those drugs.
Anyways, thanks for coming to my TED talk on the magic of modern medicine.
- Coffee increases systolic by 15 mmHg for 6 hours, so does smoking.
- Lisdexamphetamine (I am diagnosed ADHD) decreases BP by 10 mmHg
- Good sleep for 5+ consecutive days decreases BP. One day isn't enough.
- Rebound hypertension when forgetting my BP meds is a thing. +10 mmHg the next day.
- Low carb diet decreases BP steadily after the first week or so, especially if your metabolism is out of whack (understandable due to the deleterious effect of fructose on nitric oxide production)
- Amateur BP readings (wrong time of day, single measurement, not relaxed enough) can add 30 mmHg easily. Readings taken at the GP's office are worthless for this reason. My advice is measure every 3 minutes until your BP measurement stabilises. The correct reading is the lowest. Sometimes you need 15 minutes to reset to baseline.
- Also important is the delta between systolic and diastolic. Mine is around 40 mmHg, if it's higher than that, it's an indicator of a stress peak (bad sleep, bad day, overwhelmed) that usually resolves after a couple days.
Potassium relaxes the walls of the blood vessels. It's a counterbalance to sodium.
Doctors will say 3.5 is fine, but there are several studies demonstrating that as you approach 4.5, the risk of cardiac events drop.
Doctors get very tense about potassium supplementation in fear of hyperkalemia.
But the RDA for potassium use to be ~4200mg. I'm guessing most don't remotely approach the new or old RDA.
If you're taking potassium sparing medications, things are further complicated. K levels would have to be checked more often.
I supplement with potassium citrate. My blood pressure has normalized.
If my blood pressure is low before hand, the nurses get me to drink two jugs of water, blood pressure goes up to normal range with in minutes. Same before they let me drive home.
This has turned out to be a really useful tip for me life in general. If I'm feeling shit, I now suspect low blood pressure and force myself to drink two or three pints of water. It usually results in me feeling much better
I also have been checking my levels a little obsessively, unsuccessfully trying to find ways to drop them. And like you, I noticed that I spike during cold weather. I’m probably particularly sensitive because I have very low body fat.
The root cause was that I moved to a 2000’ higher elevation, and was dehydrated.
Since winter air is lower humidity, I suggest you drink two extra pints of water per day, spread across three-four sittings.
Will it work? Probably not. But, I’d give it an over 10% chance, and it will cost you nothing.
Wait what? explain more please.
It's surprisingly tricky. The way a BP cuff works (the auscultatory method[1]) is that the pressure is continuously decreased and you listen for the sound of a pulse. When the cuff pressure is higher than your systolic (peak) pulse, bloodflow is blocked and you don't hear a pulse. When the cuff pressure is lower than your diastolic, the cuff is no longer blocking bloodflow at all, and the pulse suddenly becomes much quieter because it's not restricted. It's only between the two pressures that you hear it extra clearly.
So the problem with a sensor is that you can't just measure pressure against the skin. At minimum, it really should actually impede a large artery. You can squeeze the arm as tight as you like but if the brachial artery is not affected then your measurement will be very poor.
You can do fancy computer vision etc to look at special veins/arteries, and coupled with some demographic assumptions you can infer somewhat accurate measurements- but they really miss out on outliers, which is really a lot of the point of taking measurements. This also generally will require an upper arm strap or something, and be fairly tight. Not great to wear always
At some point, I think we will probably see implantable blood pressure monitoring. We do something similar with implantable glucose monitors- which need regular replacement, unfortunately. BP probably wouldn't. Problem is that direct pressure measurement is usually done by tapping off an artery- something that will never be routine. You'd want to do some combination of acoustic and pressure measurement, and it'd need to be calibrated from a base station regularly.
[1]: https://en.wikipedia.org/wiki/Blood_pressure_measurement#/me...
(I'm not a medical professional nor do I know much about sensing, or even really the basics of how blood pressure is measured or what it indicates.)
The technology already exists and is approved by the EU.
https://aktiia.com/
I just want to speak against a trend people have to dismiss bad medical news by finding excuses. "The blood pressure reading doesn't count because I was nervous in the doctors office"; it's true, but the guidelines have probably accounted for that. "That medical study doesn't apply to me because it was done on the general population, but the general population is overweight and I'm not"; "that study doesn't apply to me because I do yoga, they didn't study people who do yoga"; etc.
I know it's hard, I'm in the middle of excusing some bad medical news of my own right now, trying to decide what's best for me.
Medicines have risks, untreated conditions have risks, choose your risk, but don't live in denial that the risk exists.
They have not. The guidelines are against controlled studies with strict protocols on how to take the measurement.
To know your blood pressure relative to the guidelines, you want to be as close to the guideline protocols and possible. That can be a 20/10 point difference or more.
The average physicians office doesn’t follow those protocols unless you deviate significantly. e.g you walk in with 140/90 and they aren’t going to bother. 160/95 and they will recheck you with more care given to the proper measurement technique.
This isn’t to say one should dismiss the numbers when taken properly; I’m just pointing out that calibration is necessary.
Personally I definitely have some degree of "white coat" syndrome, doctors offices just put me on edge for whatever reason. Several years ago as a healthy 30 year old at a routine office visit, the doctor found my blood pressure to be right on the upper bound of normal. She didn't immediately take any action on it, she just told me to stop by a local pharmacy and use their automatic machine a few times over the following weeks, and to enter the numbers in her organization's medical chart app. I did, it was normal, she sent me an email "thanks, looks good!". Case closed.
My Withings BPM Connect takes 3 measurements automatically at intervals and takes the average of those + saves them to Apple Health.
Before I was taking my BP when I was feeling "weird" and of course it was through the roof, by taking it in the mornings my BP is still a bit high, but not Hypertension Level 2 high.
People underestimate how valuable a medical tool the Apple watch already is and how game-changing it can get if they manage to extend the sensor suite - as you say, blood pressure, perhaps also body temperature and glucose level.
Another fun fact from the visit, they did monitor glucose level and one morning they did so directly after waking me up. Which caused the nurse to run to get me an early breakfast as it was very low. Not as if I hadn't known for decades, that I need a slow start and at least a small bite for breakfast to get into gears...
https://www.amazon.com/Amazfit-Fitness-Monitoring-Tracking-R...
Some of the reports it produces are superior to Apple Health (it measures stress, a proprietary overall health score, and I prefer its sleep monitoring analysis).
It’s $39. The 15-25 day battery life claim assumes you disabled most of the functionality.
Insert privacy disclaimer here.
This is a known thing called White Coat Syndrome
Deleted Comment
>right after you've driven to the appointment, made your way through the intake pipeline, and finally sat down in the chair, is not representative of its reading during a typical day in your life.
So? It is taught pretty early in med school that before measuring the vitals, you should let the patient rest while you take their story, and ask questions related to things that might change the measurements (did you walk here? did you walk up the stairs? did you drink coffee? did you smoke etc.). And if you still want more measurements throughout the day for various reasons, you can just use holter.
>all combine to make blood pressure a fairly variable statistic with limited diagnostic power when it's only measured infrequently.
[citation needed]
If you are hypertensive, non of the things you've mentioned will matter. Your blood pressure will be high regardless, and it will still be caught. In addition, you can't just diagnose with a single reading anyways.
It is funny to read comments regarding medicine on HN.
https://omronhealthcare.com/blood-pressure/
Even these, though, tend to overestimate your actual blood pressure, sometimes by as much as 10 points.
But having one in the home makes it easy to take several readings throughout the day, since each one hardly lasts a minute.
I've been getting much better readings at the doctors but then I realized I always ride my bike there, sit in the waiting room for a while and then get a low reading. Not representative!
The biggest correlation with my blood pressure is how regular my sleep is. Once I started militantly waking and sleeping on a set schedule, the numbers came down. They seem to spike for a few days if my sleep gets messed up badly somehow.
I also have been trying to standardize my measurement: same time of day, after sitting quietly alone for five minutes.
https://my.clevelandclinic.org/health/diagnostics/16330-24-h...
I have worn a holter several times. I had better results than in a doctor's office. It seems to be a classical case of white coat syndrome.
After being diagnosed with elevated BP, I googled and read what I could and concluded: 1) Cheap "BP monitors" on Amazon just show random readings or the same readings so they are worse than useless: someone may actually use them and believe their readings. 2) There are only few smart watches that have BP measuring function.
I am currently using Samsung Watch Active2, and it seems to do the job. There is calibration that is good for 30 days only. After 30 days it expires and I calibrate it again. Calibration involves making 3 measurements in parallel, watch on one hand and manual BP monitor on the other. After each measurement on the manual BP monitor, I tell the watch App what was measured.
After each calibration I do another 3 measurements in parallel, again using both the watch and the manual monitor. I compare the watch (post calibration) readings with the manual BP readings. Usually the difference is small within few percent. If it is more than 8-10% I redo the calibration. This has happened 2 times in the 25 odd calibrations I have done. Usually the reason is noise instead of perfect silence (person coming in the room and talking, TV being turned on).
I have tried using the watch on Person2 after being calibrated on Person1 - and Person2 got crazy BP readings. So the calibration really does something, it is not nothing.
The watch measurements also approximately agreed with measurements taken over 24h period when I wore BP holter (automated BP cuff that inflates every 30 mins and measures and records the BP).
Over time I have become more lazy with the re/calibration: now several days pass before I re/do it. So I'm acutely aware that any non-100% automated data collection will eventually be abandoned on long enough time horizon. Redoing the same is boring and becomes more so with time.
This is a healthcare issue specific to your country. It is not a problem of "not enough measurements".
Regarding using tech like smartwatches for blood pressure measurement, it is currently not possible. They aren't measuring your blood pressure, they are simply correlating optical data like pulse transit time with your blood pressure, which is mostly inaccurate. If you have to calibrate every now and then using actual bp measurements, then you already have enough data and don't need your smartwatch.
How? Do we have any idea what we would do with that data? AFAIK, all treatments we currently have aren’t suited for treating short-duration spikes in blood pressure (do they even need treatment? I wouldn’t know).
Also, why would we need preventive medicine for most people with hypertension? https://en.wikipedia.org/wiki/Hypertension#Prevention:
“The 2004 British Hypertension Society guidelines proposed lifestyle changes consistent with those outlined by the US National High BP Education Program in 2002 for the primary prevention of hypertension:
- maintain normal body weight for adults (e.g. body mass index 20–25 kg/m2)
- reduce dietary sodium intake to <100 mmol/ day (<6 g of sodium chloride or <2.4 g of sodium per day)
- engage in regular aerobic physical activity such as brisk walking (≥30 min per day, most days of the week)
- limit alcohol consumption to no more than 3 units/day in men and no more than 2 units/day in women
- consume a diet rich in fruit and vegetables (e.g. at least five portions per day);
- Stress reduction”
With 70% of the population being overweight or obese and on a dog shit diet I very much doubt that.
We already know what we do is bad, we know how to fix it, virtually no one does it. If people can't be arsed to even walk 30 min a day I don't think they'll care about continuously monitoring their blood pressure. You can track your pulse continuously with ultra cheap gadgets and it'll tell 50%+ of the population their heart is in bad shape, nobody cares
The best preventative medicine is your lifestyle, if you wait for symptoms you already failed your body and are 10+ years late to the party
It would be, if the most reliable way to get BP data wasn't to apparently violently compress the upper arm until it physically hurts and leave it like that for a minute. How people can do that on any kind of regular basis completely escapes me, and I'm not convinced it's not actively harmful. The wrist monitors are tolerable but seem to be very sensitive to wrist height.
I am not nervous when they measure my blood pressure, but I might have been late to my doctors appointment, so of my 25 min walk to the doctor, I was running half of it. I had non-optimal blood pressure values at the doctor, because I was running not to miss the appointment, and as I arrived, I had to immediately go get my BP checked.
After the incident, I religiously measured my BP at home various times a day for a week and my numbers looked okay.
It also does nice things like a detailed check of my sleep, how I'm acclimatizing to altitude when visiting the mountains, the number of steps I walked and pulse-ox.
I don't know how these correlate to what blood pressure tells you, but I blood pressure will be directly measured in the same way in a few years.
No blood test over the next decade showed even a hint of elevated blood sugar.
At least in the United States, you'll get your pulse, blood pressure, and iron levels all checked. Additionally, your blood will be tested for some infectious diseases like HIV.
Lots of free testing, and you also get to help someone out!
Gets rid of most of my white coat hyper tension
[^1]: https://newsroom.heart.org/news/high-blood-pressure-while-ly...
Submitters: "Please submit the original source. If a post reports on something found on another site, submit the latter." - https://news.ycombinator.com/newsguidelines.html
I decided to work on it and see if I can "fix it naturally". I did 2 main things : first one was extremely easy (for me), I dropped more than 29kgs (approx 60lbs) which was 34% of my body weight over more than 15 years (techinally the first 20 kg was pretty quick, last 9 kg took a few years and experimenting with food and eating habits). Secondly, I started practising meditation. That's a hard one, takes me a lot of effort but I'm doing it quite consistently now.
Anyway, I barely check my blood pressure now and last I checked it was 118/75. I can't emphasize how important it is to eat well and live a stress free life to keep your heart healthy. Of course it worked for me because mine was just borderline high (on the best days it used to be 135/85), it won't work if you have severe hypertension but there's no harm in trying, it will definitely drop a few points on the meter and your heart will thank you.
Most people though, even being technically capable of similar feats, are not in a position to do so, because of the time and attention expenditures required. Rebuilding large chunks of your life to accommodate for a new lifestyle is the harder the more other people depend on you. Keeping your resolution for many years also.becomes harder.
I'm not sure of your circumstances. I'm pretty lucky being young, single, and having no kids, so maybe I could manage a similar feat in your position.
I don't think it's the norm, though, which maybe is why medication is the default.
Why not? Serious question not an attack.
Outside of catatonic states and so on what would make those things impossible?
Caloric deficit is the only way to lose weight. If you hear someone say, “No! You need to exercise and reduce calories!” That’s just burning the candle from both ends - increasing caloric requirements and decreasing caloric intake (e.g. caloric deficit). There are good reasons to do exercise, but it’s not strictly required for weight loss.
(Consult a medical professional before beginning any weight loss routine, etc., etc.)
Question: what kind of meditation has helped you the most?
That said, what works for me is : I have been a gym rat for many years now, I never skip my gym and I am there 6 days a week. I recognized that the only way I can stick to meditation is by including it in my gym routine. So I always do my meditation after working out. Minimum 10 minutes and on good days 20 to 30 minutes. But I never leave the gym without doing it.
I try different meditation on different days. Some days I do simple focus on breathing type meditation, other days I imagine myself circling some random star/planet and focus on it, then sometimes I just imagine waves coming in going out (I try to think of waves as thoughts that pop in and out from my mind), I have also tried chanting meditation - that can be extremely useful in the beginning - I don't do it much though. Finally on days when I have my headphones with me I also try guided meditation (generally I prefer Sam Harris or someone like him who guides through as a non-religious practice).
I really think the key is to try a few styles and experiment with them. I won't trust all the "self-proclaimed experts" who say "this is the only way", just find one that you can relate to and understand the basics of it and come up with your own style - meditation is an art and not a science. I would also recommend that you include it in your routine that you never break (it could be as simple as saying I will meditate before I brush my teeth assuming you brush your teeth everyday :-)). Some days are better others not so much. On some days, the thoughts just keep popping in and out, and other days I feel in a zen mode.
It is incredibly powerful practice, the biggest improvement I noticed is that you become aware of your emotions before they take control of you. For instance, I am short tempered, (and although I am still working on it) these days I notice right before when I am going to loose it and then I think of my "zen state" and suddenly the anger can't take control of me. It is almost like magic.
All the best in your journey :).
Similar thing with my petite old grandma. Always measured high if an unknown person did it because they would overinflate. But when someone would just put it 20 over her previous known good reading, then her blood pressure was fine.
But nobody cares. In, out, get paid.
Try measuring my BP while pinching me, don't be surprised what you get.
When I went to the medical exams to get my drivingllicense one year ago I was told my blood pressure was a bit high - maybe due to the nervousness of being checked, but it was better to ask my doctor - both of my parents suffer from high blood pressure.
So I did. He told me my blood pressure was high and gave me that famous table to fill up with daily readings for two weeks.
My sister (physiotherapist) has a sphygmomanometer at home but she will scream at me to be perfectly still and seated for at least 5 minutes before doing the reading - and it _always_ was 120/80.
Went several days to a nearby pharmacy and they gave me a little chair to be sat for 10 minutes before standing up and going to a small cubicle where they did the measurement with an electronic sphygmomanometer. Measurements there always were fairly inconsistent and above 131/87 - going up to 150/87.
Also went to several other points to get my blood pressure measured and they always had a different method and (unsurprisingly) yielded different results. But for some reason when they measured with analogic/traditional sphygmomanometers, the measurements always were lower compared with electronic ones.
Fortunately could afford a decent electronic sphygmomanometer for myself and started doing my own measurements, which are fluctuating between 117/77 and 122/82.
BP level seems to highly correlate with the environment you're in, stressful driving can bring it up and keep it high for a while.
Instead, using a sphygmomanometer is much more likely to give accurate results.
Anecdotally, I always have a super weird initial blood pressure reading when I go to the doctor and they use the electric machine (one time it was 112/95), but when it is rechecked with a sphygmomanometer it tends to level out at somewhere around 130/85.
You will probably find that your blood pressure varies more over a 10 minute window than the difference in readings between the two meters.
[1] Oscillometric vs. Auscultatory, JFYI:
https://news.ycombinator.com/item?id=36550719
I redid the measurements after reading the manual, sitting straight up, feet on ground, measuring at heart level, etc. Suddenly I got 100/110 over 80/85, and while that wasn't ideal, it obviously calmed me down a good bit.