Can High Blood Pressure Make You Tired

Can High Blood Pressure Make You Tired

By Dr Joe

Can high blood pressure make you tired? This is a common question that bothers people with high blood pressure.

The problem with tiredness and fatigue is that they are non-specific symptoms. Tiredness and fatigue can be caused by a huge array of medical and non-medical conditions.

It is therefore not surprising that tiredness can become a diagnostic nightmare for both you and your doctor.

For instance, it is very easy to blame your tiredness on menopause, if you are a woman who is post-menopausal. Of course, menopause may make you feel tired but the problem of feeling exhausted most of the time may well be due to your high blood pressure.

can high blood pressure make you tired

Men may blame constant tiredness on low testosterone which may well be the cause. But when you have high blood pressure, you may be barking at the wrong tree there blaming your testosterone level.


Your doctor being confused as well may well tell you “there’s no magic bullet” to solving the constant tiredness and fatigue. He might suggest you start getting used to it because he too has become helpless.

Sometimes as human beings we have a better ability to deal with situations when we know the reasons why we are having a particular symptom. Not knowing why is just as exhausting as the problem itself.

So, can high blood pressure make you tired?

You already probably know the answer from the forerunner to this but for avoidance of doubt, if you want the answer to the question: can high blood pressure make you tired?

The answer is; yes, high blood pressure can make you tired. Yes, high blood pressure can cause fatigue. Yes, high blood pressure can make you feel exhausted most of the time.

For the most part, people with high blood pressure tend not show any symptoms. Hence, if you are not someone already diagnosed with hypertension (high blood pressure) the finger-pointing exercise will probably be in the wrong direction.

This is particularly so if you are one of those with masked high blood pressure. These are individuals with high blood pressure that is not obvious to their doctor when their blood pressure is measured.

These folks have “normal blood pressure” in front of their doctor; but in actual fact they have high blood pressure in their day to day lives. The exact opposite of ‘white coat hypertension‘. The only way to diagnose these folks is through ambulatory 24-hour blood pressure monitoring.

Ambulatory blood pressure monitoring will reveal the aha moment. High blood pressure diagnosed. Cause of tiredness and fatigue uncovered. Problem solved.

See also: can alcohol cause high blood pressure

What are the symptoms of high blood pressure?

It will be unusual to talk about the relationship between tiredness and high blood pressure without mentioning the other symptoms of high blood pressure.

As I said earlier on, hypertension (high blood pressure) is usually without symptoms in the vast majority of people with the disease. But one or two symptoms will lead your physician to suspect high blood pressure as the cause of your problem.

Some symptoms of high blood pressure will include:

  • Headache
  • Tiredness
  • Nausea or vomiting
  • Sweating
  • Feeling anxious or keyed-up
  • Pale skin colour
  • Chest pain
  • Tight chest
  • Visual difficulties
  • Difficulty breathing
  • Ringing in the ear
  • Problems with concentration
  • Confusion
  • Buzzing in the ear

how does high blood pressure make you tired

 

How does high blood pressure cause tiredness?

We have already established that lethargy, fatigue, feeling tired all the time, are some of the symptoms of high blood pressure.

In fact, in older folks, the problem of fatigue can be so bad, they find it difficult to have a productive day. That can make for a frustrating experience. But how does high blood pressure cause fatigue?

High blood pressure causes tiredness through a variety of ways.

  • The high blood pressure itself
  • The high blood pressure medicines can cause tiredness
  • Lifestyle issues
High blood pressure condition itself

When you have high blood pressure, it means there’s relative narrowing of your blood vessels. Your blood vessels have stiffer walls. Meaning your blood vessels aren’t very compliant to the rush of blood coming through from the heart.

With this relative narrowing and hardening of your blood vessels, the flow of blood through the vessels is sub-optimal. You need an unimpeded flow of blood through your vessels to bathe your cells.

If the flow of blood is not free, then the supply of oxygen and nutrients will be sub-optimal. This relative deprivation of rich oxygen and nutrients to your tissues inclusive of your muscles will make you feel tired, fatigued and lethargic.

Because sup-optimal supply of nutrients and oxygen means sub-optimal metabolism.

So, it is not unusual for someone with high blood pressure to feel exhausted most of the time.

The high blood pressure medicines can cause tiredness

High blood pressure is one disease where both the disease and the treatment can cause the same symptom(s). How bizarre.

For instance, high blood pressure can cause erectile dysfunction. At the same time, the medications used for the treatment of high blood pressure can cause the same erectile dysfunction. Sad, isn’t it?

The same thing applies to tiredness and fatigue. Just like high blood pressure can make you feel tired, so can the medications used for the treatment of high blood pressure.

One of the commonest complaints from people on high blood pressure medications is feeling tired and having low energy.

This problem of fatigue with high blood pressure medications is particularly so at the start of treatment and when a new medication had just been added to an existing one.

Blood pressure medications are a pain in the backside. Just as they save lives, they can make one’s life miserable as well.

How do blood pressure medications make you feel tired?

Some blood pressure meds like diuretics also called water pills, work by contracting your blood volume. They make you pee more. This reduces what we call the pre-load of the heart. It reduces the amount of ‘fluid work’ the heart has to do.

In doing so, these diuretics like Lasix, Thiazides may unintentionally make you lose electrolytes like potassium. A low potassium in the body is a guaranteed way to feel lethargic all day. Not what you want.

The beta blockers, like Atenolol, Bisoprolol, Propanolol, slow down your heart rate and reduce your heart’s output. This mode of action might not be liked by your body. The net result being; feeling tired all the time.

Centrally acting blood pressure medications like Clonidine, Methyl dopa, depress the central nervous system. With a mode of action like this, it is little wonder if you are taking one of these medications, you feel lethargic all the time. You need your central nervous system to be ‘firing on all cylinders’ for you to have the right energy levels.

So, if you are someone who always wonders why you feel so tired with your BP, your blood pressure medications could be playing havoc with your current low energy problem.

Yes, it’s nice to have your blood pressure under control but this may come at a price. Fatigue.

Lifestyle issues

This is linked with some of the causes of high blood pressure.

Are you overweight? Being overweight does not help your blood pressure  control. Even though your hypertension can cause your fatigue, problems related to weight issue can exacerbate your tiredness.

A lot of people overweight especially if obese have sleep apnea. Sleep apnea leads to poor sleep. Poor sleep is neither good for your physical nor your mental health. Poor sleep from sleep apnea will certainly make you tired practically everyday.

Is your diet unhealthy? Eating heavily processed meals may give you the buzz of yummy tasty food but you pay the price by getting tired as this will make your blood pressure control a lot harder.

The same thing applies to your level of physical activity. If you are not physically active, you may gain weight.

But beyond weight gain issues, not getting enough physical activity is a recipe for stubborn pressure which in turn will make you feel tired. Fatigue which may be made worsened further by your blood pressure meds.

So, it is clear as daylight. High blood pressure can make you tired.

But all is not lost. If you are having high blood pressure fatigue issues, have a chat with your physician. Between the two of you, a management plan can be drawn up.

And you could have a resolution. The resolution won’t be swift but it will happen…eventually.

 

Can Alcohol Cause High Blood Pressure

Can Alcohol Cause High Blood Pressure

By Dr Joe

Can alcohol cause high blood pressure? That’s the subject of this piece. I will try and explore the research and give you an insight into the problem of alcohol and high blood pressure.

The issue of alcohol use in our society is not new. People have been using and dare I say, abusing alcohol for centuries. There is no sign that this lifestyle is ever going to change despite advice form government agencies.

It does look like there’s something about alcohol that seems to attract people to it. Young adults now start young and continue with the habit for as long as possible. To imagine that doctors are now seeing alcoholic liver disease in people in their 30s is something quite puzzling.

Anyway, this piece is not about the why we drink but more about the effect of alcohol on blood pressure.

can alcohol cause high blood pressure

Can alcohol cause high blood pressure?

Seeing as high blood pressure is the leading single risk factor for morbidity and mortality – responsible for 10·7 million deaths and 211·8 million disability-adjusted life-years worldwide in 2015, it makes sense to take this probable causative agent seriously.


The simple answer to the question: can alcohol cause high blood pressure is; Yes, it can.
Alcohol can cause high blood pressure and the word “can” is very important in that sentence.

Because even though alcohol does cause high blood pressure, it’s not as straightforward as you might think. Like everything scientific and related to the human body, there are some other factors that come into play.

See also: why we measure restuing blood pressure

For instance, the way women deal with alcohol is different from the way men handle alcohol. This in turn affects the outcome of drinking overall and blood pressure consequences.

The gender differences in alcohol metabolism has to do with body fat percentage, body fat distribution, body size and alcohol solubility.

This difference is illustrated in this cross-sectional analysis study of US National Health and Examination Survey data that looked at alcohol consumption in 3 groups – Non-binge drinkers, Binge drinkers of 12 times a year and Binge drinkers of more than 12 times a year.

That survey data found that the women in the binge drinking groups did not have raised blood pressure or high cholesterol but had high blood sugar instead. But the men who drank more than 5 drinks or more episodically had raised blood pressure and raised cholesterol.

Binge drinking in that study was defined as drinking 5 or more drinks per episode. They looked at men and women aged between 18 and 45 years of age who reported their alcohol use and had no cardiovascular disease.

The idea behind the study was to explore the relationship between blood pressure, blood cholesterol, blood sugar and alcohol use. But an additional outcome measure was to compare gender response to alcohol use. Their findings supports the differences in the way men and women respond to alcohol use.

I should add that the study being a cross-sectional one means the results are interpretable for that point in time only. It’s not a long term study but nevertheless shows that young adults may be exposing themselves to high blood pressure problems, if they continue to binge drink.

alcohol and blood pressure

Effect of alcohol on blood pressure is dose-dependent

What is clear is that consistent drinking of alcohol leads to high blood pressure but as this meta-analysis suggests the effect of alcohol on blood pressure is dose-dependent.

What confuses people is the conflicting advice offered. Whereas research tells us that 16% of high blood pressure disease is due to alcohol consumption, we are also told in the same breadth that alcohol is good for our cardivascular health.

We are told and indeed there is evidence to support the view that light drinking may not do our cardiovascular system a lot of harm. In fact, light to moderate drinking is thought to reduce cardivascular complication and all-cause mortality even those with hypertension.

The safe alcohol dose where this “magic” appears to happen according to that meta-analysis is 8 – 10 gm of alcohol per day.

This view is also supported by the previous meta-analysis. It says:

“In people who drank 2 or fewer drinks per day (12 g pure alcohol per drink), a reduction in alcohol intake was not associated with a significant reduction in blood pressure. In people who drank at least 3 drinks per day, a reduction of alcohol consumption to near abstinence was associated with a reduction in blood pressure. Reductions in systolic blood pressure and diastolic blood pressure were strongest in participants who drank 6 or more drinks per day for a 50% reduction in alcohol intake”

If heavy drinkers discontinue and abstain from alcohol, their blood pressure improves. This was shown in this study that used 24-hour ambulatory blood pressure monitoring to assess the effect of alcohol cessation over a 1 month period.

The study authors concluded:

“These results show that heavy alcohol consumption has an important effect on BP, and thus cessation of alcohol consumption must be recommended as a priority for hypertensive alcohol drinkers”

From all of the data that I looked at, it is clear to me that alcohol can cause high blood pressure. There is no doubt in my mind that, alcohol has the potential to make the control of high blood pressure harder to achieve.

This is particularly so in people who drink consistently. In people who drink every now and again i.e the social drinkers, the effect of alcohol on blood pressure is transient and inconsequential.

And the threshold for alcohol use to cause the rise in blood pressure seems to be 3 drinks or more per day.

effect of alcohol on blood pressure

 

So, what do we define as a drink?

It becomes important for us to define what a drink is. Because all the research papers refer to “a drink” and we cannot assume everyone knows what “a drink” is.

A standard drink in the United States is usually defined as 14 g of alcohol which is ethanol. Seeing as we are talking about alcohol and alcohol is present in spirits, wine and beer, how do we correlate this amount of alcohol in the different drinks on offer.

Here we go. 14 g of ethanol will be found in:

  • 12 oz of beer
  • 5 oz of table wine
  • 1.5 oz of 80 proof (40%) distilled spirits

That guide above is not perfect. Why…because the alcohol concentration in different drinks within the same class varies. For instance, you can have 10% wine, 12% wine, 14% wine etc which confuses the picture but the guide should give you a rough idea.

How does alcohol cause high blood pressure?

The deal with alcohol and blood pressure is that there is both a direct effect and an indirect effect.

The direct effect is the fact that alcohol stimulates the sympathetic nervous system. There is a direct pressor effect on the blood vessels by alcohol.

This study gave a group of youg adults alcohol at a dose of 0.75 g/kg body weight and measured their blood pressure, heart rate and sympathetic nervous activity afterwards.

They found a raised heart rate, raised blood pressure and an increase in muscle sympathetic activity once their blood alcohol level got high.

A similar study using wine on their subjects produced similar results. The researchers found that both arousal and sympathetic activity were increased by the alcohol intake after 20 min of consuming the wine.

The way it works is this.

Initial consumption of alcohol results in what we call vasodilatation. Alcohol relaxes the blood vessels initially which means your blood pressure will be lowered. Hence, you feel flushed and warm initially when you have your drink.

Probably the reason alcohol may have some beneficial effects when consumption is at a low level.

Higher blood levels of alcohol caused by sustained intake however will reverse the relaxation of the blood vessel walls. Instead alcohol will stiffen the blood vessel walls leading to a rise in blood pressure. This is mediated by an overdrive of the sympathetic nervous system.

An additional mechanism on how alcohol causes a rise in blood pressure is that it inhibits the activity of blood vessel relaxing substances like Nitric oxide. You need your nitric oxide to have a normal low blood pressure.

Alcohol also depletes some minerals like calcium and magnesium. These minerals help to relax blood vessels just like nitric oxide. When blood vessel walls are relaxed, blood pressure is lowered. Alcohol gets in the way of that.

Indirect effect of alcohol on blood pressure

Alcohol is high in sugar and calories. Regular consumption of alcohol will lead to weight gain. Gaining excess body fat will lead to high blood pressure.

Also bear in mind, people who drink are likely to eat unhealthy diet which ultimately will lead to further weight gain. This worsens the problem of raised blood pressure in regular heavy drinkers.

Coupled with the fact that; when you are intoxicated most of the time, exercise will be the last thing on your mind. Lack of exercise will certainly have a negative impact on your blood pressure.

I should also add that alcohol intereferes with REM sleep as you saw in the video above. Not getting good REM sleep may affect your blood pressure negatively.

Below is a summary of what you need to know regarding alcohol and blood pressure:

  • Low level consumption of alcohol has only a temporary effect on blood pressure
  • Low level alcohol consumption may not affect blood pressure adversely long term
  • Low level drinking may have beneficial effect on cardiovascular system
  • The threshold for alcohol harmful effect on blood pressure is 3 or more drinks per day
  • A drink is defined as 14 g of alcohol – see above for guidance
  • Safe limits will be 1 drink per day for women and 2 drinks per day for men
  • Sustained drinking of 3 or more drinks will cause high blood pressure in a normal person
  • Having 3 or more drinks per day will make your high blood pressure worse
  • High blood pressure caused by alcohol affects all races equally – white, black, hispanics, asians alike
  • Cessation of alcohol will cause a reduction of high blood pressure
  • Resumption of alcohol consumption after cessation will cause high blood pressure again
  • Poor response to blood pressure pills may be due to alcohol intake

So, there you have it.

Alcohol does cause high blood pressure in regular drinkers of 3 or more drinks per day. That is not say if you drink less, then you should mandatorily carry on drinking.

Everyone is different. Have regular checks. You will be doing your health a favour by toning down your level of alcohol consumption, if you are having blood pressure concerns…

…even if all you have is 1 or 2 drinks per day. Use your judgement.

What Is Ambulatory Blood Pressure Monitoring?

What Is Ambulatory Blood Pressure Monitoring?

By Dr Joe

One of the things high blood pressure sufferers talk about and feel bewildered about is why we recommend home monitoring of blood pressure to be done after they have rested.

Well, the truth is; checking your blood pressure after resting is the best way to get your true blood pressure reading.

Why…because a lot of positive things can happen to your blood pressure in those precious 5 minutes. The 5-minute rest allows time for your circulatory system to come to a rest. Doing so stabilises your blood pressure.

I have written a piece on this previously. That article explains why we measure resting blood pressure as opposed to measuring it during active times.

Not doing the at-rest blood pressure measurements means you have to consider the alternative. The alternative is 24 hours blood pressure monitoring. This is a continuous home blood pressure monitoring over a 24-hour period.

The secondary terminology for this pratice is ambulatory blood pressure monitoring.

what is ambulatory blood pressure monitoring

What is ambulatory blood pressure monitoring and how is it done?

As the name implies, ambulatory blood pressure monitoring is a blood pressure monitoring system that measures the pressure inside your blood circulatory system outside of the clinical setting. Checking your blood pressure when you are ambulant.

Of course, the ambulatory blood pressure monitor will measure your blood pressure when you are active and inactive. For instance, when you are sitting on your sofa watching TV and when you are asleep too.


In short, ambulatory blood pressure monitoring checks your blood pressure regardless of whatever you are doing at fixed intervals. Fixed intervals BP checks could be every 30 minutes or much more frequently.

As long as you have the ambulatory BP monitoring attached to you, it will do its own thing whether you are active or inactive. Readings are certainly more accurate than wrist monitors.

See also pros and cons of wrist blood pressure monitors

Ambulatory blood pressure monitoring can be done over a longer time but usually ambulatory blood pressure takes readings over a 24-hour period.

The cuff of the ambulatory monitor is wrapped around your arm and the blood pressure reading device or meter is given to you along side it.

You go about your business during the day and night and at fixed intervals, the blood pressure cuff will inflate and deflate spontaneously to measure your blood pressure at that moment in time.

These readings are recorded digitally over the 24-hour period.

It helps if you can manually record your activities over the 24-hour period you have the ambulatory BP device on you. In particular, a timeline of your activities will help your doctor interprete the results a lot better.

There is evidence that ambulatory blood pressure monitoring provides lower blood pressure readings compared to clinic setting readings. That can make them desirable.

Who needs 24-hour ambulatory blood pressure monitoring?

Anyone with high blood pressure really, truth be told.

But it is not practical to use the ambulatory device on everyone. Don’t forget millions of people have problems with high blood pressure all over the world.

So, getting the device to everyone will be an expensive undertaking. Although the companies making the ambulatory blood pressure monitors will not complain.

That would be good business for them. But for now, with limited resources, it makes sense to strategically deploy the devices to those in whom the need is strongest.

Who are these people?

People for whom the need for 24-hour ambulatory moniring is strongest include:

  • Anyone with suspected wild blood pressure swings during the day
  • Individuals with suspected huge blood pressure rises at night
  • Someone with suspected sustained high blood pressure
  • If white coat hypertension is thought to be an issue
  • An individual who may actually have masked high blood pressure
  • Poor response to high blood pressure medications
  • Borderline high blood pressure individuals
  • A need for prediction of risk of blood pressure complications

Why is ambulatory blood pressure monitoring important?

In 2018, we woke up one morning in spring, with screaming headlines in 3 newspapers – The Times, The Daily Mail and The Telegraph, all UK Newspapers trashing the use of clinic blood pressure readings. The implication was that current methods were not just outdated but bordered on being unsafe.

Whilst the headlines may be true such as stated by Laura Donelly of the Telegraph:

“White coat syndrome is real, confirms a new study, showing blood pressure measurements taken by a doctor are 50 per cent less accurate than those taken at home. The research confirms theories that readings taken in a doctors’ surgery bear little relation to the true state of heart health”

It still doesn’t mean that we should throw away our regular blood pressure monitors used in hospitals and clinic settings because they are useless. These regular BP monitors still have a huge role to play in the diagnosis and management of high blood pressure.

For one, they are convenient to use and the digital versions are now widely available which means patients can actually monitor their blood pressure at home.

We should not underestimate the role of these new digital blood pressure monitors that are so easy to use. They only require very little training. Meaning patients can have an input into their high blood pressure management.

In any case, doctors hardly use one-time readings in clinical settings to make decisions anyway unless the reading is astronomically high. Even then the measurement needs to be repeated a couple of times before intervention is suggested.

By the way, these newspaper headlines were the result of a study that was published in the New England Journal of Medicine.

It’s a Spanish study that tracked the health of over 63,000 adults over 18 years of age. Over a 10-year period. They measured their blood pressure the usual standard way in the clinic and were given the 24-hour ambulatory blood pressure monitor to take home.

The monitors were set to record blood pressure at 20-minute intervals during the day and 30-minute intervals at night. The participant’s records were entered as valid and included in the study only if 70% of the readings included both systolic and diatolic.

What the researchers found:

They found out the ambulatory 24 hours blood pressure monitoring was a better predictor of cardiovascular death than one-time blood pressure readings in the clinic. This was particularly linked to 24-hour systolic blood pressure rises.

They also found that masked high blood pressure had the highest risk of death.

Hear them:

“In our study, unlike most previous studies, we observed consistently greater mortality associated with masked hypertension than with sustained hypertension, which might be due to the delayed detection of masked hypertension in patients, who consequently could have more organ damage and cardiovascular disease than patients with sustained hypertension”

Interesting!

Another thing is that we tend to be dismissive of white coat hypertension as nothing to worry about. Well, be careful of how quickly you reassure yourself or doctor reassures you.

Because white coat hypertension was associated with increased risk of death. Although not as high as masked hypertension.

By the way, masked hypertension are individuals who were thought to have normal blood pressure with the standard clinic blood pressure measurement techniques but in actual fact aren’t.

The net effect is silent damage to target organs. This exemplifies the ‘silent killer’ image of high blood pressure. You couldn’t make it up!

Why Do We Measure Resting Blood Pressure?

Why Do We Measure Resting Blood Pressure?

By Dr Joe

On this page you are going to learn about why we measure resting blood pressure. Not just that. You are also going to know what blood pressure is; why we measure blood pressure at all in the first place, and I also discuss what ambulatory blood pressure monitoring is and when and why we do it..

So, strap on for the ride…

Some of the commonest questions that bothers peope with high blood pressure is; why do we measure resting blood pressure. Why don’t we measure blood pressure when we are active instead? Does resting blood pressure represent our true blood pressure?

I have lost count of how many times I have had to answer this question in our blood pressure forum. So, I felt it will be a good idea to write this resting blood pressure piece here.

That way I can just direct such enquiries here. Saves me writing the same response all the time.

And if you are not one of those people in that forum, well, you are in luck, because you will now know the answer in advance of other people.

why do we measure resting blood pressure

 

Why do we measure blood pressure at all?

Before I delve into why resting blood pressure measurements are important, let me quickly talk about why we measure blood pressure at all in the first place.

May be we should start with the definition of blood pressure first.

What is blood pressure?

Blood pressure is an index of the pressure generated in the circulatory system during a cardiac cycle. A cardiac cycle includes when your heart ventricles contract and when the ventricles are relaxed. Ventricular contraction followed by relaxation represents one cycle.

Every time your heart contracts to push blood out of it into the circulatory system, there is a force behind it. That represents the systolic blood pressure. That is the top figure you see when you take your blood pressure reading.


In between the contractions (when the heart is relaxed) there is still some pressure within the circulatory system otherwise, blood flow will cease. That will not be compatible with life and as you know life has to go on.

The pressure within the blood vessels between those ventricular contractions represent the diastolic blood pressure. That is the bottom figure you see when you measure your blood pressure.

So, your blood pressure is a measure of the force or resistance within the circulatory system at that point in time.

Why should we bother measuring the pressure within the circulatory system? Why not let it do its own thing…

Why is it important to measure our blood pressure?

It is important to measure our blood pressure because it gives an idea of how much force the heart is generating with each pump and how much resistance there is in the receiving vessels downstream.

Measuring our blood pressure also provides us an ‘implied measure’ of the diameter (thickness) and elasticity of the walls of our arteries.

  • Because thicker arteries are not very compliant to allow blood flow through them easily, hence diameter.
  • Inelastic arteries are also fairly resistant to free blood flow too.


Therefore thicker, inelastic blood vessels will give rise to higher blood pressure. The net effect is, the heart has to pump harder i.e work harder, to get blood through in that scenario.

Hence thicker, inelastic blood vessels will rebound on the heart, leading to enlarged heart with thicker muscle too. Ultimately leading to heart failure, if high blood pressure is undiagnosed and untreated for a long time.

Another complication of high blood pressure when the blood vessels have become thicker and inelastic is such vessels are prone to becoming narrower.

When blood vessels are narrower, they can become clogged up readily. This can lead to blood clots which can result in heart attack, stroke, vascular dementia, peripheral vascular disease and even kdney disease.

Why do we measure resting blood pressure?

From the above analysis, if you have high blood pressure, then your blood vessels are becoming thicker and inelastic. The higher your blood pressure is, the more inelastic your blood vessels have become.

Or put in another way, the higher your blood pressure is, the more the resistance they are putting up against free flow of blood.

The American Heart Association (AHA), the European Society of Cardiology (ESC), the European Society of Hypertension (ESH) and other bodies have come out with guidelines for blood pressure measurement.

These guidelines have recommended a resting time of between 3 minutes to at least 5 minutes before blood pressure measurement at home. Also make sure you are using an upper arm monitor as opposed to wrist monitor.

Wrist monitors are not accurate. You may also want to read my piece on wrist blood pressure monitors pros and cons here.

So, why do we recommend checking your blood pressure at rest?

Well, it’s very simple. Your blood pressure fluctuates throughout the day. In fact, whilst you are out and about, your blood pressure changes from minute to minute.

If I left my phone upstairs in the bedroom and I am downstairs in the living room and I hear my phone ringing and I rushed upstairs to get the phone, my blood pressure will change dramatically having done one flight of stairs very quickly.

Even if I went upstairs leisurely, my blood pressure will change. Heck, just talking on the phone answering the call, my blood pressure will change.

Worse still, if I was getting irritated over the phone by the attitude of my Energy Company’s Customer Service consultant because I have been mistakenly overcharged for my energy use in the last 3 months and he was fobbing me off, my blood pressure will hit the roof.

The point is; your blood pressure is affected during the day by all sorts of environmental and human factors like:

  • Physical activity
  • Cold weather
  • Heat
  • Stress
  • Physical pain
  • Emotional pain etc

With that in mind, it is better to measure your blood pressure at rest. Check your blood pressure when you have rested for those mandatory 3 – 5 minutes.

Those 3 – 5 minutes gives your body and your circulatory system an opprtunity to come to rest. Because measuring your blood pressure when those other factors are in play would give a skewed unreliable results.

A lot of those rises in blood pressure as a result of those environmental and human factors are temporary.

Temporary readings do not reflect your true blood pressure. Your at-rest blood pressure is a better reflection of your true blood pressure reading. Measure your blood pressure when the sea is calm before the storm begins.

A second point is this:

Your resting blood pressure is your baseline reading. Your starting point. Your best reading. Because we know that your blood pressure will change during the course of the day. That’s a fact.

So, if your resting blood pressure is normal, we don’t have to worry about what it does during the day as you go about your business.

Now imagine a scenario where your at-rest blood pressure is 190/135 mmHg. And we know that the only way is up once you are active.

Can you then imagine what could possibly happen with a blood pressure like that; if say that individual gets that customer service irritation or went out in the freezing cold winter weather or received some terrible news?

If that’s not a recipe for a heart attack or a stroke, I don’t know what is. This is an individual who needs attention. Urgently.

Compare that to someone else whose resting blood pressure is 125/70 mmHg. We know that barring something really calamitous happening to this individual, it’s unlikely his/her blood pressure rises during the day will do him/her any harm.

You should see your resting blood pressure as a baseline that either reassures us or tells us we need to do something…like adjusting your treatment. But of course, you need more than one reading.

resting blood pressure

In fact, there was a study that was carried out sometime ago that suggested the 5-minute resting rule before measuring blood pressure is not adequate.

The authors of this study are actuallly suggesting 25 minutes resting time before checking your blood pressure. In their study, the researchers found a steady decrease in both the systolic and diastolic blood pressure reading over the 25-minute period. A bigger decrease in systolic than diastolic.

This steady decrease in blood pressure was noted in all the study participants regardless of whether they were on blood pressure medications or not.

The researchers opined that the 5-minute resting blood pressure rule may be leading to over-diagnosis of hypertension and called for the resting time to be extended in the guidelines.

…because the minimal resting time before blood pressure measurement to obtain a stable Systolic Blood Pressure in 90% of the population is 25 minutes according to their research.

Their conclusion:

“Our study suggests that the current recommended practice of measuring Systolic Blood Pressure after 5 minutes of resting may not allow for adequate stabilization of SBP, which we find could take at least 25 minutes. Public Health Policies should take into account this result to organize the best way to diagnose hypertension in our societies and avoid overdiagnosis”

What is Ambulatory Blood Pressure Monitoring?

Now you know why we measure blood pressure at rest, I need to say a few words about ambulatory blood pressure monitoring. Because it sort of ties in with the concerns of those who feel their blood pressure should be measured in active periods instead of resting times.

Ambulatory blood pressure monitoring is a technique where your blood pressure is monitored with a portable meter and you wear the attached blood pressure cuff for 24 hours.

The blood pressure machine will measure your blood pressure at fixed intervals and it’s recorded digitally. You may assist your doctor by writing down some of the activities you were engaged in during the day. That way your doctor can match the readings with the activities.

Indeed, the main concerns by individuals who feel that measuring blood pressure at rest is not ideal is because they feel that at-rest blood pressure reading mechanism is missing out on the blood pressure fluctuations that occur during the day and may be at night.

Valid concern…I must admit.

But for most people though, this is really not an issue if your blood pressure is well controlled. Even when your blood pressure is marginally elevated, those diurnal blood pressure fluctuations are not clinically significant.

In fact, this underscores why a good blood pressure control is important, if you have high blood pressure. Because you don’t have to worry about these diurnal blood pressure excursions, if your blood pressure control is good.

But there are circumstances where ambulatory blood pressure monitoring is indicated.

When is ambulatory 24-hour blood pressure monitoring necessary?

It may be wise to perform ambulatory blood pressure measurements in these individuals:

  • Anyone with suspected wild blood pressure swings during the day
  • Individuals with suspected huge blood pressure rises at night
  • Someone with suspected sustained high blood pressure
  • If white coat hypertension is thought to be an issue
  • An individual who may actually have masked high blood pressure
  • Poor response to high blood pressure medications
  • Borderline high blood pressure individuals
  • A need for prediction of risk of blood pressure complications

In all of those scenarios above, it may be wise to undertake 24-hour ambulatory blood pressure assessment. That way the right treatment strategy can be mapped out between you and your doctor.

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Wrist Blood Pressure Monitors Accurate

Wrist Blood Pressure Monitors Accurate

By Dr Joe

Are wrist blood pressure monitors accurate? This is a question that I set about answering some years ago. Not out of medical research curiousity but as a patient myself.

Apart from knowing the answer to the accuracy of wrist monitors, I also explain why my answer is what it is and finally I’ll tell you if I recommend wrist BP monitors as a home blood pressure monitoring kit or not. That’s what you are going to get on this page.


Keep reading:

are wrist blood pressure monitors accurate

Being a doctor and someone who suffers from high blood pressure, I accidentally found the answer to the question: are wrist monitors accurate for blood pressure; more out of luck rather than by design.

It’s a long story. Well kind of.
I have told the story here when I wrote about the pros and cons of wrist blood pressure monitors.

So, are wrist blood pressure monitors accurate?

My curious search for an alternative to upper arm blood pressure monitor led me to discover the truth about wrist blood pressure monitors. The long and short of my short adventure was that the wrist blood pressure monitors are not accurate.

So, if you want to know the real answer to the question: are wrist blood pressure monitors measurements accurate? The answer is; No, wrist monitors are not accurate for blood pressure measurement.

My claim is based on my personal experience of 4 different brand of wrist monitors. These wrist monitors kept giving wild blood pressure readings. Usually BP readings that would suggest I am about to have a stroke or heart attack.

With doubts in my mind as to such ridiculously high readings, I had to do a validation of the readings. Fortunately I had an upper arm monitor at home.

When I checked my blood pressure with my upper arm monitor at the same time as the wrist monitor, I had normal blood pressure.

So, whereas the wrist monitor was producing BP readings that would suggest I needed to go to ER (A&E) immediately for medical attention, my upper arm monitor was giving readings that were perfectly normal.

The contrast between the wrist monitor and the upper arm monitor was as clear as the Biblical ‘Red Sea parting for Moses and his troops to go through’.

When you have recurrent episodes of false readings with different brands, it is not unreasonable to reach that conclusion that wrist monitors are not accurate for blood pressure measurements.

Mind you on each occasion, I validated with the upper arm monitor. Occasionally, there was a close match of the readings from the wrist monitor and the upper arm one.

But these episodes of the close match were very few and far between. Scenarios like that meant I had to reach that conclusion, that the wrist monitors were inaccurate and therefore unreliable.

are wrist blood pressure readings accurate

Why are wrist blood pressure monitors not accurate for Blood pressure reading?

Okay I won’t just make a statement like that and not give you reasons for why wrist blood pressure monitors are not as effective as upper arm monitors.

One reason for this inaccuracy of blood pressure readings from the wrist monitors is the blood vessel from which the wrist monitor is getting its reading from.

The wrist monitor measures the pressure in the Radial artery whereas the upper arm monitor measures the pressure in the Brachial artery.

Our body’s arterial tree is a high pressure system. But the walls of our arteries have been cleverly designed by nature to maintain a pressure gradient that drives blood onwards and forwards downstream.

This means smaller vessels are more muscular than larger vessels. Larger vessels closer to the heart are lot more elastic than smaller vessels downstream. The larger vessels have to be elastic to withstand the high pumping pressure of the heart ventricles.

  • Larger vessels – elastic
  • Smaller vessels – muscular

The brachial artery is larger than the radial artery. Meaning the brachial artery is more elastic than the radial artery. The smaller arteries will have a higher resistance i.e pressure, within them than the larger blood vessels because they are more muscular.

This differential pressure is necessary for the continuous flow of blood within the arterial tree. That’s the concept of the physics of flow through vessels of different sizes.

But of course nature is very clever, you have a sudden drop in pressure when blood arrives at the very small arteries called the arterioles. This is designed to protect us from harm and keep the delivery of nutrients and oxygen efficient.

I am digressing here for good reason but the video below explains it a little bit more about the physiology.

The point I am making is that; you will more than likely get higher blood pressure readings in the smaller radial artery (that the wrist monitors measures) than the larger brachial artery (that the upper arm monitor measures).

The second reason wrist monitors give inexact readings is that they are very sensitive to positioning. Any slight adjustment of your wrist position will lead to swings in blood pressure readings.

Which brings me nicely to the third reason for wrist blood pressure monitors inaccuracy. We advise high blood pressure patients to measure their blood pressure by placing the cuffed area to the level of the heart.

Now imagine trying to place the cuffed wrist at the level of the heart. It’s not a natural position for the wrist. That causes all sorts of positional problems.

Compared to the upper arm, which is almost at the level of the heart requiring just a little elevation, the wrist monitor will need a higher elevation. That’s a recipe for errors in blood pressure readings.

Would I recommend Wrist blood pressure monitors?

The short answer to that question is: No, I won’t.

The American College of Cardiology and the American Heart Association are in favour of home blood pressure monitoring. Just like me, both organisations do not recommend the use of wrist blood pressure monitors.

They both recommend the upper arm monitors and I support the recommendation as well.

Why is this?

For the same reasons that I have outlined earlier on this article. It is clear. The wrist blood pressure monitor readings are not accurate. If you want to monitor your blood pressure at home, you’d want to use a device that is reliable.

You would use a blood pressure measurement device that produces clear, unambiguous blood pressure readings every time. Not some of the time but every time.

The wrist monitors cannot be trusted to do that. The wrist blood pressure monitors are not effective home BP monitoring kit.

The last thing you want is showing results of blood pressure readings to your doctor that are ambiguous and inaccurate. Situations like that will lead to your doctor making wrong management decisions.

You don’t want that. In fact, it could be downright dangerous. Avoid!

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Wrist Blood Pressure Monitors Pros and Cons

Wrist Blood Pressure Monitors Pros and Cons

By Dr Joe

Are you considering getting one of these fancy wrist blood pressure monitors for yourself? Or may be you have one already and you are wondering if you have made the right decision.

Well, you have come to the right place because we shall be discussing wrist blood pressure pros and cons here on this page.

Are wrist blood pressure monitors any good? Do wrist blood pressure monitors provide accurate blood pressure readings? Are wrist blood pressure monitors reliable?

I shall be providing answers to these questions right here.

wrist blood pressure monitors pros and cons

What are the pros and cons of wrist blood pressure monitors?

Sadly, I want to start with the cons of wrist blood pressure monitors. I apologize for this because it is never a good idea to begin a journey on a negative note.


Always start with the positives; my mother always told me when I was younger.
But I am constrained to do disobey my mother in this instance, because I want to tell my story of my first romance with these wrist blood pressure monitors.

Wrist blood pressure monitor cons

And my story unfortunately does not lead to pros of wrist BP monitors but rather to the cons of wrist blood pressure monitors.

My Story

I am a sucker for innovation and innovative products. I needed to say this upfront as that’s how my relationship with these wrist blood pressure monitors started.

A couple of years ago, I saw a full-page newspaper ad on a brand of wrist blood pressure monitor. I was enthralled by the ad. Mainly because the focus of the ad was the simplicity of using this blood pressure machine. I was sold. In an instant.

I must admit at the time I had not heard of these wrist blood pressure monitors, so my curiousity was piqued. Really piqued. I went past curiousity and made a purchase straightaway.

I felt such an innovative product was something I needed in my life. I should say that I am a medical doctor and also someone who suffers from high blood pressure too. Therefore my need for the product was a match made in heaven.

In any case what’s the point of having your curiousity aroused by an innovative product and not do the follow through business – make the purchase, that is. Call it impulsive buying and you’ll be right.

I should also say that up until that point, I had not heard of wrist blood pressure monitors. They were not available in the hospital environment that I work at the time and still aren’t. I shall come to this point again later on…

Anyway, the product arrived a couple of days later and I was so keen to use it, I unboxed it straightaway.

Off I went, slammed it on my left wrist, pushed the button to inflate the cuff and measure my blood pressure. Oops…I got a ridiculously high reading. I sat back, rested a while, breathed deeply, tried another reading. Same high reading.

Tried wrist number 2 – same high reading.

Called the retailer who requested I send it back for exhange as that may be a faulty item. New wrist blood pressure monitor arrived days later. Same outcome.

Now, how do I know the wrist blood pressure monitor was the issue and not my blood pressure hitting the roof at 240/135 mmHg for instance? Well, that’s because I have an older upper arm monitor that I had been using reliably in the house.

I double-checked with that upper arm monitor and my blood pressure was perefctly normal at the same time the wrist blood pressure monitor was giving me ridiculously high blood pressure readings.

As stated in the video below, I tried some other brands of the wrist blood pressure monitors and I wasn’t impressed.

As you can tell from the above story, reliability and accuracy are big cons of the wrist blood pressure monitors.

The problem with accuracy and reliability are one big disadvantage of wrist blood pressure monitors that I find difficult to overlook.

One of the reasons wrist blood pressure monitors give higher readings that are not reflective of your true blood pressure is the artery who’s pressure is being measured.

Wrist blood pressure monitors take the blood pressure readings from the Radial artery unlike the upper arm monitors that measure the pressure in the Brachial artery.

The radial artery is narrower and more superficial compared to the brachial artery that is deeper and larger. If you remember your physics from secondary school, you will understand why the pressure in a smaller vessel will be higher than a bigger vessel.

wrist blood pressure monitors any good

Another problem with wrist blood pressure monitors is the placement of the blood pressure cuff. Ideally when measuring your blood pressure at home, we advise you to place the cuffed area at the level of the heart when the blood pressure measurement is taking place. This is actually the same advice offered by the American College of Cardiology too.

With the wrist monitors, the wrist where the cuff will be wrapped is not naturally at the level of the heart. Achieving that objective of having the cuffed wrist at the level of the heart makes for some awkward positioning.

This is very much unlike the upper arm monitors where the upper arm is almost at the level of the heart. Your arm only requires a little elevation.

Summary of the cons of wrist blood pressure monitors:

  1. Difficulty positioning the cuffed wrist at the level of the heart
  2. Readings very sensitive to positioning
  3. Smaller blood vessel pressure being measured
  4. Gives inaccurate readings most of the time
  5. Reliable readings are few and far between
  6. Therefore cannot be trusted as a home blood pressure monitoring kit

Pros of wrist blood pressure monitors

That said, it’s not all bad news with the wrist blood pressure monitors. They do have some advantages. May be it wasn’t a bad idea after all, that I started with the cons whilst tackling this subject of the wrist blood pressure pros and cons.

Saving the good news for last…

Anyway in the interest of a good balance of facts and without bias, here are the advantages of the wrist blood pressure monitors:

Wrist blood pressure monitors are small, therefore very easy to carry around. You can easily shove them in your handbag, briefcase and off you go. So, quite suitable for On-The-Go ambulatory blood pressure measurement.

Meaning they are very portable because they are small and lightweight.

They require very little dexterity to use them. You hardly need any handiwork to use the wrist blood pressure monitors. If you can wear a wrist watch, you can use the wrist blood pressure monitors.

Just like the upper arm nonitors, the wrist blood pressure monitors will provide both the systolic and diastolic blood pressure readings. This is nice because you want both.

Cuff size is usually not a problem with wrist blood pressure monitors. Because wrist sizes do not vary much, so you shouldn’t have an issue with cuff being too small or too big. Therefore suitable for those with big arms, although you can shop for bigger cuff for upper arm monitors too.

wrist BP monitor cuff

Practically all wrist blood pressure monitors are automatic as opposed to having to choose between manual and automatic. Meaning there’s very little learning curve involved.

This also translates to being very easy to use.

Summary of pros of wrist blood pressure monitors:

  1. Small in size
  2. Portable
  3. Easy to use
  4. Provides dual readings of systolic and distolic Blood pressure
  5. Cuff size not usually a problem
  6. Quite comfortable to wear and use
  7. Little or no dexterity involved to get a blood pressure reading
  8. Usually automated so little learning required

 

Wrist blood pressure monitors Vs Upper Arm Monitors: Which should I buy?

Those are the wrist blood pressure monitor pros and cons. Now, if you ask me which of these monitors to buy for your home use, my professional advice will be to go for the upper arm blood pressure monitors. Sounds crazy, right? After everything I’ve said…

See video below

As far as I am concerned, even though the wrist blood ressure monitors do have some really good advantages over the upper arm monitors, the one disadvantage I cannot get over is unreliability.

If you are going to monitor your blood pressure at home, you want something reliable. You want a blood pressure kit that gives you accurate readings that you can take to your doctor. Readings your doctor can trust.

Doctors don’t want to make decisions on blood pressure readings that are sketchy and probably accurate 25% of the time. Not even 75% of the time. We want to make decisions on readings that are accurate 99.99% of the time.

Why is this?

Doctors don’t want to make the wrong management decisions. Wrong readings lead to wrong decisions. That’s not the basis for a sound high blood pressure (hypertension) management.

Like I said in the video, given the fact that these wrist BP monitors have been around for a long time now, and are very easy to use, how come we don’t use them in hospital settings?

Your guess is as good as mine. I rest my case!

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