By Karen L. Kier
Pharmacist on behalf of the ONU Healthwise Team 

Our House was recorded by Crosby, Stills, Nash & Young and released on their Déjà Vu album in 1970.  Nash wrote the song after eating breakfast with Joni Mitchell and returning to her Los Angeles home. He went to Joni’s piano and the song just flowed in a short period of time.  The song has been used in various commercials, TV shows, and movies such as Kenmore appliances, My Girl 2, and How I Met Your Mother.

Our house is a very good place to measure blood pressure (BP) to reduce the risk of heart disease!

Cardiovascular or heart disease (CV) continues to be the leading cause of death in the United States with over 900,000 deaths in 2020. CV is the most expensive disease in the US with direct and indirect costs of around 400 billion dollars each year.

While there are multiple factors that contribute to the development of CV, high BP (hypertension) is the top modifiable risk factor. Nearly 50% of US adults have high blood pressure, but only 25% have their BP controlled according to the American Heart Association (AHA) goals.

According to the AHA, a normal BP is a systolic (top number) of less than 120mmHg with a diastolic (bottom number) of less than 80mmHg.  So, this is where you will hear healthcare professionals talk about the normal BP of 120/80. 

An elevated BP is a systolic of between 120-129 with a diastolic less than 80. High BP (hypertension) is defined as a systolic greater than 129 and/or a diastolic greater than 89.  Only one number has to be elevated to be called hypertension.  

Studies including a recent one in the AHA journal Circulation have demonstrated at home blood pressure measurements are more effective in identifying high BP than in office or clinic settings. 

Why would our house be a better place to measure BP?

Dr. Shimbo, a cardiologist with Columbia University Irving Medical Center, discusses why a one-time in office BP measurement may not be an accurate reflection of a person’s average pressures.  Various factors can influence an accurate reading such as not having both feet on the ground, a full bladder, not resting for 5-10 minutes before taking, caffeine or tobacco use, and the wrong cuff size wrapped around the arm. Another factor is called white coat hypertension caused by our bodies increasing our BP in a healthcare setting (nerves, anxious, scared).  Our BP even fluctuates depending on the time of day or if we are sleeping. 

Home BP measures can give us a better perspective of our daily averages.  Dr. Shimbo and colleagues evaluated numerous studies showing positive results with home measurements in their 2015 Annals of Internal Medicine publication.  

What are the important steps to getting an accurate BP at home?

It is important to sit in a comfortable chair with your back supported.  Do not eat, drink, or use tobacco products including vaping within 30 minutes of the measurement.  Make sure to have both feet flat on the ground without crossing your legs.  Do not talk while the machine is measuring your pressure.  Make sure to go to the bathroom and empty your bladder before taking a measurement.  

Other critical elements are to make sure the cuff is on bare skin and not over clothing and your arm with the cuff is resting on a table at chest height.  Think about the arm being at or slightly above your heart when it is resting on the table. 

Home BP machines are readily available and maybe covered with health insurance or health savings accounts.  Finding the right machine is the key.  

Avoid BP machines that wrap and measure BP around the wrist. They often give false readings.  Omron devices are consistently rated at the top each year for accuracy.  Consumer Reports is a good source that reviews quality machines. The review discusses features to think about when purchasing a machine such as giving visual and verbal readings.  Other machines may provide a log book to keep track of previous readings.  Keeping a log book is a great way to record your BP measurements.  Make sure to take the log to your healthcare provider appointments.  

Besides providing a copy of your log book to your healthcare provider, it is important to contact their office if you ever get a high BP reading.  A good guide for when to call or visit an urgent care or ER is if your systolic is over 180mmHg and/or your diastolic is over 110mmHg.  

Cuff size matters when measuring your BP. Make sure to get a reading with the right size cuff to go around your upper arm (ask a pharmacist for help).  Some individuals may need an extra-large cuff or a child’s sized cuff.  A June 2023 study from the American College of Cardiology showed the wrong cuff size can result in a 20mmHg difference in BP readings.  

Talk to your pharmacist or healthcare provider about measuring BP in your house.