Blood pressure

Managing blood pressure is key to maintaining cardiovascular health. High blood pressure puts stress on your arteries, making them more prone to rupture or plaque build-up, increasing risk for heart attack, aneurysm, and stroke. The American Heart Association has published extensive information on their website about diet and life-style changes to reduce your risk of heart disease and stroke, which we encourage you to read. However, even after implementing healthy life-style changes, your blood pressure may still be too high and require medication. Adjusting blood pressure medication is a process that takes time to get right, and requires accurate blood pressure monitoring. However some patients will have significantly higher blood pressure in the doctor’s office than at home (called “white coat hypertension”). For this reason we encourage patients to periodically monitor their blood pressure at home also.
Home blood pressure recordings are particularly important when adjusting blood pressure medication. But this is not always easy as easy, since blood pressure can vary significantly throughout the day. If you happen to be someone whose blood pressure is only high at night, sampling your blood pressure only in the morning will give an incorrect impression.
Tracking blood pressure at different times during the day also allows one to determine the effect of medication. However, it is important to recognize that the effect of any blood pressure medication is delayed—the pill needs to be digested and absorbed into the blood stream before an effect will be seen. The blood level of medication will gradually rise, then peak, and then gradually decline. This process causes a “building up, and then fading out” effect of medication on blood pressure that is superimposed on the natural variability in your blood pressure throughout the day. All of this is to say that it can be complicated, and good blood pressure control with medication often takes time and organized record keeping to figure out.
In our practice, when we are trying to “dial in” blood pressure control, we generally recommend patients keeping a tabular record of blood pressure at specific times during the day, specifically:
  • At 8AM (or when you wake up)
  • At noon (or lunch time)
  • At 5pm (or dinner time)
  • At 10pm (or bed-time)
To make things easier, we will generally encourage patients to take their blood pressure medication at one of these four times as well. For example, a twice daily blood pressure medication could be taken at breakfast and dinner. It is important, however, not to significantly vary the timing of your medication, since that will introduce variability in the blood pressure that you are trying to track.
Bringing this data to your office visit will help your physician to adjust your blood pressure medication.
A sample work-sheet for tracking your blood pressure can be downloaded here.  An example of how to use this spreadsheet can be seen here. We encourage our patients to use this as a resource to help monitor your blood pressure.