When should you measure your blood pressure?

High blood pressure is rarely noticed but is a constant threat. It can only be detected by routinely measuring your blood pressure. If high blood pressure is diagnosed, it becomes even more important to monitor the values regularly. But how often is this useful, and when are the best times to measure?

High blood pressure can cause strokes, heart attacks, and damage to the kidneys and eyes. However, the high pressure can be reduced. Measures include losing excess weight, increasing physical activity, eating a low-salt diet, and cutting down onor ideally avoidingalcohol and smoking. If needed, tablets can lower blood pressure. The success of these measures can only be checked by measuring blood pressure.

According to the guidelines of the German Hypertension League and the European Society of Hypertension (ESH), as well as the European Society of Cardiology (ESC), you should measure your blood pressure in the morning and in the evening. We recommend sitting on the edge of the bed for 5 minutes right after waking up and then measuring your blood pressure. In the evening, please measure immediately before going to bed. Again, sit on the edge of the bed for 5 minutes and measure your blood pressure before you lie down. Take two measurements 1 to 2 minutes apart and record both readings.

In addition to the measurement schedule described in the guidelines, your doctor may consider further measurements at other times to be necessary. In that case, please follow the instructions you agreed on with your doctor.

Regular blood pressure monitoring at home, together with measurements at the doctor's office, helps guide hypertension treatment. This reduces risks because extreme spikes are detected in time. Measuring at home also lets patients link how they feel to their blood pressure. Constantly high blood pressure is often barely noticed in daily life, but during pressure spikes there can be symptoms such as headache, tiredness, nausea, and even nosebleeds. Another advantage of regular home measurements is that patients can see differences between their own readings and those taken in the doctor's office. Initial errors when first measuring at home are completely normal; your doctor can advise you. However, such errors are not the only reason for discrepancies between office and home readings. Some patients have socalled "whitecoat hypertension," meaning their blood pressure is only high at the doctor's office. The opposite is "masked hypertension": these people have normal readings at the doctor's office but higher readings at home. If this is suspected, a 24hour automated measurement with a portable blood pressure monitor is usually performed. The device records blood pressure every 15 to 30 minutes including at night.

Ambulatory long-term blood pressure monitoring that is, using a portable device to record continuously is essential for the accurate diagnosis of elevated blood pressure. The large number of measurements allows the doctor to draw reliable conclusions. This is the only way to determine the patient's true blood pressure level. Blood pressure fluctuations and variability can only be captured with this approach. Another important piece of information is the normal nighttime drop in blood pressure. Long-term measurements are also used for follow-up. After high blood pressure is diagnosed, medications are often prescribed; long-term monitoring is used to check their effectiveness. If necessary, treatment can be changed to a different drug and/or additional measures can be taken. When using medication, it is also important to detect and avoid periods of very low blood pressure, since these can be dangerous for example, because they increase the risk of falls from fainting. Devices for ambulatory long-term monitoring are normally provided by doctors.

If the device is used correctly, blood pressure can be measured reliably, but there are a few rules. It goes without saying that the measurement should be taken before you take blood pressurelowering medication. Before measuring, allow about five minutes of rest. The measurement point should be at heart level. Always use the arm that shows the higher blood pressure reading. The cuff must not be too small otherwise it will show a systolic (upper) value that is too low and a diastolic (lower) value that is too high. The cuff should cover two thirds of the upper arm and be large enough to fit even a very muscular arm. The device description always states the upper-arm or wrist circumference for which the cuff is suitable; please measure this if necessary.

Wearing a thin shirt on the arm usually does not affect the measurement. However, follow the instructions in your device manual. Thicker clothing should be removed. Rolling up the sleeve is only acceptable for very loose garments, because folding tighter sleeves can restrict blood flow and distort the measurement. According to the guidelines, measure twice at intervals of one to two minutes.

We hope you found the article helpful. Accurate measurements are essential for good blood pressure control. Our app BloodPressureDB can help with that. Clear instructions walk you through taking measurements according to current guidelines. The app can also remind you if you wish. These features are fully available in the free version as well. Get the free app now.

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