Doctors Suggest At-home Blood Pressure Tests for Heart Health

Healthy Homework: To get the most-reliable reading for possible hypertension, more doctors are suggesting that heart patients take at-home blood pressure tests



Contract talks are inherently stressful. But when school administrator Wayne Holland was in a union negotiating session in 2007, they became downright shocking.

In the middle of bargaining, a high-pitched whine started coming from his chest: the recently implanted pacemaker-defibrillator to help his heart was charging up. Then, as it fired, the others in the room saw a startling sight.

“When it shocked me, I was lifted out of my chair,” he recalls. But Holland, 62, was unfazed. He finished his meeting before calling Dr. Joan Crawford, his metro Detroit heart specialist.

Holland has known since fifth grade that his heart’s faulty electrical current can make it beat at breakneck speed, and that an electric shock from a defibrillator normalizes his heartbeats. But that was the first time the device had fired, and the episode triggered a reaction from Crawford.

She told Holland to start taking his blood pressure daily at home, and to report his results monthly.

“If she sees anything she doesn’t like, she calls,” Holland says.

He’s part of a growing number of heart patients — most of them with hypertension — who now take their own blood pressure. DIY-ers everywhere may be glad to know that the most reliable blood-pressure reading is one taken at home, according to heart specialists. It’s a way to filter out the effects of the stress of traveling to a doctor’s office, sitting in a waiting room, and wondering if the doc has bad news to deliver — the so-called “white-coat effect.”

Like a medical Herbert Hoover, who proposed a chicken in every pot, Crawford urges a home blood-pressure monitor in every household medicine cabinet. “Why shouldn’t everyone own one?” she says.

Taking your blood pressure at home is a proven way to get a reliable result, and a handy way to keep tabs on your health. Hypertension is the No. 1 reason for doctor visits in this country, and one out of three Americans has the problem. Keeping yours at 135/85 or less has huge effects on your risk for heart disease, stroke, and kidney failure.

Getting correct numbers is vital. Inaccurate measurement may mean not being treated for hypertension if you have it, or taking unnecessary medication for a condition you don’t have. If you have hypertension, it also tells you whether your medications or lifestyle changes are working.

Getting correct numbers is vital. Inaccurate measurement may mean not being treated for hypertension if you have it, or taking unnecessary medication for a condition you don’t have.

Dr. Kim Eagle, preventive cardiologist at University of Michigan, is also a proponent of taking blood pressure at home. “I prefer to use home blood-pressure readings in addition to office readings to figure out where a patient’s true blood pressure is,” he says. “Most physicians, if they’re in doubt whether the blood pressure is accurate or not, will have the patient take the blood pressure at home.”

Eagle then goes even further: “Before initiating therapy, I get a home measurement.”

Taking a reading at home also increases compliance with blood-pressure medications and lifestyle factors because it shows if readings are edging back into the danger zone, according to research by Dr. Nancy Artinian, associate dean for research at Wayne State University’s College of Nursing.

“If people are feeling well, they may not see the need for treatment,” Artinian says. “A home measurement provides a cue that blood pressure is high.”

Artinian, who has hypertension herself, recently completed a new feasibility study that has implications for better blood-pressure control among uninsured African-Americans.

“African-Americans not only suffer from hypertension at a disproportionately higher rate than whites,” says Artinian, explaining the reason for her research. “They [also] suffer from complications at a disproportionately higher rate than whites.”

The research used a card-accessed kiosk in the waiting room of a Detroit health clinic for the uninsured that included lifestyle information on reducing blood pressure. It recorded 25 patients’ blood pressure weekly for six weeks, and displayed results to the patients on a chart.

The strategy apparently inspired both lifestyle changes and better adherence to medications: the upper number of the patients’ blood pressure subsequently fell by an average of 14 points, and the lower number by an average of more than 13 points.

More frequent readings also allow doctors to use another, recently confirmed technique that leads to greater reliability. Recent research found that it’s better to use the average of up to six measurements to get a reliable picture of blood pressure. The study included more than 111,000 readings of just the top blood-pressure number (systolic) for 444 military veterans taken in three settings: home, clinic, and research center. An individual’s systolic readings taken at the three settings varied by up to 24 percent.

Meanwhile, Holland continues to take home readings, but on the East Coast where he now lives. The administrator, a speech pathologist who previously was executive vice president and CEO of Lakeshore Ear Nose and Throat in the Detroit area, moved to Stamford, Conn., and leads its school district’s special-education programs.

And he’s not about to completely avoid the doctor’s office: He still travels to Michigan twice yearly for checkups with Crawford.


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