Blood Pressure and 24 Hour Blood Pressure Measurement

Elevated blood pressure is often referred to as “the silent killer.”  The first sign of high blood pressure for many people is kidney failure or stroke.  Most people will develop blood pressure that is higher than we know is optimal to avoid the risk of early heart attacks,strokes, or kidney failure.  Whether we develop it in our twenties, thirties or later, it’s a consequence of our genetics that eventually most of us develop blood pressure high enough that lowering it with medication will allow us to live longer lives.  Romeo and Juliet only marginally outlived their peers.  If everyone eschewed modern advancements in medicine, we would all be bound to live the three decades that people born into the nineteenth century hoped to achieve.

Many people have an elevated blood pressure reading when they come to me for their first visit.  I don’t take it personally.  I strive to make the doctor patient thing as normal and low-stress as possible, but it’s inherently stressful.  When one comes to visit a doctor, she is thinking about all of the things that can go wrong with her body, and maybe she is thinking about the bigger picture issues like the finality of death, the infinity of the universe, and other unanswerable questions that we typically suppress so we can get on with the daily tasks of actually enjoying our lives.

If you’ve had an elevated blood pressure reading in my office, you’re not alone.  I typically recommend that people find a drug store or a nurse at work to measure their blood pressure at various points during the day.  Usually these measurements are normal, and the elevated readings are representative of the anxiety that being in a doctor’s office presents.  Sometimes,though, they are consistently elevated. People with truly high blood pressure will (based on every study done thus far) reduce their risk of dying early from heart attacks, strokes, kidney failure, and every other high blood pressure related condition by lowering their blood pressure with medication.

While several elevated blood pressure readings are more than likely to indicate that one would benefit from blood pressure lowering medication, I understand the need to want harder data before starting a lifelong course of blood-pressure lowering therapy.  Of course therapy for high blood pressure does not need to be life-long, but the benefits of therapy only persist while one is taking it.  It’s hard to dispute the data that comes from a 24-hour measurement of one’s blood pressure.  We have a device that we can send patients home with that will take their blood pressure every 15-30 minutes over a 24hour period.  “Ambulatory blood pressure” measurement as it’s called has been shown to be very effective at discerning people who’s blood pressure is only elevated when they’re  at the doctor’s office (so called White Coat Hypertension) from those people who truly have hypertension. It’s also very effective at diagnosing people who have elevated blood pressure at night or in the morning.  The reference below speaks to the utility of ambulatory blood pressure monitoring.

Ambulatory Blood Pressure