Blood pressure monitors and how to use them; taking a blood pressure measurement; continuous monitoring

ZebraL said:
@mango have you or others found a different home blood pressure monitor that works better? My Omron gives me the E5 (pulse not detected) error when standing (and sometimes seated). Omron customer service essentially told me it's not their problem because you're only supposed to use them seated on a hard surface. They suggested I take my BP manually (not something I know how to do and not convenient to do 3 times in a row for orthostatic vitals). Thanks!
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I use an A&D Medical BP monitor that I bought, as this was the same as the one my GPs surgery loaned me to begin with.
I've used it to take it standing, sitting, lying down.

 
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Does anyone have any idea whether any portable blood pressure monitors are reliable?


Particularly looking at one not attached to a separate display that has to sit on the side or lap or wherever it can balance but something all in that I could put on for a day

and usable - the ideal would be something that connects eg to a phone or online so I don't need to write down somewhere the result. The portable part is so I'd already have it in place rather than wrestle with doing so ideally but I don't know about eg the wrist types vs whether ones exist in the normal sleeve area that send result somewhere so you can read it.

But ideally if it does log it that I could perhaps put a note with it eg if I was able to press the button on it when I was actually feeling funny or exerting myself.

I'm not sure what sort of OI type thing I might have and so would be interested in being able to see what happens to both blood pressure and heart rate on the occasions where I stand in particular. And of course when I'm feeling funny

But the normal type involves me getting the thing on my arm which involves both time and exertion/wherewithall. And I'm likely to have already had to recline to stop myself from fainting.

I'd quite like something that means I can catch it either before or while it is happenning rather than trying to work out just from the 'after' part
 
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I think they are good enough if they have an MDR CE certification (in the EU). But my cardiologist said that the automatic ones (including their stationary one) are not very good with movement. So they did my OI measurements the old fashioned way with a hand pump cuff and a stethoscope.
 
Limited knowledge to offer, but for what it's worth:

I was given a wrist cuff and used it to take a set of readings. My GP asked what type of device I'd used, and when I showed it to her she advised me against using it—too unreliable, apparently. She gave me a list of affordable home monitors they recommended at the time, and I bought one of those.

The readings from the arm cuff type reflected the range I got when the nurse took my readings, but there could be a 10 or 15 point difference to what the wrist cuff said.

Obviously I don't really know whether either of them were reliable. For a start you're supposed to have them calibrated regularly, and I didn't know whether the wrist cuff had ever been reset since it left the factory. But on balance it seemed like the arm cuff was a better bet. Doesn't help you much, though, @bobbler!
 
I keep getting ads from within the Patient Access app/service that my GP surgery uses, linked to the UK NHS records, for Hilo (previously called Aktiia - that they describe as a 'trusted partner') which is a wearable BP monitor. It's not cheap at £210, but links to an app etc. Have been tempted a few times, but, the cost put me off tbh. www.hilo.com/uk
 
I think we have had a thread on this before. Basically, home blood pressure monitors are unreliable, especially Omron. To get an accurate reading you need to be sure that the forces on the arm applied by the cuff are not interfered with by clothing, bony bits and other things. There are various standard ways to get a wrong reading like rolling a sleeve up above the cuff.

My wife went through this and was given medication for no reason. It was only when I got out an old machine from hospital and did the blood pressure by hand as I was taught as a student that we could see that her BP was completely normal and it has been ever since.
 
Jonathan Edwards said:
I think we have had a thread on this before. Basically, home blood pressure monitors are unreliable, especially Omron. To get an accurate reading you need to be sure that the forces on the arm applied by the cuff are not interfered with by clothing, bony bits and other things. There are various standard ways to get a wrong reading like rolling a sleeve up above the cuff.

My wife went through this and was given medication for no reason. It was only when I got out an old machine from hospital and did the blood pressure by hand as I was taught as a student that we could see that her BP was completely normal and it has been ever since.
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Do you mean that it needs to be one with the squeeze ball & not an electric one?


Sometimes GB surgeries loan theirs out- presumably electric - would these readings be reliable?
 
Ash said:
Do you mean that it needs to be one with the squeeze ball & not an electric one?


Sometimes GB surgeries loan theirs out- presumably electric - would these readings be reliable?
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The old fashioned manual squeeze type are the only ones I trust. The others have automatic cut outs that screw up readings.

I think a lot of GPs assume that machines like Omron are reliable. They aren't.
 
Jonathan Edwards said:
The old fashioned manual squeeze type are the only ones I trust. The others have automatic cut outs that screw up readings.

I think a lot of GPs assume that machines like Omron are reliable. They aren't.
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Ahh. Thanks.

Would one need medical training to use one of the manual sort?

Or would it become impossible to fill up the cuff anymore and at that point just read the dial?
 
Ash said:
So no at home readings for people without a doctor with good hearing in the house….
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But doctors are just people who got taught something. I think it would be entirely possible to teach most people how to use a blood pressure machine reliably. People used to do that when all we had was old machines. But it does need to be taught by someone with a good understanding. Sadly these days in medicine that seems harder and harder to find.

Lots of people probably get a correct answer from an electric machine. It may be possible to teach people how to make sure it is set up right and all the pitfalls have been accounted for but that does not happen in my experience.

Using an old machine is not that difficult once you have got the knack. And understanding what you are listening for and why is not that hard, not really any harder than knowing that your chicken roast is likely to be done.
 
Jonathan Edwards said:
But doctors are just people who got taught something. I think it would be entirely possible to teach most people how to use a blood pressure machine reliably. People used to do that when all we had was old machines. But it does need to be taught by someone with a good understanding. Sadly these days in medicine that seems harder and harder to find.

Lots of people probably get a correct answer from an electric machine. It may be possible to teach people how to make sure it is set up right and all the pitfalls have been accounted for but that does not happen in my experience.

Using an old machine is not that difficult once you have got the knack. And understanding what you are listening for and why is not that hard, not really any harder than knowing that your chicken roast is likely to be done.
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Ahh good.
Perhaps we need an article & video tutorial from you? ;)

You can still buy the puff ones but in my search they were all pretty inexpensive which maybe suspect.
 
Ash said:
You can still buy the puff ones but in my search they were all pretty inexpensive which maybe suspect.
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They are very simple so should not cost much. They don't use mercury any more but I think the spring pressure gauges are reliable.

The basics are these:
1. Never have any clothes above the cuff that are tight - so never roll a sleeve up above a cuff. An accurate BP can be got through a shirt or even jersey as long as it is under no tension.
2. Make sure the cuff is big enough. This is the commonest error. It needs to wrap right round the upper arm to produce even pressure. Velcro cuffs are often too small and pull themselves half open when you pump them up. The cuff should not unfold at all during the process.
3. You will need to listen for knocking sounds in the brachial artery where it runs in front of the elbow just medial (nearer the body) to the big tendon from the biceps with the flat part of a stethoscope. The stethoscope can be cheap but the flat diaphragm has to be pressed well flat on to the arm in exactly the right place over the artery. I still have to fiddle around a bit to get it so that I can hear the sounds. You do not hear anything until you have started pumping up the cuff.
4. Pump up the cuff until the pressure gauge reads something like 150, or what you find is just above your usual readings. Then let air out very slowly so that the pressure falls by about 1 unit per second - 149, 148, 147. At some point you should hear a rhythmic knocking sound in the artery which is it shutting off after each pulse wave. If you hear a muffled sound that doesn't count - it may just be the artery changing shape. You record the pressure as systolic where the sound suddenly starts happening. You then let the pressure down a bit more until the sound stops knocking and record that as diastolic. Again, you may hear a muffled sound beyond this.

The sounds are due to the artery opening and then closing (the knocking). If cuff pressure is above systolic the artery does not open at all. If it is below diastolic it does not close. So you only get sounds in between.

A very common problem is that the procedure of taking a blood pressure can put your blood pressure up. So it is essential that it is done with the person completely calm and unbothered. Doing it yourself can be a good way of achieving that since it is often the fear of unexpected discomfort that puts it up.

Another problem with electric devices is that they expect the pulse to be 70 per minute or more. If your pulse is slow the machine thinks it has missed the pulse and ramps the pressure up to 250 and tries again, which is very uncomfortable and that puts your pressure right up! It also quickens the pulse so the machine takes a reading and makes you hypertensive.
 
Jonathan Edwards said:
Another problem with electric devices is that they expect the pulse to be 70 per minute or more. If your pulse is slow the machine thinks it has missed the pulse and ramps the pressure up to 250 and tries again, which is very uncomfortable and that puts your pressure right up! It also quickens the pulse so the machine takes a reading and makes you hypertensive.
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Ahh, thank you for that!

The NHS only ever uses electric machines, and I sometimes have to ask a nurse to stop trying after about the third attempt because the machine is pumping up the cuff so tight it's cutting off the blood supply. They can't work out why it's suddenly playing up after working fine all day. But if I've been sat reading the paper in a waiting room for 20 minutes my pulse will be in the mid 50s; if it's a hot summer day it can drop into the 40s. I'd no idea that could be causing the problem.
 
Jonathan Edwards said:
They are very simple so should not cost much. They don't use mercury any more but I think the spring pressure gauges are reliable.

The basics are these:
1. Never have any clothes above the cuff that are tight - so never roll a sleeve up above a cuff. An accurate BP can be got through a shirt or even jersey as long as it is under no tension.
2. Make sure the cuff is big enough. This is the commonest error. It needs to wrap right round the upper arm to produce even pressure. Velcro cuffs are often too small and pull themselves half open when you pump them up. The cuff should not unfold at all during the process.
3. You will need to listen for knocking sounds in the brachial artery where it runs in front of the elbow just medial (nearer the body) to the big tendon from the biceps with the flat part of a stethoscope. The stethoscope can be cheap but the flat diaphragm has to be pressed well flat on to the arm in exactly the right place over the artery. I still have to fiddle around a bit to get it so that I can hear the sounds. You do not hear anything until you have started pumping up the cuff.
4. Pump up the cuff until the pressure gauge reads something like 150, or what you find is just above your usual readings. Then let air out very slowly so that the pressure falls by about 1 unit per second - 149, 148, 147. At some point you should hear a rhythmic knocking sound in the artery which is it shutting off after each pulse wave. If you hear a muffled sound that doesn't count - it may just be the artery changing shape. You record the pressure as systolic where the sound suddenly starts happening. You then let the pressure down a bit more until the sound stops knocking and record that as diastolic. Again, you may hear a muffled sound beyond this.

The sounds are due to the artery opening and then closing (the knocking). If cuff pressure is above systolic the artery does not open at all. If it is below diastolic it does not close. So you only get sounds in between.

A very common problem is that the procedure of taking a blood pressure can put your blood pressure up. So it is essential that it is done with the person completely calm and unbothered. Doing it yourself can be a good way of achieving that since it is often the fear of unexpected discomfort that puts it up.

Another problem with electric devices is that they expect the pulse to be 70 per minute or more. If your pulse is slow the machine thinks it has missed the pulse and ramps the pressure up to 250 and tries again, which is very uncomfortable and that puts your pressure right up! It also quickens the pulse so the machine takes a reading and makes you hypertensive.
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Thank you very much for this! A detailed explanation really helpful :)
 
Sly Saint said:
I use an A&D Medical BP monitor that I bought, as this was the same as the one my GPs surgery loaned me to begin with.
I've used it to take it standing, sitting, lying down.

Click to expand...
Approved by the British Heart Foundation and on offer from them directly at the moment:

Buy approved Blood Pressure Monitors | British Heart Foundation

Buy BIHS Approved Blood Pressure Monitors from the British Heart Foundation. Check your numbers from the comfort of home. Wide range of leading brands.
shop.bhf.org.uk shop.bhf.org.uk
 
Jonathan Edwards said:
I think you probably have to understand how the process works. You have to listen for sounds as you lower the pressure and you have to know how to interpret the sounds.
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My surgery has been using the electronic ones for some time except for one GP not UK trained, Polish I think, who uses a sphygmomanometer. A friend of mine had his atrial fibrillation picked up by this during traditional BP testing which led to a lot of other tests, heart procedure, medication, reviews etc. He lived for several years after this dying from a stroke at the beginning of the first lockdown. Maybe this pick up gave him that few more years of life.
 
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