Which would you believe?

1. Manual BP check (Stethescope held by a nurse with good hearing): "I can barely hear your pulse!  - I come up with something like 85/48."

2. Arm BP device: Usually "E" - due to my PVC's or various numbers high and low.

3. Wrist BP device: Seems the most reliable. My usual numbers are 105/64 P85 PVC's ignored 

Who would YOU believe?



The gold standard

by crustyg - 2019-08-15 10:56:54

The gold standard was (and still is) intra-arterial pressure monitoring.  Many, many studies have shown how easy it is to get the wrong values, compared to the gold standard.

Cuff size, Korotkov phase IV or V sounds, poor arterial supply, aortic co-arctation, posture, lack of support for the arm during BP measurement, immediately prior activity etc. can all lead to incorrect values.

It seems *unlikely* that you'll be happy and free from faintness when standing unaided at 85/48, but one learns in Medicine to accept all things at face value until there is good evidence that they are wrong.

Why does it matter so much? They think you're hypertensive?!!


Blood pressures

by Dave H - 2019-08-15 11:16:37

Actually, hypotension has been my buggaaboo!


Blood Pressure Measurements

by IAN MC - 2019-08-15 12:10:08

Hi Dave . I am in the UK and have always had concerns about blood pressure measurements :-

-  It is not that long ago since a systolic ( top number ) of   "100 plus your age " was considered to be normal. I know for a fact that the pharmaceutical industry ( who are never selling enough tablets)  had enormous input into persuading the medical profession to lower their BP targets !  I am very aware of the published evidence to support current targets ( which I believe are lower in he U.S. than in Europe ) but I often wonder if blood pressure problems are over-diagnosed ?

- If I go anywhere near my GP surgery I am dragged in and told that they will measure my BP ( " while you're here  " )    My cynical side never lets me forget that UK doctors are financially incentivised to  measure B.P.  and diagnose blood presssure problems

- I believe that  ' White Coat Syndrome " is often ignored by the medical profession.. My readings are a good 25 mms higher when done in-surgery than at home

- My GP asks me to measure my BP 2 or 3 times a day and work out " average " readings. Common sense would suggest that it may be spikes in BP which lead to problems such as strokes !

In answer to your question. Like you I had a wrist monitor which correlated really well with my GP's big machine but I'm sure Crusty is right in suggesting the more invasive intra-arterial method is the only method which is truly accurate.

You seem to have a hypotension issue. If I were you, I would increase my salt intake and see what happens or, better still, ask your Dr for advice !

Best of luck




Blood pressures

by Dave H - 2019-08-15 12:40:14

Hi, Ian! Cardio guy has instructed me to half my daily Tamulosin intake from 0.8 mg to 0.4 mg and also half my metoprolol to 50mg daily down from 100 mg daily. We'll see what happens!!


Blood pressures

by Dave H - 2019-08-16 20:54:21

Why this poo pooing of the wrist device?  The "Gold Standard" to pulse checking has been the wrist. Three days ago, I had a left and right heart cath procedure. That blood flow from the wrist catheter insertion site was he-man. Again today, arm BP device readings: "E", then the next: 85/55 P44 (PVC's at play).  Wrist device showed 106/70 P85. I'm sticking with the wrist!!


BP Measurement

by donr - 2019-08-18 01:19:38

I'd believe all choices!  BTDT.  If you have PVC's frequently, an automatic device can easily be spoofed.  In my humble opinion, as a patient having a BP measured nearly 1000 times (I'm an old coot, like Ian),  I would not opt for the intra-arterial method for routine measurements - too invasive. 

To me, the gold , non-invasive method is a manual cuff + a stethoscope.  Your nurse m ay not have as good a hearinf acuity as he/she claioms.  They may not sense the wimpy beat of a PVC any better than the auto devices.  Frequently, you mrrd to use common sense - if the wrist device has successfully workrd for you, ny all means depend on it.  My wife has problems w/ BP measurement, & techs taking it routinely go for the wrist device - which worls quiter nicely.  BTW - I have a lot of PVC's so know3 whereof you speak on thoi issue.


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