To measure the patient’s blood pressure is a routine and essential part of most of the doctor visits. It is done to keep a close check on the vital signs as there are many medical problems which are associated with prehypertension, hypertension (high BP) and hypotension (low BP). To be on a safer side, a person should get the blood pressure checked at least once in two years. Blood test is the method to check if there are any chances of developing heart diseases or stroke at an early age.

The doctor may advise checking blood pressure at a younger age in certain cases to prevent the risk of heart problems, such cases include, if there is any family history of heart disease, high or low blood pressure, obesity, and frequent headaches. In case the patient is suffering from hypertension or hypotension, the patient must get blood pressure checked more frequently (almost every day). Especially the geriatric population should get BP checks done frequently as the problem of hypertension (high blood pressure) is very common in old aged people primarily because in the old age the arteries start getting stiffer and the vascular system changes leading to an increase in the blood pressure. Also by checking the blood pressure the doctor gets to know about patient’s overall physical health. Hence, it is important to keep monitoring blood pressure regularly, BP monitoring of patients.

Checking the blood pressure even on a daily basis has no risk to the person's health in any way. It is a very safe method to know a patient’s physical health state. There might be a slight discomfort felt by some patients when the patient’s arm is tied with the cuff and squeezed but the discomfort is only for a few seconds. If a patient is taking any antiplatelet drugs, then there might be some small red spots (petechia) observed on the area of the arm below the cuff.

There are no specific preparations required for the blood pressure test. The patient is suggested to wear a short-sleeved shirt as it is easy for the technician or the nurse to assess the brachial artery on the arm. The blood pressure apparatus is kept at a height parallel to the patient’s heart. The doctor usually advises the following points before the blood pressure test:

• Empty bladder – Patient is advised to go to the toilet before BP is measured.
• Avoid eating
• Avoid drinking caffeinated beverages
• Avoid smoking at least one hour before the test
• Avoid strenuous exercise at least one hour before the test.
• Avoid medications like any pain relievers, birth control pills, antidepressants, cold medicines (decongestants), immunosuppressants and herbal supplements.
• Avoid consuming any illegal drug such as anabolic steroids, methamphetamine or amphetamines, and cocaine.

It is important to inform the doctor if the patient is already taking any medications so that the doctor can advise whether to take the medication before the blood pressure test or not.

Steps before the procedure:

A patient, before the blood pressure test, can follow certain steps as mentioned below:

• Find a silent/quiet place.
• Check the size of the cuff and avoid any vigorous movements.
• Ask questions to the healthcare provider if in doubt.
• Roll the sleeve up or remove any tight fitted clothes. It is preferred to check the BP from the left arm if the patient is right-handed.
• Relax for 5 to 10 minutes in the chair. The arm should rest safely on the table at the level of the heart with the palm facing upwards.
• Sit straight with the back upright, legs unfolded/uncrossed touching the ground.
• Avoid talking while the test is in progress

During the blood pressure test:

• A cuff will be tied on the upper arm of the patient and slowly inflated with air. This cuff is attached to a display or equipment known as Sphygmomanometer.
• The technician or the nurse will feel the brachial artery on the patient’s arm and put the diaphragm of the stethoscope on it.
• While checking the BP the patient will feel a slight squeeze on the part of the arm where the cuff is tied.
• After about a minute, the cuff would be released, the air let out and immediately the technician or the nurse will tell the readings.

After the procedure:

After the BP is checked the doctor will inform the patient if the blood pressure is high or low than normal (120/80 mm Hg). The doctor will be able to assess the physical condition of the patient based on the reading of the Blood test. Also the doctor can get an idea about any risks of heart diseases or any other associated issues and accordingly can prescribe medicines or any treatment to the patient if needed.

If the blood pressure is not normal then the doctor will advise the patient to get BP checked frequently in order to closely monitor the problem. The patient is allowed to go home after the test is done. The patient can then eat and drink normally. Keeping a record of Blood pressure readings, as and when they are done, is helpful for a better understanding of the changes occurring in the body. The blood pressure can change every day and every moment

Getting an understanding about the blood pressure test results is easy. The reading of the blood pressure is measured in “mm Hg”. Both the systolic pressure and diastolic pressure are measured in the Blood test.

 Blood pressure results can be classified as mentioned:

1. Normal Blood pressure – Systolic pressure should be less than 120 mm Hg and diastolic pressure less than 80 mm Hg.
2. Low (hypotension) blood pressure – Systolic pressure below 90 mm Hg and diastolic pressure below 60 mm Hg.
3. Prehypertension – Systolic pressure is in the range 120-139 mm Hg and diastolic pressure between 80-89 mm Hg.
4. Hypertension/elevated/high blood pressure-
• Stage 1 – Systolic pressure in the range 140-159 mm Hg and diastolic pressure between 90-99 mm Hg.
• Stage 2 – Systolic pressure in the range 160 mm Hg and above and diastolic pressure in the range 100 mm Hg and above.

The blood pressure ranges mentioned above may be lower in teenagers and children. In addition, if the parents feel that their child has a blood pressure problem then they must consult the doctor immediately.

Recommendations in cases of Prehypertension and Hypertension (stages 1 and 2) -

If the blood pressure of the patient is higher than the normal values, then the doctor might suggest making some changes in the lifestyle as mentioned below:

• Nutritious Diet – The patient is advised to have a nutritious diet like eating fruits, green vegetables, low-fat dairy food, and whole grains. The patient is also advised to consume less total fat and saturated fat foods.
• Reduction in salt consumption – For the people who are of 51 years age and above, chronic kidney patients and diabetic patients should not consume more than 1,500 milligrams (mg) of salt in their food per day.
• Exercises – Obese or overweight patients are advised to loose weight by at least 5 pounds. Regularly doing exercises or performing physical activities can keep weight and blood pressure in control. At least 30 minutes of exercise, 5 days a week is helpful.
• Quit smoking – Patients are advised to quit smoking or avoid passive smoking as it has very injurious effects on the health of the patient.
• Control alcohol consumption – Patients are advised to reduce their alcohol consumption to one drink a day for people with an age of 65 years or above. Also women are advised to have maximum 1 drink per day and men are advised to have not more than 2 drinks per day.
• Stress management – A person should take counseling for managing the stress and keeping the blood pressure in control.
• Avoid caffeine – People with high blood pressure are advised to avoid caffeinated beverages.
• Avoid medications – The doctor should be informed about all the medicines the patient is taking. This would help the doctor in assessing the medications and prescribing the patient to stop the medicines, which are resulting in high blood pressure.

Recommendations for low blood pressure –

People having a low blood pressure than normal without signs or symptoms of any malignancy, do not require any special treatment. However, people with mild symptoms, such as blood pooling (fainting while standing), are advised to have a healthy and nutritious diet, drink lots of water and exercise regularly.

Q1. How can I get accurate or normal blood pressure?

A1. The blood pressure rises due to some of the following reasons:

• Smoking
• Stress
• Caffeine
• Full stomach
• Exercise
• Full bladder
• Cold temperatures
• Certain medications

Avoiding these reasons, would help in controlling blood pressure largely. Also it is advised to measure blood pressure at the same time each day.

Q2. What health issues are associated with hypertension?

A2. There are multiple health issues related to elevated blood pressure.

• Heart diseases – Hypertension causes heart failure.
• Kidney diseases – High BP causes the filtration problems in the kidneys making them incompetent in excreting out the waste properly.
• Stroke – Hypertension leads to the weakening of the walls of the artery and hence, causes them to rupture.
• Atherosclerosis – High BP lead to a condition called Atherosclerosis, wherein certain plaques or fatty substances block the arteries causing more force and stress on the artery walls.
• Eye problems – High BP can damage the tiny blood vessels present in the retina.