0604pressureaudHear cardiologist Gary Minkiewicz talk about how a home monitor can help patients control their blood pressure.
But if you have high blood pressure, chances are you only get your pressure checked a few times a year, when you go to a doctor’s office.
Many physicians now believe that’s not enough. About 72 million Americans have high blood pressure, also known as hypertension, and the majority do not have their condition under control.
That’s a serious concern.
"If blood pressure is not well-controlled, damage to blood vessels can cause strokes, heart attacks and aneurysms," said Dr. Gary Minkiewicz, a cardiologist with Northeast Georgia Heart Center in Gainesville.
Last month, the American Heart Association recommended that hypertension patients should have a home monitor that allows them to check their blood pressure every day.
The theory is that if patients keep a record of their readings, the doctor can see how much their level fluctuates on a daily basis, indicating whether the medication is working. The drug or dosage then can be changed if necessary.
Minkiewicz said he and his colleagues have been recommending home monitors for years.
"I am very happy to see the AHA pushing this," he said. "Having home blood pressures to work from is extremely helpful."
Minkiewicz said if he makes treatment decisions based only on a patient’s blood pressure reading at the doctor’s office, he may treat too aggressively.
"Some (patients) don’t have sustained, chronic high blood pressure that requires treatment," he said. "It may spike in response to stress, but it goes back down. The biggest error is that (the doctor) may prescribe unnecessary medication. Then the patient has blood pressures at home that are much too low and they end up passing out."
A consistent reading of 140 over 90 used to be considered the threshold for being diagnosed with hypertension. Now, the acceptable range is 100-130 for the upper (systolic) number and 50-80 for the lower (diastolic) number.
When Minkiewicz has a patient whose blood pressure has tested high several times at the doctor’s office, he advises them to start checking it at home.
Do-it-yourself monitors are sold at almost any pharmacy and can range from $30 to $100.
Minkiewicz doesn’t recommend getting the kind of monitor that requires a stethoscope, unless the patient is a medical professional who has been trained how to use it.
He also doesn’t recommend the self-inflating cuffs, because they’re more expensive. He suggests a cuff that the patient inflates by squeezing a bulb.
"There’s a console that has a liquid crystal display, and it comes with very good directions," he said. "It also tells your pulse, whether it’s regular or irregular."
The least expensive monitors are those that wrap around a finger or wrist. But Minkiewicz said they’re worthless.
"I always insist that (patients) get the ones that go around the arm, which are much more accurate," he said.
He instructs patients to check their pressure once a day and keep a written record for him.
"It gives me a much better idea of where their blood pressure is ranging, so I can make adjustments (in medication) as needed," he said.
But the monitor that works for one patient may not be appropriate for another. Eva Johnson, heart failure disease manager at Northeast Georgia Medical Center, said the self-inflating models are best for her patients.
"We recommend an automatic cuff that goes around the upper arm," she said. "A lot of our patients are weak, and it’s hard for them to press a bulb."
Johnson said many patients with congestive heart failure also have hypertension. But paradoxically, some of the drugs used to treat heart failure can cause blood pressure to plummet too low, so patients need to be monitored for fluctuations in both directions.
Johnson said most of her patients are on Medicare, which covers the cost of the monitors. "It’s a lot less expensive than the cost of most blood pressure medications," she said.
Private insurance doesn’t always cover the devices. But Minkiewicz said if patients have to pay out of pocket, it’s a worthwhile investment. A good monitor will last for years, and unlike the glucose meters used for checking diabetes, no test strips or other daily supplies are necessary.
"It’s a one-time expense," he said. "All you need is the monitor and a pencil and paper."
Johnson said the device can potentially save thousands of dollars in medical bills. "For our patients, keeping blood pressure under control can prevent re-hospitalizations," she said.
Do home monitors actually save lives? There hasn’t yet been a study that shows a direct connection. But according to statistics from the American Heart Association, 69 percent of people who have a first heart attack and 77 percent who have a first stroke turn out to have hypertension.
If their blood pressure isn’t brought under control, those patients may not be lucky enough to survive a second attack.