[HN Gopher] Blood pressure should be measured lying down: study
___________________________________________________________________
 
Blood pressure should be measured lying down: study
 
Author : Vaslo
Score  : 148 points
Date   : 2023-09-11 18:20 UTC (3 hours ago)
 
web link (newsroom.heart.org)
w3m dump (newsroom.heart.org)
 
| idoubtit wrote:
| The original media release[^1] is much clearer, with a 3 points
| abstract followed by a detailed summary. I don't know if this
| derived article was written by a human or by an AI, but I think
| it's junk like this that contributes to makes the web a mess of
| noise and echo.
| 
| [^1]: https://newsroom.heart.org/news/high-blood-pressure-while-
| ly...
 
  | dang wrote:
  | Changed from https://studyfinds.org/measuring-blood-pressure-
  | wrong/ above. Thanks!
  | 
  | Submitters: " _Please submit the original source. If a post
  | reports on something found on another site, submit the latter._
  | " - https://news.ycombinator.com/newsguidelines.html
 
| cm2012 wrote:
| I hate getting my blood pressure taken. It feels invasive when
| the coil squeezes my arm. I'll do it but only when necessary.
 
  | hwillis wrote:
  | invasive?
 
    | goostavos wrote:
    | I'm with this OP. I absolutely cannot stand it. I have no
    | good "logical" reason for why, but it's the most stressful
    | part of the doctors office for me. I've been as high as 170
    | at the doc due to sheer stress of getting the measurement
    | taken. I've tried "exposure therapy" by just doing it at home
    | every day, multiple times per day. It never stopped being
    | stressful.
    | 
    | I've also fainted during a blood draw. I _wish_ I wasn 't
    | this guy... but alas. I am begrudgingly this guy.
 
    | cm2012 wrote:
    | Yes, it makes me feel trapped.
 
      | genman wrote:
      | This description actually kind of makes sense.
      | 
      | What could help (or could have no effect) is taking the
      | blood pressure with the electronic device. There nobody
      | could be next to you (entrap you) and you would have a
      | complete control over the strap - you could take it off any
      | time you felt uncomfortable if you just wanted to.
      | 
      | I have an electronic meter at home and I use it time to
      | time to check my pressure. I can be much more relaxed and I
      | indeed usually lay down first.
 
      | hwillis wrote:
      | Hmm, fair enough. It is possible to measure BP at the ankle
      | (while lying down, legs flat), although it is usually
      | higher. If you do want to test it yourself, that's an
      | option. Your doctor probably won't really want to bother
      | but it's certainly worth asking if you think that would be
      | more comfortable.
 
  | [deleted]
 
| sdo72 wrote:
| I went through 2 high blood pressure periods in my life (~10
| years apart), and I think measuring blood pressure like this is
| very wrong to know the root causes of fix the problem. Here are
| my solution (at least to the young folks like myself):
| 
| 1. Avoid triggering factors like: the cold, salt, large meals,
| sour/sugary food, alcohol, even holding up urine, etc... I found
| these are not causes, they just make it worst.
| 
| 2. Breath, breath, and breath: learn to breath properly and the
| body will regulate the blood pressure. You can immediately test
| this by close your eyes and breath for 10-15', your blood
| pressure will go down, sometimes very significantly.
 
| TechBro8615 wrote:
| I think the bigger issue with measuring blood pressure is that,
| aside from diagnosed diabetics, it's a measurement done
| infrequently and at mostly arbitrary times. Your blood pressure
| reading on the day of a doctor's appointment, right after you've
| driven to the appointment, made your way through the intake
| pipeline, and finally sat down in the chair, is not
| representative of its reading during a typical day in your life.
| Other factors like recency of coffee or alcohol consumption,
| exercise and sleep, all combine to make blood pressure a fairly
| variable statistic with limited diagnostic power when it's only
| measured infrequently.
| 
| Regardless of whether you're lying down, standing up, or sitting
| in a chair, it would be beneficial to take more frequent blood
| pressure readings, throughout the day and during typical
| routines, than it would to only take them every time you visit
| the doctor. This seems like common sense, and you can even buy
| blood pressure sensors for $20 on Amazon, but how many people
| take their blood pressure on a regular basis? Once you're a
| diagnosed diabetic, then maybe you start measuring it every day -
| but wouldn't it be better to start such a habit _before_ you
| become diabetic? After all, if you 're continuously measuring a
| variable then you can notice patterns and anomalies, and take
| steps to mitigate them - possibly avoiding becoming diabetic
| before it's too late.
| 
| It seems the limiting factor is sensor technology, which is
| obviously lacking compared to wearable sensors for tracking heart
| rate. Any health-conscious person with an Apple Watch or similar
| wearable device can easily track their pulse throughout the day.
| But no similarly accurate and seamless sensor exists for
| measuring blood pressure (as far as I know?), so nobody measures
| it as frequently as they do their pulse. Once we have the
| technology to accurately and passively measure blood pressure
| throughout the day, preventive medicine will become much easier,
| and people will have a better feeling for how their blood
| pressure responds to small changes in their environment and
| lifestyle.
 
  | moffkalast wrote:
  | > it would be beneficial to take more frequent blood pressure
  | readings, throughout the day and during typical routines, than
  | it would to only take them every time you visit the doctor
  | 
  | It would be, if the most reliable way to get BP data wasn't to
  | apparently violently compress the upper arm until it physically
  | hurts and leave it like that for a minute. How people can do
  | that on any kind of regular basis completely escapes me, and
  | I'm not convinced it's not actively harmful. The wrist monitors
  | are tolerable but seem to be very sensitive to wrist height.
 
  | scythe wrote:
  | One time a doctor at the on-campus clinic looked at my blood
  | sugar reading said I might be prediabetic. This was an early-
  | morning appointment at a time in my life when I wasn't very
  | used to that and had rushed out of my dorm while scarfing down
  | a bagel that had been hastily topped with the only thing in the
  | cabinet that was in a squeeze bottle -- honey!
  | 
  | No blood test over the next decade showed even a hint of
  | elevated blood sugar.
 
  | zwieback wrote:
  | Yeah, I have a machine and unless I take measurements very
  | frequently (different times of day, etc.) it's really hard to
  | make sense of the numbers. You really need to get a long term
  | chart to weed out the noise.
  | 
  | I've been getting much better readings at the doctors but then
  | I realized I always ride my bike there, sit in the waiting room
  | for a while and then get a low reading. Not representative!
 
    | _ph_ wrote:
    | I am not sure, while the values obtained this way might
    | require calibration, it sounds like very controlled
    | conditions to me. The exercise should bring your body into a
    | very controlled state, beyond the physical load very relaxed.
    | So after a short rest, this should be a good time to get
    | reliable readings. But I am not a doctor.
 
      | zwieback wrote:
      | Yeah, agreeed, and I think the BP is a bit lower because
      | I'm warmed up and then rested a bit. My worst BP is in the
      | mornings after getting up and sitting and drinking coffee.
 
    | gryfft wrote:
    | I've been using Google Fit to track my blood pressure over
    | time. I've been measuring every other day. The charts really
    | are helpful.
    | 
    | The biggest correlation with my blood pressure is how regular
    | my sleep is. Once I started militantly waking and sleeping on
    | a set schedule, the numbers came down. They seem to spike for
    | a few days if my sleep gets messed up badly somehow.
    | 
    | I also have been trying to standardize my measurement: same
    | time of day, after sitting quietly alone for five minutes.
 
  | inglor_cz wrote:
  | There is a device called "holter" that you wear for a day and
  | it measures your BP repeatedly, even during the night.
  | 
  | https://my.clevelandclinic.org/health/diagnostics/16330-24-h...
  | 
  | I have worn a holter several times. I had better results than
  | in a doctor's office. It seems to be a classical case of white
  | coat syndrome.
 
  | m463 wrote:
  | I have a garmin watch and one wonderful thing it does is show
  | me my resting heart rate, which is a nice indication of my
  | level of fitness (and correlates with good sleep, sickness,
  | etc)
  | 
  | It also does nice things like a detailed check of my sleep, how
  | I'm acclimatizing to altitude when visiting the mountains, the
  | number of steps I walked and pulse-ox.
  | 
  | I don't know how these correlate to what blood pressure tells
  | you, but I blood pressure will be directly measured in the same
  | way in a few years.
 
  | ipqk wrote:
  | > Your blood pressure reading on the day of a doctor's
  | appointment, right after you've driven to the appointment, made
  | your way through the intake pipeline, and finally sat down in
  | the chair, is not representative of its reading during a
  | typical day in your life.
  | 
  | This is a known thing called White Coat Syndrome
 
    | [deleted]
 
    | Gibbon1 wrote:
    | That's actually different. The stress of being at the doctors
    | causes blood pressure to elevate vs more mundane things like
    | running, walking, driving stress. The difference is someone
    | without white coat syndrome will have a lower blood pressure
    | reading at the end of the doctors visit.
 
      | pixl97 wrote:
      | Honestly I think in most US cities the driving stress would
      | drive ones BP far higher. I know one time just right before
      | I got to the Drs office some one almost ran into me, I mean
      | just missed, and my BP was way high still.
 
  | serial_dev wrote:
  | People mentioned the white coat syndrome, but that's not the
  | only issue.
  | 
  | I am not nervous when they measure my blood pressure, but I
  | might have been late to my doctors appointment, so of my 25 min
  | walk to the doctor, I was running half of it. I had non-optimal
  | blood pressure values at the doctor, because I was running not
  | to miss the appointment, and as I arrived, I had to immediately
  | go get my BP checked.
  | 
  | After the incident, I religiously measured my BP at home
  | various times a day for a week and my numbers looked okay.
 
    | BaculumMeumEst wrote:
    | I was late to an optometrist appointment a few weeks back.
    | Sprinted up six flights of stairs and into the office. The
    | literal second I got in they called my name and immediately
    | measured BP. The tech looked like they were going to shit
    | themselves.
 
  | vonnik wrote:
  | Fwiw, OMRON produces high-quality blood-pressure monitors for
  | consumers.
  | 
  | https://omronhealthcare.com/blood-pressure/
  | 
  | Even these, though, tend to overestimate your actual blood
  | pressure, sometimes by as much as 10 points.
  | 
  | But having one in the home makes it easy to take several
  | readings throughout the day, since each one hardly lasts a
  | minute.
 
  | llm_nerd wrote:
  | I suffer from hypertension (which pushed as high as 170/120)
  | and went through a period where I was measuring my blood
  | pressure many times a day to try to essentially hack what the
  | problem was to try to find a natural solution.
  | 
  | What I learned is that, for me,
  | 
  | -salt intake had zero impact
  | 
  | -coffee had no impact
  | 
  | -stress level had almost no impact
  | 
  | -alcohol had no impact
  | 
  | -exercise / activity levels had no impact
  | 
  | The single and only controllable factor I could find, short of
  | drugs, was that if I was cold my blood pressure spiked
  | significantly. I had much higher BP in the winter than in the
  | summer, and could improve it by wearing layers, gloves, etc.
  | 
  | My body decided to go full ham on blood pressure and it was
  | destroying my kidneys. I would be constantly annoyed by the
  | sound of my own heartbeat doing things like trying to sleep.
  | 
  | Telmisartan + Caduet (which is amolodipine + lipitor) and now
  | my blood pressure averages 100/60. And courtesy of the lipitor
  | my cholesterol and triglycerides dropped 60%, from high to
  | normal. Many thanks to the very brilliant people who work in
  | that field and developed those drugs.
  | 
  | Anyways, thanks for coming to my TED talk on the magic of
  | modern medicine.
 
    | itissid wrote:
    | > I would be constantly annoyed by the sound of my own
    | heartbeat doing things like trying to sleep.
    | 
    | Wait what? explain more please.
 
      | llm_nerd wrote:
      | Pulsatile tinnitus (didn't know this name before but just
      | looked it up), which is when blood pressure is so high that
      | in quiet you hear your own heartbeat and the whooshing of
      | blood in your veins.
 
      | hwillis wrote:
      | Ever run real hard and felt your heartbeat in your ears?
      | Like that but always. It can also happen if you have valve
      | or other heart defects that cause enlargement, but that
      | isn't loud in your ears. It's just so loud in your chest
      | that you can hear it. Sometimes other people can as well.
 
    | ungruntled wrote:
    | Myself being someone who suspects that they have high blood
    | pressure (based on infrequent measurement), would you mind
    | sharing if you had any recurring symptoms (outside of hearing
    | heartbeat) when your blood pressure was at its peak?
 
      | rapfaria wrote:
      | Pain on the back of the head constantly, specially at the
      | end of the day.
      | 
      | Been on Olmesartan since then and couldn't be happier
 
      | llm_nerd wrote:
      | My initial decision to seek treatment was recurring massive
      | migraines that would wake me up in the middle of the night
      | and last for hours. I had known that I had high blood
      | pressure but didn't really track it closely at all, always
      | attributing the few really high readings I did get to white
      | coat syndrome (which is a very real, but it also can be an
      | easy dismissal as well). During one of those migraine
      | sessions I hopped on Amazon and ordered a unit.
      | 
      | It came and I was sure it was defective because it kept
      | measuring 170+ / 120+, which seemed impossible. A few days
      | later I stopped by a pharmacy with one of the big units,
      | and it read the same thing. So I visited my doctor.
      | 
      | He put me on 5mg of amolodipine and it did very close to
      | nothing. Then it was upped to 10mg and still little
      | benefit. It was the addition of telmisartan that completely
      | changed everything for me. The effect was overwhelming.
      | 
      | It's hard for me to really identify the symptoms because I
      | lived with it, I suspect, for many years. It was my norm. I
      | will say this: at my current blood pressure I constantly
      | feel _way_ more relaxed, physically. Like my body doesn 't
      | feel in a constant fight state.
 
        | ungruntled wrote:
        | Thanks. This is very helpful to me. I have weekly
        | migraines. I never thought to attribute it to high blood
        | pressure.
        | 
        | For the record, my blood pressure is not nearly as high,
        | but its typically 140/85 as infrequently measured. I've
        | never measured during a migraine, but I will now.
 
        | hwillis wrote:
        | dizziness can also be a symptom.
 
    | hwillis wrote:
    | Raynauds?
 
      | llm_nerd wrote:
      | Secondary Raynaud's absolutely. In any below room
      | temperature setting my fingers would be incredibly cold to
      | the point of being debilitating. I ended up being a glove
      | wearer in situations where it looked pretty goofy.
      | 
      | This has dramatically improved/disappeared under the
      | medication listed above.
 
        | url00 wrote:
        | Wow, it sounds so familiar to myself! I have all the same
        | symptoms and went down the path of testing BP and blood
        | glucose with similar results. How did you get the doctor
        | to prescribe the drugs? Or was it a pretty
        | straightforward diagnosis?
 
        | llm_nerd wrote:
        | To add to the great reply by hwillis, I just went to my
        | doctor with a concern about my blood pressure and he
        | prescribed amlodipine with follow-up bloodwork to make
        | sure there aren't other factors. When the amlodipine
        | wasn't effective he upped the dose with another set of
        | bloodwork, and then he added telmisartan and lipitor
        | (coupling it in with the amlodipine for convenience)
        | given cholesterol issues with my bloodwork.
        | 
        | There are a lot of different blood pressure medications
        | (like a ridiculous array of options) and I let my doctor
        | decide. There are side effects but I have suffered zero
        | of them, and now that the blood pressure is under control
        | my bloodwork across the board has been improving
        | significantly.
 
        | hwillis wrote:
        | Definitely does not sound straightforward given all the
        | things they tested and excluded. It also very atypical
        | and medicating specifically for this would be unusual.
        | That said it sure sounds like it perfectly treats the
        | root problem.
        | 
        | If you have symptoms like Raynauds and POTS (note that
        | POTS can be hard to demonstrate, so may be less
        | convincing to a doctor) then Amlodipine or similar may be
        | helpful. If you take it and you feel lightheaded when
        | standing up, or have trouble with exercise or fatigue,
        | you probably don't need it and it isn't good for you.
        | 
        | You may have more consistently high blood pressure rather
        | than transient spikes if you don't have POTS, or if you
        | don't react immediately to cold temperatures. In that
        | case an angiotensin blocker like Telmisartan may help. It
        | can take weeks to become effective, vs Amlodipine should
        | show effects in just a few days.
        | 
        | If you have high blood pressure then just telling your
        | doctor you want Amlodipine or something will probably be
        | enough- convincing insurance will be harder. Amlodipine
        | can be used off-label for Raynauds. If you don't have
        | particularly high blood pressure and haven't
        | systematically tried to exclude causes it will be harder
        | to convince your doctor. They might let you try it for a
        | bit to see if it helps, and the generic isn't too
        | expensive.
 
        | xattt wrote:
        | Amlodipine is a calcium-channel blocker which lowers
        | blood pressure by promoting systemic vasodilation. This
        | would have a beneficial side effect of counteracting
        | idiopathic vasoconstriction caused by Raynaud syndrome.
        | 
        | If the drug is taken with food (when drug absorption is
        | highest), some folks will develop edema in their legs for
        | several hours.
 
    | BaculumMeumEst wrote:
    | Wow, that sounds like quite an ordeal. Glad you landed okay!
    | I had no idea medication could have that strong of an effect.
    | 
    | I also have been checking my levels a little obsessively,
    | unsuccessfully trying to find ways to drop them. And like
    | you, I noticed that I spike during cold weather. I'm probably
    | particularly sensitive because I have very low body fat.
 
      | manmal wrote:
      | You probably tried potassium chloride/bicarbonate already?
 
        | BaculumMeumEst wrote:
        | I just tried upping dietary potassium with more bananas
        | and avocados and reducing sodium, haven't looked in to
        | potassium chloride/bicarbonate
 
    | aantix wrote:
    | What's your potassium level?
    | 
    | Potassium relaxes the walls of the blood vessels. It's a
    | counterbalance to sodium.
    | 
    | Doctors will say 3.5 is fine, but there are several studies
    | demonstrating that as you approach 4.5, the risk of cardiac
    | events drop.
    | 
    | Doctors get very tense about potassium supplementation in
    | fear of hyperkalemia.
    | 
    | But the RDA for potassium use to be ~4200mg. I'm guessing
    | most don't remotely approach the new or old RDA.
    | 
    | If you're taking potassium sparing medications, things are
    | further complicated. K levels would have to be checked more
    | often.
    | 
    | I supplement with potassium citrate. My blood pressure has
    | normalized.
 
      | llm_nerd wrote:
      | 4.5 mmol/L. Coincidentally just got a blood test six days
      | ago (this is in Canada and Lifelabs lets you see your own
      | results). I don't go out of my way to consume potassium at
      | this point, but my potassium has been 4.5 steady for all
      | the tests I've gotten over the past year. My sodium has
      | been rock solid at 139 mmol/L as well.
      | 
      | I didn't add it as one of my listed items, but I did try
      | supplementing with potassium before starting with
      | medication and for me it wasn't beneficial, though it
      | certainly would be for people with deficiencies.
 
      | aantix wrote:
      | Hyperaldosteronism.
      | 
      | If someone has a consistently low potassium level, you
      | should see an endocrinologist and get tested for
      | Hyperaldosteronism.
      | 
      | Surplus aldosterone causes the body to retain more salt,
      | which in turn increase blood pressure.
      | 
      | Consistently low potassium, early onset of hypertension,
      | taking three or more BP medications (one of which is a
      | diuretic), all red flags.
      | 
      | Hyperaldosteronism should be pursued.
      | 
      | I had my left adrenal gland taken out to address it.
 
      | hwillis wrote:
      | Potassium and sodium are also excreted together, so
      | decreasing sodium/increasing potassium typically results in
      | beneficial impacts on the other.
      | 
      | > Doctors get very tense about potassium supplementation in
      | fear of hyperkalemia.
      | 
      | Supplementing with potassium is not recommended because
      | it's not very effective. 99 mg of potassium citrate gives
      | you only 38 grams of potassium- *you need ~100 pills to get
      | your daily value!* You will see much better results from
      | changing your diet to include more potato (note: 1/4 of the
      | potassium is in the skin), beans, and spinach (although a
      | _lot_ of spinach- 10oz has as much as a large potato). One
      | large potato can give you 900 mg of potassium.
 
  | jliptzin wrote:
  | Are you confusing blood pressure and blood sugar? My boyfriend
  | is type 1 diabetic, he measures his blood sugar multiple times
  | a day, but I have never seen him measure his blood pressure.
 
  | Buttons840 wrote:
  | What you say is true, but at the end of the day blood pressure
  | readings in the flawed doctor's office setting are still
  | correlated with medical outcomes.
  | 
  | I just want to speak against a trend people have to dismiss bad
  | medical news by finding excuses. "The blood pressure reading
  | doesn't count because I was nervous in the doctors office";
  | it's true, but the guidelines have probably accounted for that.
  | "That medical study doesn't apply to me because it was done on
  | the general population, but the general population is
  | overweight and I'm not"; "that study doesn't apply to me
  | because I do yoga, they didn't study people who do yoga"; etc.
  | 
  | I know it's hard, I'm in the middle of excusing some bad
  | medical news of my own right now, trying to decide what's best
  | for me.
  | 
  | Medicines have risks, untreated conditions have risks, choose
  | your risk, but don't live in denial that the risk exists.
 
    | kalensh wrote:
    | My issue is that blood pressure is being used by many
    | corporations/health insurance plans to determine your
    | premiums. So adding yet another layer of nervousness - you
    | will be paying extra money over the course of the next year
    | if your blood pressure is a little high (threshold is
    | 120/80).
 
      | pkaye wrote:
      | In the US, your health or medical history can't affect your
      | health insurance premiums.
      | 
      | https://www.healthcare.gov/how-plans-set-your-premiums
 
    | anonuser123456 wrote:
    | >but the guidelines have probably accounted for that
    | 
    | They have not. The guidelines are against controlled studies
    | with strict protocols on how to take the measurement.
    | 
    | To know your blood pressure relative to the guidelines, you
    | want to be as close to the guideline protocols and possible.
    | That can be a 20/10 point difference or more.
    | 
    | The average physicians office doesn't follow those protocols
    | unless you deviate significantly. e.g you walk in with 140/90
    | and they aren't going to bother. 160/95 and they will recheck
    | you with more care given to the proper measurement technique.
    | 
    | This isn't to say one should dismiss the numbers when taken
    | properly; I'm just pointing out that calibration is
    | necessary.
 
      | nomel wrote:
      | I'm a nervous person. There have been several times where
      | they had to recheck, because my rate was so high. My watch
      | says my resting rate is 40 to 50 lower. Whatever protocols
      | probably didn't have me in mind.
 
        | Buttons840 wrote:
        | We're talking about blood pressure. Does your watch
        | measure blood pressure?
        | 
        | I think this might be an example of what I was talking
        | about: you think blood pressure guidelines might not
        | apply to you because of something your watch says.
 
  | redox99 wrote:
  | At least in my country, to diagnose you with high BP they'd
  | have you wear a holter monitor for 24 hours.
 
    | readthenotes1 wrote:
    | That's standard in the US as well.
 
  | ljosifov wrote:
  | You are spot on. Random once a year BP measurement is not good
  | enough. Doctors are being asked to provide life altering advice
  | while being effectively blind in this case. I have no idea why
  | we don't try harder to make their (tough) job easier rather
  | than just accepting the current (sorry) state. My cars and my
  | computers have more sensors on them than I have on me! That's
  | crazy - I have to drop nearly dead and only then will I go to
  | doctors' for diagnosis and treatment. My car preventative
  | maintenance is miles better.
  | 
  | After being diagnosed with elevated BP, I googled and read what
  | I could and concluded: 1) Cheap "BP monitors" on Amazon just
  | show random readings or the same readings so they are worse
  | than useless: someone may actually use them and believe their
  | readings. 2) There are only few smart watches that have BP
  | measuring function.
  | 
  | I am currently using Samsung Watch Active2, and it seems to do
  | the job. There is calibration that is good for 30 days only.
  | After 30 days it expires and I calibrate it again. Calibration
  | involves making 3 measurements in parallel, watch on one hand
  | and manual BP monitor on the other. After each measurement on
  | the manual BP monitor, I tell the watch App what was measured.
  | 
  | After each calibration I do another 3 measurements in parallel,
  | again using both the watch and the manual monitor. I compare
  | the watch (post calibration) readings with the manual BP
  | readings. Usually the difference is small within few percent.
  | If it is more than 8-10% I redo the calibration. This has
  | happened 2 times in the 25 odd calibrations I have done.
  | Usually the reason is noise instead of perfect silence (person
  | coming in the room and talking, TV being turned on).
  | 
  | I have tried using the watch on Person2 after being calibrated
  | on Person1 - and Person2 got crazy BP readings. So the
  | calibration really does something, it is not nothing.
  | 
  | The watch measurements also approximately agreed with
  | measurements taken over 24h period when I wore BP holter
  | (automated BP cuff that inflates every 30 mins and measures and
  | records the BP).
  | 
  | Over time I have become more lazy with the re/calibration: now
  | several days pass before I re/do it. So I'm acutely aware that
  | any non-100% automated data collection will eventually be
  | abandoned on long enough time horizon. Redoing the same is
  | boring and becomes more so with time.
 
  | _ph_ wrote:
  | You are so right. Earlier this year I had to spend a week in
  | hospital and they took a variety of measurements every day. It
  | was interesting to see how much variation there was, especially
  | in blood pressure. But one thing was especially interesting,
  | pulse. As I was wearing my Apple watch, I had the values for
  | blood and blood oxygene before they took them. And with pulse,
  | you could clearly see with the graph, how much systematic
  | variation there was. So their single measurement was not great.
  | Best example, the last measurement was taken before I was about
  | to be released, awaiting the doctors sign-off visit. Of course
  | my pulse was off. But the doctor was quite interested to see my
  | pulse for the last couple of hours.
  | 
  | People underestimate how valuable a medical tool the Apple
  | watch already is and how game-changing it can get if they
  | manage to extend the sensor suite - as you say, blood pressure,
  | perhaps also body temperature and glucose level.
  | 
  | Another fun fact from the visit, they did monitor glucose level
  | and one morning they did so directly after waking me up. Which
  | caused the nurse to run to get me an early breakfast as it was
  | very low. Not as if I hadn't known for decades, that I need a
  | slow start and at least a small bite for breakfast to get into
  | gears...
 
  | hwillis wrote:
  | > so nobody measures it as frequently as they do their pulse.
  | Once we have the technology to accurately and passively measure
  | blood pressure throughout the day
  | 
  | It's surprisingly tricky. The way a BP cuff works (the
  | auscultatory method[1]) is that the pressure is continuously
  | decreased and you listen for the sound of a pulse. When the
  | cuff pressure is higher than your systolic (peak) pulse,
  | bloodflow is blocked and you don't hear a pulse. When the cuff
  | pressure is lower than your diastolic, the cuff is no longer
  | blocking bloodflow at all, and the pulse suddenly becomes much
  | quieter because it's not restricted. It's only between the two
  | pressures that you hear it extra clearly.
  | 
  | So the problem with a sensor is that you can't just measure
  | pressure against the skin. At minimum, it really should
  | actually impede a large artery. You can squeeze the arm as
  | tight as you like but if the brachial artery is not affected
  | then your measurement will be very poor.
  | 
  | You can do fancy computer vision etc to look at special
  | veins/arteries, and coupled with some demographic assumptions
  | you can infer somewhat accurate measurements- but they really
  | miss out on outliers, which is really a lot of the point of
  | taking measurements. This also generally will require an upper
  | arm strap or something, and be fairly tight. Not great to wear
  | always
  | 
  | At some point, I think we will probably see implantable blood
  | pressure monitoring. We do something similar with implantable
  | glucose monitors- which need regular replacement,
  | unfortunately. BP probably wouldn't. Problem is that direct
  | pressure measurement is usually done by tapping off an artery-
  | something that will never be routine. You'd want to do some
  | combination of acoustic and pressure measurement, and it'd need
  | to be calibrated from a base station regularly.
  | 
  | [1]:
  | https://en.wikipedia.org/wiki/Blood_pressure_measurement#/me...
 
    | alphanumeric0 wrote:
    | Yes, the most accurate method is via arterial catheter. It's
    | basically a needle directly into the artery.
 
    | jkingsman wrote:
    | Worth mentioning that BP is about _arterial_ , not venous
    | pressure. Venous pressure is an order of magnitude lower than
    | arterial pressure; usually 0-10mmHg.
 
      | hwillis wrote:
      | ty, edited. oopsies!
 
    | boringuser2 wrote:
    | I'm confused.
    | 
    | The technology already exists and is approved by the EU.
    | 
    | https://aktiia.com/
 
    | TechBro8615 wrote:
    | I wonder if there are methods that could take advantage of
    | natural movements throughout the day, where your body
    | naturally emulates what the cuff forces it to do. For
    | example, when you transition suddenly from sitting to
    | standing, is it possible for a sensor to measure some proxy
    | metric that, combined with an accelerometer, can be used to
    | infer blood pressure? If there is some method like this, even
    | if it has large margins of error, maybe cumulative
    | measurements could converge on a fairly accurate reading?
    | 
    | (I'm not a medical professional nor do I know much about
    | sensing, or even really the basics of how blood pressure is
    | measured or what it indicates.)
 
  | tguvot wrote:
  | take a look at aktiia. tracks blood pressure through the day.
  | currently under trials in usa to get fda approvalm but you can
  | buy it from eu
 
| Mobil1 wrote:
| Any disparity between interarm BP--especially when large and
| persistent--should prompt consideration of diseases known to be
| the cause: coarctation, dissection, or aneurysm of the thoracic
| aorta; Takayasu (pulseless) disease; and various types of intra-
| and extra-arterial obstruction in an upper extremity.1,9,11,23,24
| These diagnostic considerations become much more likely if the
| arm with the lower BP also has a grossly diminished radial pulse.
 
| Blammar wrote:
| Am I correct in interpreting this study that your recorded BP
| should be the MAX of sitting BP and supine BP?
 
| giantg2 wrote:
| We also need people who are knowledgeable on how to take blood
| pressure. Seems like half the time the nurse uses a machine and
| has that thing cranked up to 200mm so they don't have to redo it
| if the patient is high. No shit my blood pressure is elevate - I
| can feel my pulse get stronger because my arm isn't getting any
| blood flow.
| 
| Similar thing with my petite old grandma. Always measured high if
| an unknown person did it because they would overinflate. But when
| someone would just put it 20 over her previous known good
| reading, then her blood pressure was fine.
| 
| But nobody cares. In, out, get paid.
 
| Gualdrapo wrote:
| I don't know about you but getting somewhat concise readings for
| my blood pressure at several facilities has been difficult in
| here.
| 
| When I went to the medical exams to get my drivingllicense one
| year ago I was told my blood pressure was a bit high - maybe due
| to the nervousness of being checked, but it was better to ask my
| doctor - both of my parents suffer from high blood pressure.
| 
| So I did. He told me my blood pressure was high and gave me that
| famous table to fill up with daily readings for two weeks.
| 
| My sister (physiotherapist) has a sphygmomanometer at home but
| she will scream at me to be perfectly still and seated for at
| least 5 minutes before doing the reading - and it _always_ was
| 120/80.
| 
| Went several days to a nearby pharmacy and they gave me a little
| chair to be sat for 10 minutes before standing up and going to a
| small cubicle where they did the measurement with an electronic
| sphygmomanometer. Measurements there always were fairly
| inconsistent and above 131/87 - going up to 150/87.
| 
| Also went to several other points to get my blood pressure
| measured and they always had a different method and
| (unsurprisingly) yielded different results. But for some reason
| when they measured with analogic/traditional sphygmomanometers,
| the measurements always were lower compared with electronic ones.
| 
| Fortunately could afford a decent electronic sphygmomanometer for
| myself and started doing my own measurements, which are
| fluctuating between 117/77 and 122/82.
 
  | pixl97 wrote:
  | When you say you went to the pharmacy and doctors office, did
  | you drive?
  | 
  | BP level seems to highly correlate with the environment you're
  | in, stressful driving can bring it up and keep it high for a
  | while.
 
| [deleted]
 
| Mobil1 wrote:
| A recent study confirms a link between different arm-to-arm blood
| pressure and an increased risk for heart attack, stroke and
| death.
 
| cableshaft wrote:
| Well....that sucks. Maybe I don't have normal blood pressure.
| 
| Doctors never test me lying flat. Closest I've gotten is laying
| at an angle in a hospital bed.
| 
| I'm a middle-aged heavyset guy as well, so I know I'm at greater
| risk for these things.
 
  | bpoyner wrote:
  | I've only once had a doctor test my blood pressure lying flat.
  | I had a suspected GI bleed and he wanted to see the difference
  | between flat and sitting up. Then he called up the hospital and
  | got me a spot reserved in the ICU.
 
  | Aurornis wrote:
  | An at home blood pressure cuff is relatively cheap if you're
  | concerned about it.
 
    | lowercased wrote:
    | Seconded. Got one and tested myself a couple times a day for
    | a few weeks. I'm not necessarily sure it's 'accurate', but
    | having repeated readings from same device, same arm, same
    | position, same times of day seemed to at least show
    | consistency and identify when things were out of whack (a
    | couple times). Got one for about $25.
 
  | Broken_Hippo wrote:
  | My doctor's office sent me home with a monitor for 24 hours. It
  | tested every 15 minutes during the day and every 30 minutes
  | during the night. I generally went about my day at home and
  | eventually even slept.
  | 
  | This seems pretty normal in Norway - but I don't think it was
  | in the US (Am from the US, father had heart problems). Perhaps
  | your doctor would be able to do something similar, though.
 
    | WWLink wrote:
    | Yea they do that in the US as well. But not very often.
 
| umeshunni wrote:
| Saved you a click: Our findings suggest people with known risk
| factors for heart disease and stroke may benefit from having
| their blood pressure checked while lying flat on their backs
 
  | [deleted]
 
| Gys wrote:
| > Sixteen percent did not have high blood pressure -- a reading
| greater than 130/80 mm Hg -- while seated. However, these same
| people did show high blood pressure when researchers measured
| their BP while lying flat on their backs.
 
| clumsysmurf wrote:
| Seems like it might also be important to check the difference in
| pressure between the two arms
| 
| https://www.uclahealth.org/news/why-you-should-have-your-blo...
 
| wing-_-nuts wrote:
| TLDR: Doctors need to check blood pressure while the patient is
| laying down.
| 
| I do wonder about recent changes that suggest anything beyond 120
| / 80 is above 'normal'. You would think that something like blood
| pressure would be highly regulated in the body but it varies
| throughout the day, month and year.
| 
| They also say that salt is seriously bad for high blood pressure
| but I find little effect for myself personally. I do wonder how
| much sensitivity varies from person to person.
 
  | UncleOxidant wrote:
  | > but it varies throughout the day, month and year.
  | 
  | yep. I've taken my BP laying down and it's generally lower than
  | when I'm sitting up, but then again, I usually do that after
  | going to bed, blood pressure is generally going to be lower at
  | night so maybe I'm just noticing that difference vs during the
  | day.
 
  | [deleted]
 
  | SirMaster wrote:
  | Technically 80 diastolic is considered hypertension stage 1
  | under the current guidelines.
  | 
  | https://www.heart.org/en/health-topics/high-blood-pressure/u...
  | 
  | The highest you can be and be considered "normal" is 119/79.
  | 
  | Elevated is 120-129/<80
  | 
  | Stage 1 hypertension is 130-139/80-89
  | 
  | Stage 2 hypertension is 140+/90+
 
    | noman-land wrote:
    | Did you mean to say stage 2 in your last line?
 
    | themagician wrote:
    | *in the US.
 
  | lawlessone wrote:
  | I think if you get a decent amount of water and potassium your
  | body is able to more easily expel the excess sodium
 
    | vitorgrs wrote:
    | I have hypertension and take my med everyday... If you drink
    | watermelon juice, it makes wonder to incredible lower it.
 
  | Aurornis wrote:
  | > They also say that salt is seriously bad for high blood
  | pressure but I find little effect for myself personally. I do
  | wonder how much sensitivity varies from person to person.
  | 
  | You'd be shocked at how much salt some people consume. A little
  | bit with your vegetables or steak isn't going to move the
  | needle, but some processed foods have unbelievable amounts of
  | sodium relative to how they taste.
  | 
  | Salt definitely impacts blood pressure. Salt supplements are
  | used with good effect in certain conditions of low blood
  | pressure/volume.
 
    | btilly wrote:
    | Most would be shocked at how much salt they consume.
    | 
    | That healthy prepackaged salad option at the grocery store?
    | Often has more salt than a burger!
 
      | wing-_-nuts wrote:
      | I mean, I make my salads to be both nutritious AND tasty,
      | and yeah, salt's an important part of that. I'm not eating
      | just raw veggies with a light sprinkle of balsamic
 
        | btilly wrote:
        | And if I ate like you do, I'd wind up in the hospital.
        | Again.
        | 
        | We've discovered that humans respond really well to a
        | particular mixture of sugar, fat and salt. Basically
        | every prepared food has about the same mix of those
        | three. That mix is lethal for me.
        | 
        | In the case of salads they do that by using the veggies
        | as a salad dressing delivery mechanism. If I can't add
        | the oil and vinegar myself, I can't eat the salad.
 
    | black6 wrote:
    | Salt is water soluble and your body peepees and sweats out
    | what it doesn't need. Most people don't consume too much
    | sodium; they consume too little water and don't get enough
    | exercise.
 
    | croes wrote:
    | According to this
    | 
    | https://news.ycombinator.com/item?id=37355083
    | 
    | Sodium isn't the problem
 
      | pdonis wrote:
      | I think a better take would be: sodium isn't the _only_
      | possible problem.
 
  | hwillis wrote:
  | > You would think that something like blood pressure would be
  | highly regulated in the body
  | 
  | Counterpoint: a 6' (1.83 m) tall column of blood has a pressure
  | of 142 mmHg at the bottom- higher than your normal blood
  | pressure. When you change posture from prone to sitting to
  | standing, your blood pressure is basically swinging 100%. Hell,
  | the diastolic blood pressure at your feet is almost double what
  | your arms are at.
  | 
  | Plus, the oxygen consumption of various body parts is hugely
  | variable. More oxygen requires more blood and more blood
  | requires more pressure. With that kind of variance all over
  | your body it's not a shock that it's also generally pretty
  | variable.
 
  | nradov wrote:
  | The issue with salt and blood pressure is not so much the
  | quantity but rather the osmolality. You can mitigate the
  | effects by drinking more water.
  | 
  | https://peterattiamd.com/rickjohnson2/
 
  | bryanlarsen wrote:
  | AFAICT and INAMD, but it's generally accepted that potassium is
  | good for your heart. Sodium may or may not be bad for the heart
  | by itself, but it also limits potassium absorption. So the
  | differences in sodium sensitivity between individuals might be
  | more about potassium than sodium.
 
  | btilly wrote:
  | Sensitivity varies by a lot.
  | https://www.heart.org/en/news/2021/04/26/salt-sensitivity-ma...
  | 
  | I'm at the extreme end of sensitivity. If I want my blood
  | pressure medications to work, I need to eat something like half
  | the recommended daily allowance of salt. Let's just say, eating
  | out is a challenge.
 
  | zingababba wrote:
  | Salt absolutely does not matter for me. I eat a ridiculous
  | amount of salt. Caffeine on the other hand == day long 10-20
  | point increase in my systolic BP regardless of if I'm using
  | chronically or not. Ultimately one of the primary reasons I
  | quit caffeine.
 
    | Try1275 wrote:
    | Do you drink decaf?
 
      | zingababba wrote:
      | I don't :)
 
| nmz wrote:
| I went to a cardiologist and was tested while lying down. This
| was an extensive test though.
 
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