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HEALTH organizations such as the American Heart Association and American Society of Hypertension (hypertension is the medical term for high blood pressure) recommend that individuals with high blood pressure monitor their readings more often at home since, for the millions of women with high blood pressure, intermittent blood pressure checks at the doctor’s office might not be enough, says the October 2013 issue of the Harvard Medical School’s Harvard Women’s Health Watch.

Home blood pressure monitoring can help:

• Guide your treatment by showing whether your medicines are working or if you need a different approach - A study published in Circulation: Cardiovascular Quality and Outcome found that individuals who monitored their blood pressure at home were more likely to reach their blood pressure goals than those who were monitored only by their doctor.

• Get an accurate accounting of the variations, if your levels tend to fluctuate - getting an accurate accounting of variations will help your doctor better treat your blood pressure.

• Women with diabetes or kidney disease who have high blood pressure, or are at risk for it, can also benefit from home blood pressure monitoring.

• Women with symptoms such as dizziness or headaches can take regular readings “to see if their symptoms correlate to their blood pressure,” says Dr. Randall Zusman, director.

• Avoid “white coat syndrome,” the nervous surge in blood pressure some individuals experience during a doctor’s visit.

• ...“give some feedback about how they’re doing and that helps reinforce the efforts they’re making.”

• Lower your risk for a heart attack - or other heart-related event - better than occasional measurements at a doctor’s office.

Some conditions, particularly if you have an irregular heart rhythm known as atrial fibrillation, can make it harder to take your own blood pressure - even if your arrhythmia is controlled, you may need to take your blood pressure several times in a row for accuracy.

For individuals interested in home blood pressure monitoring the following steps are offered to get you started:

• Step 1: Buy a blood pressure monitor - Pharmacies and online merchants sell a variety of blood pressure monitors, typically ranging in price from $50 to $100 - a higher price doesn’t necessarily correlate to better quality; ask your insurance company whether it will cover part or all of its cost.

A blood pressure monitor should include these important features:

1. Buy a monitor that goes around your arm - Dr. Zusman does not recommend wrist or finger monitors because they aren’t as accurate.

2. An automatic monitor is easiest to use, because it doesn’t require a stethoscope and the cuff inflates by itself - whereas manual monitors require you to squeeze a bulb to inflate the cuff, which can be hard to do if you have arthritis.

3. Choose a monitor that meets standards for your age and health conditions according to an organization such as the European Society of Hypertension, dabl Educational Trust, or the Association for the Advancement of Medical Instrumentation (AAMI). Each organization has posted its list of approved devices on its website - for a comprehensive list of approved devices, visit: www.dableducational.org/sphygmomanometers.html

4. Make sure the cuff fits your arm - if it’s too large or too small, the reading won’t be accurate.

5. Check that the numbers on the dial or display are large enough for you to read clearly.

6. Determine what other features you want in a blood pressure monitor - for instance, some monitors will take an average of your last few readings, record your measurements over time, and send them to your doctor via your smartphone.

• Step 2: See your doctor - Make an appointment with your doctor and bring your monitor so a nurse or assistant can make sure it is properly calibrated and will teach you how to use it correctly. Then, at least once a year, return with your monitor to your doctor’s office for rechecks and discuss with your doctor how to use your home blood pressure readings to fine-tune your treatment, Dr. Zusman advises.

• Step 3: Determine when to take your blood pressure - For most women, Dr. Zusman recommends taking two to three blood pressure readings in the morning and two to three readings at night, a few times a week - it is counterproductive to take your blood pressure constantly: “You become so focused on your blood pressure that every time the cuff comes near your arm your blood pressure goes up just from the anxiety,” says Dr. Zusman.

• Step 4: Take your blood pressure - Here’s how to take your blood pressure at home:

1. Avoid caffeine, alcohol, tobacco and exercise for at least 30 minutes before measuring your blood pressure.

2. Sit with your feet flat on the floor, rest your back against the chair, and place your arm on a table or other flat surface.

3. After sitting quietly for five minutes, wrap the cuff around your arm - the center of the cuff should be over the artery (some blood pressure monitors have an arrow to help you with placement).

4. Whereas an automatic monitor will inflate by itself when you press a button, with a manual monitor, you’ll have to squeeze the bulb to inflate the cuff, and then deflate the cuff slowly.

5. Note the top and bottom numbers on the dial or display window:

a) The top number is your systolic pressure - the blood pressure when your heart beats;

b) The bottom number is your diastolic pressure - the pressure in-between heartbeats. Write down your blood pressure number each time you measure it so you can track it over time. (For a demonstration of how to monitor your blood pressure at home, visit www.health.harvard.edu/stress/how-to-measure-your-blood-pressure-at-home.)

• Step 5: Use the readings - The following guidelines will help you determine whether your blood pressure is within normal range:

1. normal: less than 120 systolic and less than 80 diastolic

2. prehypertension: 120 - 139 systolic or 80 - 89 diastolic

3. hypertension: 140 and higher systolic or 90 and higher diastolic

Women over 80 should use 150 as the upper limit of normal for systolic blood pressure.

If your blood pressure is high or if it’s fluctuating significantly from day to day, discuss with your doctor about whether you need to change your treatment plan - medications such as angiotensin-converting enzyme (ACE) inhibitors (e.g., benazepril [Lotensin], captopril [Capoten], Isinopril [Prinivil, Zestril], ramipil [Altace]); angiotensin-receptor blockers  (e.g., candesartan [Atacand], losartan [Cozaar], valsartan [Diovan]); beta blockers (e.g., atenolol [Tenormin], metoprolol [Lopressor], metoprolol succinate [Toprol-XL], propranolol hydrochloride [Inderal]; calcium-channel blockers (e.g., amlodipine [Norvasc, Lotrel], diltiazem [Cardizem, Dilacor], nisoldipine [Sular]; and diuretics (e.g., bumetanide [Bumex], chlorothiazide [Diuril], chlorthalidone [Hygroton], furosemideare [Lasix], spironolactone [Aldactone]) are just part of this plan.

“The control of blood pressure is a process that involves both lifestyle modification and drug therapy, and lifestyle modification may be as important or more important than drugs,” Dr. Zusman says.

Lifestyle changes to lower blood pressure include:

• eating a diet high in fruits, vegetables, whole grains, fat-free and low-fat dairy products, beans, skinless poultry and fish; and low in saturated and trans fats, added sugar and salt (Dr. Zusman recommends less than 2,000 mg. of sodium daily for individuals with high blood pressure)

• exercising for at least two-and-one-half hours weekly, combining aerobic activity with muscle strengthening and stretching

• maintaining a healthy weight for your height

• avoiding tobacco products and limiting alcohol

• managing the sources of stress in your life by using relaxation techniques such as meditation, music and yoga.

Keep a record of how your blood pressure changes in response, as you implement these lifestyle changes, and inform your doctor about any blood pressure changes you experience - up or down, concludes the health letter.