Dr. Roccella: Are there any symptoms for high blood pressure that women should watch out for?
Ms. Houston Miller: High blood pressure is an asymptomatic condition, except in very rare situations like when extremely high blood pressure can cause headaches to occur. Because most people do not experience any symptoms, it’s important to get your blood pressure checked on a regular basis. That includes with every single visit to a physician or nurse practitioner, irrespective of why you are there.
Dr. Roccella: When you say to have your blood pressure measured, you mean having a doctor or nurse put a blood pressure cuff put on your arm?
Ms. Houston Miller: Exactly. That is the first step in the process. However, there is increasing evidence for people to recognize the benefits of home blood pressure monitoring not only for diagnosing hypertension, but also for looking at how well people are being treated for hypertension and for monitoring how well medications are lowering blood pressure. Today’s state-of-the-art home blood pressure monitors can also help detect white coat hypertension -- when blood pressure is elevated in the office but may not be elevated at home -- and also the reverse of that which is masked hypertension, in which blood pressure may be totally normal in an office setting but elevated at home.
Dr. Roccella: Do you recommend home blood pressure monitors to your patients?
Ms. Houston Miller: I certainly recommend them to all of my patients and I think that it is important for people to recognize that we are recommending oscillometric devices that are used for the arm, that have really gone through validity and reliability testing, so that we know of their accuracy. There are two websites people can visit to determine which monitors have passed the vigorous standards that are so necessary to ensure accuracy. One is the dabl Educational Trust and the other is the British Hypertension Society website.
Dr. Black: One thing I think is important for home monitoring is that we do it intelligently. I have colleagues who feel that every home should have a blood pressure monitor just the way they have a thermometer. I do not think that is quite the case because we use the thermometer when we think we are sick, and we do not want people to take their blood pressure just when they think they are sick. We want people to take their blood pressure routinely to keep an eye on it -- on a standard day, maybe a couple of times a week, maybe once a week, maybe even once a month. That is the way we are going to get the most important information.
Dr. Roccella: So is it fair to say that the two of you agree that working with your doctor and nurse clinician, monitoring your blood pressure at home, and bringing in your recordings to show them is a good way of keeping tabs on what is going on with your blood pressure?
Ms. Houston Miller: Yes. I think what is often missing for people is the physiologic feedback that they need to see in terms of what is actually happening to blood pressure when they go on new medicines or are trying to determine a diagnosis of high blood pressure. The only way to get that is to have multiple measures, and home blood pressure monitoring is much easier than having to constantly go to the doctor’s office.
Dr. Roccella: What should a woman do if she is, say, at the gynecologist’s office and has a high blood pressure reading? Should she go see a cardiologist? Should she tell her primary care physician?
Dr. Black: It can be any healthcare provider with whom she feels comfortable. One of the things we need to explain is that having an elevated reading when you are anticipating a gynecological exam or when you are in a traffic jam or other stressful situation isn’t the same as diagnosing hypertension. To properly diagnose hypertension, you need to take blood pressure three times in a quiet room and then you see what those numbers are.
Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals