THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 513.5 Guest: Louis Grenzer, M.D. Topic: Home Blood Pressure Testing - One Part Host: Richard Roeder Producer: Ed Graham

NEMA : This is a discussion of home blood pressure testing with cardiologist Dr. Louis Grenzer from Baltimore, Maryland.

NEMA : Dr. Grenzer, there are all kinds of devices in pharmacies nowadays and even department stores where you can put a device on your finger or on your arm and it has a beeper and basically this is a home test for blood pressure. My first question to you is about these devices. When a person maybe has a questionable blood pressure problem, how safe do you feel they are in doing self-testing and how critical do you think the doctor is for testing or do you think it's okay that they use these devices periodically but still rely on their doctor for the main results? What are your feelings on that in general?

GRENZER: My feeling is that there are pluses and minuses to the patient testing his or her blood pressure. Let me go over some of the pluses. There are some patients who get high blood pressure just when they see their doctor. We call that "white coat syndrome" - some doctors wear white coats and just the anxiety of having the blood pressure cuff put on by a doctor will put that patient's blood pressure up. In that particular type of patient, it might be very helpful to have some way to test that patient's blood pressure at home and more frequently under less stressful situations to see if indeed the blood pressure is running high all the time or if it's just a brief elevation in the blood pressure that's occurring because the patient is upset about going to see the doctor so that would be one area where it might be a plus to have the patient check their blood pressure at home. Now there are some minuses to it too. For instance, some of the blood pressure equipment that is purchased is not really very accurate or perhaps the patient doesn't know how to use it properly so one of the things I do if I have a patient with high blood pressure who wants to check his blood pressure at home is to have that patient bring the equipment in at the time of his visit in my office. I'll then have the patient check his own blood pressure and then I will check it and see if the readings correlate. If they don't correlate, I guess there are three possibilities. Either the equipment is not accurate or the patient isn't using the equipment correctly or there's still that possibility that just my presence in putting the blood pressure cuff on will elevate the patient's blood pressure. So a way to get around that is for me to then check the blood pressure using the patient's equipment. I'll check it myself using the patient's equipment so I always have the patient check it himself with his equipment but then I verify it by using his equipment just to rule out the possibility that my presence is elevating the blood pressure.

NEMA : In general, is it important that a patient prepare themselves whether they're taking their own blood pressure or a doctor's doing it, with a couple of minutes of relaxation prior to taking the test?

GRENZER: Well that might vary from patient to patient. There are some patients who, even when I take the blood pressure when they come in the office, it's initially elevated and then after you let the patient lie down and calm down a little bit, the blood pressure will come back down. Some patients, it doesn't seem to matter so certainly if the patient is getting an elevation when he takes the blood pressure, it would then be helpful to have that patient rest a little bit and recheck it.