The last time you went to the physician's office, did you pay attention to all of your vital signs? If you didn't, then now is the time to get started. Even if you have been told that your blood pressure is "okay" it is the context of the blood pressure in relation to all of your other vital signs that are important. These "High Blood Pressure Vital Signs" help determine your cardiovascular and stroke risk, as well as your risk of developing high blood pressure over time (even if your blood pressure is normal).
* Blood Pressure: Trend your blood pressure over time and at home. Many people keep blood pressure diaries and many don't. If your blood pressure is high, write down what you were doing when the blood pressure was higher. Were you upset? Did something happen? It is the trending of blood pressure that is important, not just one isolated blood pressure value. White coat hypertension is not just a phenomenon that occurs in the doctor's office.
* Heart Rate (or Pulse): Many blood pressure medications can certainly have an effect on the heart rate. Medications such as Beta blockers and Clonidine can have an effect and slow the heart rate. Other medications such as Hydralazine can increase your heart rate in some people. A "normal" rate at rest is 50-70 beats per minute. Some people on Beta blockers and medications that slow the heart rate can have baseline heart rates in the high 50s to low 60s.
* Orthostatic Vital Signs: Is your blood pressure low when changing body positions? This is an important vital sign that is done in many doctor's offices, but is also one that you should do yourself at home. You take your blood pressure sitting down. Stand up slowly and stand for at least 90 seconds before taking your blood pressure. Write down what your blood pressure is standing up.
Red flags concerning your blood pressure standing up compared to sitting down:
* If your top number (the systolic blood pressure) decreases by 20 points, or the bottom number (diastolic) decreases by 10 points these are signs that you may have orthostatic hypotension. That being said, if your top number decreases by ten, for example, but you have symptoms of dizziness and ligtheadedness standing up, then your blood pressure medication may need to be changed.
* Concerning the Pulse: If your blood pressure is lower standing up compared to when you are seated, your pulse should increase when you stand up. This is how the body compensates for a lower blood pressure. Be aware that certain medications like beta blockers can affect the heart rate; it may not increase when you stand up. Diabetes can affect the nerves (diabetic neuropathy and autonomic neuropathy). If you have diabetic neuropathy, your blood pressure can decrease with standing and your pulse may not increase.
* Body Mass Index (BMI): This is a calculated measurement that of your weight divided by your height squared. If your BMI is over 30, then even if your blood pressure is normal, this is a significant metabolic risk.
Do you know what your BMI is? If not, then you should.
* Waist circumference: There are many studies that demonstrate that an increased waist circumference is associated with centripetal obesity which can increase your heart and stroke risk. It is associated with significant inflammation.
Do you know your waist circumference? Is this measured when you go for your physician visit?
Opinion: In the prior high blood pressure guidelines, there was a focus on prehypertension which was a classification according to the old schema. The focus was not just on blood pressure, but also on risk factors including obesity, inflammation, hyperlpidemia, and the metabolic syndrome. It is not just about blood pressure, it is understanding your blood pressure with your other vitals. The goal is to decrease your stroke and blood pressure risk and improve your overall health.