Why it is vital to get the blood pressure reading from BOTH of your arms

Have you had your blood pressure checked in one arm and the reading seemed ‘normal’? Typically it is checked by your GP or another healthcare professional, or you can even do it yourself with a home testing kit. A reading between 90/60 and 139/89 is judged to be normal.

Not many people usually request to have their other arm checked for a blood pressure reading or check it themselves, however it might be worth doing this in the future as it could just save your life.
A new American study into apparently healthy individuals discovered that in instances when there was a significant difference between the blood pressure readings in each arm, there was 38% increased risk for a heart attack, stroke or other cardiovascular problems.

Researchers from Harvard Medical School in the US decided to look at the blood pressure reading of both arms from almost 3,400 men and women over the age of 40 and deemed in good health.

Generally, a small difference between the two readings is considered normal and not sufficient to cause alarm. In this study, systolic pressure – the pressure of the blood when your heart pushes blood out and the higher of the two figures within a blood pressure reading – was found to vary by an average of roughly five points.

For 10% of the people monitored in the study, a difference of at least ten points was found between the two arms. In the subsequent 13 years, those particular men and women were 38% at a higher risk of a potentially deadly heart attack, stroke or other cardiovascular health problems.

For two readings with a large difference, it is believed that the arm showing the higher reading probably has an artery that is congested with fat.

NHS guidelines advise GPs to extract the blood pressure readings of both arm. However, many are guilty of simply getting the reading from whichever arm of the patient happens to be nearest to them.

Thembi Nkala, a senior cardiac nurse with the British Heart Foundation, importance of having your blood pressure checked in both arms, saying: “Even if someone has no other cardiovascular risk factors, uneven high blood pressure could be a sign of an increased future risk of cardiovascular problems. UK guidelines already call for blood pressure to be measured in both arms when diagnosing high blood pressure. If you’re worried about your blood pressure or cardiovascular risk, speak to your GP or practice nurse.”

In respect to a blood pressure reading, you should not instantly panic if you have one blood pressure reading that seems high, you have not actually have high blood pressure (hypertension). Many of us are nervous or may feel stressed when visiting our GP and this can cause fluctuations in blood pressure, increasing it.

In that scenario, patients can be provided with a blood pressure kit to use throughout the day to check if there is a consistent high blood pressure reading or not. Your GP could also request you to undergo blood and urine tests to see if you have conditions that increase blood pressure, such as kidney disease.

A healthy lifestyle could reduce high blood pressure as effectively as drugs

Whilst we all know that exercising regularly, keeping our weight down, drinking in moderation and eating plenty of vegetables can affect our blood pressure, new research suggests that it can reduce the risk of developing high blood pressure, by two thirds.

The impact of these measures on high blood pressure was much higher than expected, and in some cases could even be just as effective a way to treat sufferers as prescribing drugs. Just walking to work and restricting alcohol to two drinks a day can reduce the risk markedly, according to the study of more than 20,000 people.

Every day there are 350 preventable strokes or heart attacks in the UK caused by high blood pressure. In developed countries the lifetime risk of developing high blood pressure is now 90 per cent, and six million Britons take drugs to control it.

People with hypertension (the medical term for high blood pressure) are already routinely advised to make the lifestyle changes highlighted in the study, but the effect far surpassed expectations. The Finnish study followed 9,637 men and 11,430 women aged 25 to 74, who did not have hypertension.

Their adherence to healthy lifestyle factors was recorded, which included alcohol consumption of less than 50g per week (roughly six units), exercise at least three times per week, daily consumption of vegetables, and normal weight. During a follow-up period covering an average of 16 years, 709 of the men and 890 of the women developed hypertension.

Proffesor Pekka Jousilahti, ofFinland’s National Institute for Health and Welfare said: “The risk of hypertension was only one third among those having all four healthy lifestyle factors, compared with those having none. Even having one to three healthy lifestyle factors reduced the risk of hypertension remarkably.

For example, having two healthy lifestyle factors reduced the risk of hypertension by nearly 50 per cent in men, and by more than 30 per cent in women. Alcohol consumption, physical activity, daily consumption of vegetables and keeping normal weight are the four lifestyle factors that seem to have a remarkable effect on the development of hypertension.

Professor Jousilahti went on to add “people should drink a maximum of one to two drinks of alcohol a day and that even a relatively low amount of exercise was enough to make a difference.”  This was backed up by Professor Gareth Beevers, a trustee of the Blood Pressure Association UK charity, who said: “This study shows a big effect from simple changes in lifestyle. It’s surprising and more than you would expect.”

Professor Jousilahti concluded by saying: “that although participants were healthy at the start of the study, it was likely the findings would also help those who already have high blood pressure. Patients could reduce their blood pressure by modifying the four lifestyle factors alone, or by making these modifications while taking blood pressure-lowering medication.”

Could a ‘Virtual Doctor’ improve patient care and save money?

For many elderly patients particularly ones suffering from diseases such as chronic obstructive pulmonary disease (COPD), heart disease or diabetes, getting to the doctors can be an ordeal.

Such patients need to have their vital signs and other parameters regularly monitored in order to effectively control and treat their conditions. However such patients may only see their doctor or nurse for such checks every few months, and if there is a problem in between then often they will have to be admitted to hospital.

However there is now a programme called Telehealth that has been in development since 2007, and is now being trialed by the North Yorkshireand York Primary Care Trust, using 500 patients suffering from diseases such as COPD, heart disease and diabetes.

The equipment called a Telestation is placed in a patient’s home and can monitor key readings from a patient within just five minutes every morning. The equipment has an integral scale to weigh the patient, a blood pressure cuff to take blood pressure readings, a pulse oximeter to measure pulse and blood oxygen levels, a glucose meter to measure blood sugar levels and even has a video camera built in so the doctor/nurse can physically see the patient if the need arises.

The really clever part of the Telehealth system is that the Telestation wirelessly transmits the readings once taken, to the patient’s phone line where they are transmitted directly to the Telehealth central control, where their own dedicated Telehealth nurse will daily review the readings.

The machine verbally takes the patient step by step throughout the five minute checkup and will also ask pre-set questions as well as taking various readings. If any of the readings fall outside of the pre-set parameters, an alarm will be triggered and the patient will immediately be contacted by their own dedicated Telehealth nurse.

Vera who is 71 and is suffering from COPD was initially skeptical about the scheme, but after taking part in the year long trial Vera claimed that the Telehealth system is “the best thing since sliced bread and that they should be in everybody’s home.” Normally patients suffering from COPD can easily be susceptible to infections that though may be easy to treat, often escalate into much larger problems necessitating hospital admission. The reason for this is that often patients leave it too late to get help, however with the Telehealth system the infection can be nipped in the bud by early diagnosis and treatment. Patients such as Vera suffering from COPD are given medication rescue packs containing antibiotics and steroids that can be taken as soon as needed after a consultation with their Telehealth nurse.

Telehealth nurse Dawn Watson who looks after Vera, tells how by working remotely she can look after more than 200 patients instead of the normal caseload of closer to 30 patients. As well as improved patient care the Telehealth system could obviously cut costs for the NHS especially when you consider that seven out of ten hospital beds are occupied by patients with long term conditions like Vera’s.

Paul Burstow, the minister for care services, claimed at a conference in March that “Telehealth could save the NHS up to £1.2 billion by 2014.” That claim seems to be well backed up as the trial which claims to be a success was launched in 2007, cost £30million, lasted three and a half years and was one of the most complex trials ever carried out by the NHS.

However the jury is still out on whether the Telehealth system is capable of saving the amount of money claimed, and also whether it can provide the improved patient care it claims. The reason the jury is still out on this is that the data analysis is being carried out by five academic institutions, and that for the findings to be both credible and useful, the academic analysis needs to be peer reviewed (a vital process of evaluation by independent experts.)