How do you know if you’re at high risk for something? This assumes a medically literate and motivated person will seek care based on … what? Realizing that grandpa, great-grandpa and dad all didn’t live past their 60’s? High cholesterol and hypertension can be “silent killers” - how do you know to check for them?
According to the AHA, blood pressure is supposed to be taken with feet flat on the floor, relaxed, and quiet for five whole minutes before, on an empty bladder, without caffeine and not having exercised within 30 minutes. I can count on zero hands the number of times I've had my blood pressure measured in accordance with this procedure in a doctor's office during a check-up. [1] It's a highly variable thing that can spike instantaneously and take a long period of time to return to normal without issue.
Which is probably part of why 30% of people who get their blood pressure taken in a doctor's office will register a higher than normal blood pressure principally only in the doctor's office. This is called 'white-coat hypertension' and doctors and researchers are pretty split on whether or not this represents an actual problem. With that in mind, it makes this a pretty worthless test in the context of an annual physical.
The optimal way to make a hypertension determination is a 24-hour continuous blood pressure monitoring cuff. You should take your blood pressure at home, on your own time, in a relaxed environment and if you see a consistently elevated reading, only then reach out to your doctor and set up an appointment to confirm with a 24h test.
[1] https://www.heart.org/-/media/files/health-topics/high-blood...
My favorite conspiracy theory is that this is why we always have to wait so long after we're in the exam room but before the nurse comes in to take BP. My BP monitor's instructions say to sit calmly for 15 minutes for an accurate reading and I think that's what they're doing.
Meanwhile, since the kids are so hyper it's not even worth trying the delay tactic so the pediatricians come in much faster.
It's not "calm" to be on edge for 15minutes wondering when the provider will appear.
Also my office takes my BP as soon as my appointment time starts and then we sit waiting for doctor.
Baseline blood measurements can also be invaluable. When getting sick you don‘t want to go down rabbit holes.
The US has a comparatively high hurdle to access to doctors. When doctors see patients they need to assume it is bad (liability another factor) driving costs up. Also people are not used to reach out to doctors letting them hesitate when they should not - regular contact can help here.
Every year major bloodwork and investigations may not be worth it but seeing your doctor regularly, being able to communicate effectively, doctor having a baseline of you as a person and some bloodwork too makes other countries a lot more efficient in providing health care.
In other words, building a relationship. Continuity of care improves health outcomes.
FWIW, my cheap OMRON blood pressure thing has agreed with the pro results, thus far.
https://www.mayoclinic.org/diseases-conditions/high-blood-pr...
I just meant it may also be a factor in elevated office BP measurements even if done properly, hence “potential contributor”.
If you have multiple documented normotensive measurements on your home BP monitor that’s more reliable than even proper technique in a medical setting to be honest.
The hierarchy of BP measurement accuracy is:
24 hour ambulatory measurement > multiple home patient measurements > in-office automated BP cuff (with proper technique) > in-office BP measurement with auscultation (not sure why this was suggested as more accurate to the commenter you replied to).
Automated cuffs are great and reproducible.
For stats like blood glucose, heart rate, blood pressure, etc.
I last worked in primary care back in 2016 but even back then we would either do multiple visits or ask the patient to check multiple times at a pharmacy (or at home if they could afford a cuff).
24 hour ABPM is the preferred method for diagnosis as you stated but has limited (albeit growing) availability today.
Fortunately consumer health-tech advancements has resulted in cheaper accurate BP cuffs but this is a recent-ish phenomenon.