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Comment by coldcode | Hacker News Reader

As a person who had a hypertensive crisis late last year, nothing boils my blood (yes, a pun, I am fine now) more than how people measure blood pressure incorrectly in doctors offices and even hospitals. There are many different things than can increase a BP measurement above the "baseline" including talking, moving around, not having rested but also just waking up, not being in a supported position, only a single value, etc. Most of the major health agencies (AMA,AHA,CDC, etc in the US) have recommendations on how to do it properly, but in medical situations like doctors offices and hospitals, these are rarely done as they take too much time. A single measurement is not sufficient and can result in misdiagnosis.

A more reliable way to measure a continuum would make a difference, but I imagine it would still require time to collect as BP is a dynamic value that changes with behavior, posture and activity.

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I'm a resident physician and I deny having my BP taken in outpatient clinics.

The techniques used are ridiculously inappropriate:

"Ok, Mr. So-and-so, come with me." calls the nurse, as the pt who is irritated for having to wait 30 minutes quickly gets up to walk along unknown hallways, while rushing to finish a phone conversation, stressed and not knowing where to turn next..."Ok, now we're going to weigh you on this scale" while the pt thinks 'oh man, I've probably gained weight', followed by "ok, now we're going to measure your blood pressure." 'I don't want BP meds...let me try to relax...breathe slooowly...but I don't want the nurse to notice I may be trying to cheat this sudden examination.'

That's why the most appropriate way nowadays is to measure it at home, and keep a BP log.

People try to cheat BP tests? Because they dont want tp taks BP meds? Daaaang I'm trying to get my head around that. I guess I'm missing something because that sounds like an incredibly tangled way to be.

Pilots (and astronauts) lie to their doctors to avoid being grounded.

https://www.washingtonpost.com/politics/2023/08/27/faa-pilot...

as someone allergic to the bulk of blood pressure medications (currently taking some very old ones that don't affect me as much as the new ones that "don't have side effects"), hell yeah I'd cheat a blood pressure test if I could.

the difference between being a little dizzy and not being able to walk more than 10 feet without having to stop and throw up is huge.

You are supposed to be calm and relaxed for a proper blood pressure reading. Doctors have to find the resting baseline to diagnose hypertension.

One thing that I think would dramatically improve the routine screening numbers at doctors' offices would be to try and take it after the patient has been sitting down for a few minutes waiting for the doctor after the other vitals have been taken. If I'm going to sit around for 15m+ anyways, why not use some of that time to let BP stabilize?

Because it's a practically impossible workflow: economics dictate that on duty your time should already be filled up doing something productive.

If anything, the usefulness of an office BP is to screen only people whose heads or hearts are about to blow up from a crazy high reading. Current guidelines now recommend people keep logs at home.

I manually recheck BPs myself if the readings are off the charts.

Robotics in the future could help the workflow though.

> That's why the most appropriate way nowadays is to measure it at home, and keep a BP log.

"Oh yea those machines are junk and totally wrong"

And/or "WHY DO YOU TAKE YOUR OWN BLOOD PRESSURE?!" followed by accusations of being a hypochondriac.

Also the log is junk because I don't know how to properly take the blood pressure. Unlike the assistant who is also doing it wrong.

lolololol

my blood pressure is significantly higher at the doctors office than home. I measure my blood pressure each morning at home. My doctor is happy to accept those readings.

One of my attendings has a running joke where he takes fresh interns in July and tells them "I will take you to <most expensive restaurant in my city> if you can take this patient's blood pressure correctly." He's been doing this for 30 years and no one has been treated to dinner yet. He's looking for the rest time, arm at heart level, everything.

Correctly performed, it wont match every other BP test the patient has ever had done.

Not only the medical personnel is very often unable to properly measure the blood pressure, they also cannot properly take blood sample for potassium. They put tourniquet and order patients to pump their fist, so that the veins appear, but that cause muscles to release potassium into the bloodstream, causing elevated levels and misdiagnosis leading to incorrect treatment. I make people aware of that, and it should be widely spread so that doctors and nurses have the knowledge that they sometimes unwittingly cause harm.

It's frustrating. I usually bike to the doctor's office, and every time I warn them that they're going to get a systolic 10 higher than if they'll wait until the end of the appointment. They don't wait. The tech-taken entry gets put in the EMR. The doctor takes my BP again at the end, says "oh, great" and that reading gets ignored. :p

As a sibling comment noted, I ended up deciding to just watch my BP at home every now and then. It turns out it's fine and it reduced my metaphorical blood pressure to monitor it myself.

However, as discovered during a family heart crisis, medical professionals will routinely ignore any kind of heart rate or blood pressure readings that you take at home. In my experience, it's not until they see the same measurement during the ($$$) ambulance ride that they take it seriously.

It really really depends on the office and their practices. I visited (and later brought my mom) to a cardiologist who is a terrible doctor, but his office does instruct you to log your blood pressure and then they review the logs. So at least they do that right.

What they do wrong: Queuing up 10 patients at a time, seeing like 60 a day, and then jumping from room to room like a kid with a bad case of ADHD. Dude told the assistant to give my mom 1 bp medicine, rushed out to another patient, and then rushed back 2 minutes later "no, give her this one instead!"

I can't trust that LOL. Our primary doctor got mad at me for taking my mom there and called the cardiologist a "f-ing a-hole" because he had a bad experience with his aunt going there LOL.

Honestly I ... I won't be going back, but I don't hate the dude. He's generally spot-on, even if he's rushed and his medicine advice is sketchy.

My primary care recommended taking my BP at home periodically and even wanted to calibrate my home system against the office system. I do tend to test higher in the doctor's office but I still periodically take it at home.

The good doctor offices do recommend all that. :)

To be fair, I'm guessing a lot of people really suck at it lol.

I found that taking it at home helped a lot with white coat syndrome, I was more relaxed and more able to tell when I'd settled. I also just set a timer when walking and told the nurse "no not yet" when they tried to take my BP. They listened except the one nurse who insisted I was wrong and that I was 5'11" not 6'2" which was entered in by the urgent care the day before because people get shorter as they get older. You know, a day later, at 40, after being 6'2" since I was 18. no possible way she could be wrong, everyone else was. Also tried to mark me as an active smoker because I'd been in a resturant with smoking before, in the 90s and she had magically never been around smoke in her 50 years. The doctor corrected the smoker note but the height hung around in some SOT field even though the next 15 height measurements were 6'2" until I had an extra 10 minutes with a PA who went over all my records with me and corrected things.

I had trouble with 2 of the BPs drugs, one gave me head spins in the afternoon seated in my car sometimes, another gave me the dry cough (could feel a prickle in my thorat). My bp is actually high esp when I've had caffiene (what coder doesnt), move around, etc, but it's usually low pre-hyper tension. I also had it taken about 300 times in the last 6 months getting certified as an EMT. There's a LOT of variation in how the tools take the BP and just how close you're listening. I compared a manual cuff with one of the fancy automated ones and it's not that hard to hear your dystolic down 10 below what the automated reads. Same with systolic, you can hear it higher if you really listen before it starts sounding like a watch with another 10 spread, and you leave that cuff at 200 for 10 seconds and everyone's going to read higher and tense up more. I can feel my blood pressure surge any time an automated machine decides "nope I need to go higher on systolic" and it squeezes and I know I'm going to read high and have yet another conversation with the nurse and doctor. Just take it to 200 and come down stupid machine.

As an adult with a congenital heart defect and white coat hypertension, I can relate. Once, a nurse took my blood pressure and immediately freaked out as I was sitting calmly on the exam table. She took it again in the same arm, then hurriedly took it in each of my other limbs before throwing her hands up.

Often, I would arrive at the cardiology office having made my way through downtown traffic to find a parking space and walk across the pedway. Then I'd find a seat as far away as possible from all the noisy children there to remind me that I should be dead. No wonder my BP is higher than usual. And you're the one freaking out?

I got so used to nurses tossing out every recommendation for measuring BP that I started taking it myself at home before visits just to prove the point. Eventually, as I grew older, my BP rose to a point where it actually needed to be addressed. I am now on medication. But I have yet to find a nurse anywhere that has taken time to follow even one recommendation for properly taking BP.

When I was a dialysis patient with frequent office visits, I've had the same experiences myself. Two things I've ended up doing is get to the hospital 30 minutes early, sit in a quiet area and relax till 10 minutes before the appt. Secondly I've found deep and slow breathing can improve your blood pressure a lot. The problem of white coat syndrome still remain though.

I had hypertension for about 15 years and after quitting drinking and smoking no longer do. I still suffer from white cost hypertension regularly and frequently have to tell nurses to just press the button again - second time drops back to normal range with a drop of about 20/10.

I had it too. When I was under stress, sometimes I could hear my pulse in my ears like a whooshing sound.

I stopped drinking and my BP is now completely normal, and RHR is low 40's. Sleep is much better too.

Are you serious? Your RHR is in the low 40s? Mine is typically 58-65 and I was told I have bradycardia!

Yes, and it was in the 50-60 range when I was drinking. My smartwatch use over a couple years has been informative.

It's a combination of genetics and athletics.

Edit: my smartwatch readings include sleep. Sitting upright at a table right now it's around 65

We have a heart rate monitor at work that we use on 1-2 patients for day. It alarms at rate below 50BPM. At least once a week it's alarming at us.

My RHR is around 35. The rare occasions I get to go on vacation it dips into the high 20s while I'm sleeping. I haven't been on a real vacation in 2 years, though :/

Serious distance runner here: about five years ago while laid up in the hospital the alarm kept going off in the middle of the night on the HR monitor machine.

Nurse: “it goes off if your HR is too low.”

Me: “what’s it set to?”

Nurse: “39 BPM”

Me: “ yeah, you’re going to want to turn that down a few notches.”

Genetics play a role, too. Back in the day, one of the fastest road bike racers in WA state told me he’d never seen his resting HR below 60.

I stopped drinking and mine went up :p

Being sober is pretty stressful

It took me a good 10 days after quitting to start to feel "normal" and sleep without waking up drenched in sweat. Depending on intake and other factors it can take a while to fully heal. Months or longer.

Something I realized was that alcohol was actually causing my anxiety and depression, which was one of several things that led me to quitting. I paid compound interest on the short term relief.

This would be the best use of the "AI Pin" fiasco of a device;

Create an AI pin that takes in all the activity associated with the BP monitoree, including telemtry for environment, movement, and diet. if I had a pin that did this (and recorded all audio for the day, and snapped pictures when I wanted and transcribed all audio via whisper and I had a full searchable day-runner...

Yay!

EDIT: The above desire is fully capable of a phone - except battery life...

I have a boatload of old phones. It would be interesting to just build a mini-build for an android phone to simply be a daily recorder. to capture audio/video only and run a slow app that will transcribe all audio to text on the device (even if it does so once its on lan, then it connects to an endpoint running locally on your docker desktop fast api to capture the audio that auto uploads as soon as on home lan. Sorts the files and pics and everything onto the NAS with simple txAI workflow to ffmpeg as needed.

> A single measurement is not sufficient and can result in misdiagnosis.

During an acute care stay, a single blood pressure is a drop in the bucket. It averages out on the long term, and it’s not taken out of context of a clinical presentation.

I would take pressures manually, question unusual values, repeat on the spot and after some time had passed.

I find doctors and nurses rush things too much in general. I guess they're paid flat-rate, like mechanics?

there's just no time. we have to write down everything you tell us, we have to come off genial, make you sure you aren't lying about something or mistaken, and fix you.

Thank you.

They have a million patients. I bet no one on that moment thinks, oh I’m only paid $10.75 for this, I better rush this so I can earn more money.

If you had to see as many patients as your doctors do, you would be rushing around too.

> not being in a supported position

does this mean your arm is not relaxed when measuring?

They always measure my blood pressure in a jury-rigged way resting on not an armrest, but some uncomfortable bracket of the blood pressure device.

Yeah I was told I had high blood pressure, was about to be put on a bunch of medication and then I decided to get a second opinion. The hospital I went to gave me a 24 hour monitor and it came back I had perfectly fine blood pressure.

Turns was scared of doctors.

Totally agree and I think the malpractice comes from laziness and a lack of interest in their patients. If they cared, they would do it correctly per the guidelines they hand out to patients themselves! By which I mean these: https://www.heart.org/en/news/2020/05/22/how-to-accurately-m...

It is especially bizarre to me when they don’t listen to patients and make medical decisions like deciding prescriptions and dosage amounts based on false readings.

i don't think it matters too much. we don't want to take it right after you just exercised obviously, but even taking it once is indicative of things. 'i have white coat etc. i have nerves!' these are all things we don't mind seeing. all those those things connect.

using up time to double check blood pressure is so/so useful but generally a waste. a patient's labs tell much more, and are better to hedge suspicions against.

white coat hypertension at 320lbs!? alright sir we can check again if you like...

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