I want to take a minute and talk to you about checking your blood pressure. I had this discussion yesterday and it was suggested to me to do a video on it, and I think that's probably a good idea. I'll briefly go over mechanically how to check your blood pressure, but the bigger point of this video is to talk about how much data to collect to get an understanding of what's going on. So I'll get to that in just a second. As far as mechanically how to do it, I mean we all have the experience of going into our doctor's office or dentist or whoever, and you get your blood pressure checked and maybe it's good, maybe it's not, but it's a single reading and a single reading is never, well, I shouldn't say never. A single reading is generally not considered to be enough to make clinical decisions like should we put someone on medication or not.

(00:48)
Now, there are readings that are so out of the normal range that you have to take action, right? But when you're talking about someone being mildly out of range or enough that it would warrant medication, but it's not an emergency, a single reading generally isn't considered enough to make those decisions. That being said, get yourself a blood pressure cuff. There are lots of different options out there. There are probably 5,000 options on Amazon. You can go to your local pharmacy and get one whatever. I prefer the ones that are on the upper arm, it's basically at the level of the heart already, and so you're going to get a more accurate reading or a more consistent reading. If you get one of the wrist monitors where you have your wrist at the time, it's reading can make a difference in the numbers you get, so you're going to be less consistent with those readings unless you're very consistent about where you hold that arm while you're taking it.

(01:50)
The little ones on the finger for blood pressure, I'm not talking about oxygen saturation. They run into the same problem as the wrist, right? They just become less consistent because the positioning is much more variable. So aim for one of these battery operated or plug into the wall. I don't know that it makes a big difference. Just make sure the batteries are fresh and make sure that you get consistent readings. Understand if you take your blood pressure on the same arm twice in a row without giving it probably four or five minutes rest, your readings can be different simply because of the previous reading, right? You got to give that arm time to calm down and resettle before you squeeze it like that again. Alright, all that being said, how much data do you need to start to get a sense of what's going on or to make an argument to your doctor that you want to change medication or start medication or make some clinical decision like that? My advice to my patients is to do three things. You're going to take your blood pressure at a consistent time relatively every day and write it down, and when I say write it down, you're going to have columns. You'll have the date and time, what the blood pressure was, what the pulse rate was, because a good blood pressure cuff should give you both. It'll give you the upper number, which is the systolic number, SYS systolic, the bottom number is the diastolic number, and then you'll get a pulse rate.

(03:24)
Then what I want is a place for notes. So you can say, just ate breakfast or had a headache or whatever, and then maybe give yourself a column where you rate your stress level one to 10. Now with that kind of data on each reading you're building something that makes sense that has some context to it. So number one, you're going to take your blood pressure at a consistent time every day for probably at least two weeks, maybe a little bit longer. Second, you're going to take your blood pressure at one other random time during the day. So let's say your first reading is eight o'clock every morning before your coffee, but maybe while the shower's warming up or something, you take your blood pressure. Then let's say you take it randomly throughout the day. One day you do it after lunch one day you do it when you get home one day you do it before bed.

(04:23)
It's just whenever, and then the third one you're going to do is take it at times of concern. If you have a headache, if you're super sleepy, if you just got in an argument with somebody or traffic was really bad or something like that and you want to know, does that have an impact on my blood pressure, long-term impact, whatever. So you take your blood pressure at that point, so now you've got three different options every day. One is consistent, one is random, one might be there might not be there depending on what went on that day and what you have questions about, there may be an extra reading. If you take one of those and it's elevated and you say, oh, okay, hold on, I'm going to relax, I'm going to reset, I'm going to clear my head and then I'll take it again.

(05:13)
That's an important reading if you get, so let me give you normals real quickly. Ideally somewhere between one 10 over 70 and one 20 over 80, that's kind of where we'd like to see your blood pressure most of the time. Under times of stress, it's not uncommon to be one 40 or one 50 over 90, but then that should come down when the stress goes away, right? That's a momentary deviation. The numbers I'm giving you as a normal range, those are resting blood pressures, calm, that's resting. When you have a blood pressure taken and you were just fighting traffic or you sat in the waiting room of the doctor's office for two hours waiting for your appointment or it's going to cost you an arm and leg to see the doctor, whatever, those are not always resting blood pressures. Those are under stress, and so you may take that blood pressure and record it and give yourself an eight out of 10 for stress level or whatever it is, but then make sure at some other time that day you get an actual resting blood pressure because there's a difference and when you're comparing it to that one 10 over 70, 1 20 over 80, that is for a resting blood pressure, not under duress, not at the gym, not in your boss's office getting chastised for something, not when your girlfriend broke up with you.

(06:42)
Those are not resting blood pressures. It's still relevant information. It tells us something about how you respond to stress, but it's not arresting blood pressure. It can't really be compared to those normal ranges. So if you're keeping a log like that and you're making notes, you can quickly see which ones were resting and which were not. When my patients bring those logs in, I scan first for all the systolics, all of those top numbers, and I'm looking for trends. What are the couple of lowest ones I see? What are the couple of highest ones I see and where does the majority fall? Let's say I see a whole lot of systolic blood pressures in the mid one twenties, but there are a couple of one forties and there are a couple of 1 0 8, 1 oh nines. I've got a couple outliers on each end and I've got the middle.

(07:37)
I may go look at those upper ones and check the notes, just left the gym or just had a flat tire on the freeway or I had a really bad headache that day or had a sinus infection. I'm going to discount some of those. Those weren't resting. Sometimes I'll see one on their log where it says it was 1 43 over 90 and then five minutes later there's another blood pressure that's 1 28 over 86 and a little note that said meditated for five minutes. So they got a high one. They forced themselves to relax. They put themselves in a relaxed state and then they got a more normal blood pressure. That's data that's very usable to a clinician. Comparing that to getting a single reading in the doctor's office. It's night and day. If you want your doctor to be able to make informed clinical decisions about what needs to happen with you, you may have to help provide them data.

(08:36)
They can't come to your house every day and check your blood pressure multiple times. That's going to have to be up to you. Alright, so quick recap. Normal resting blood pressure one 10 over 70 to one 20 over 80. Are there people who have normals outside of that range? Absolutely. I have some patients whose normals are 1 0 6 over 55 or 60, something like that. I don't know how they function like that, but they do great. Everybody has their own set point, but looking at two weeks of data will tell you what that is. So anyway, one 10 over 71 20 over 80, somewhere in that range is what we would hope to see for resting blood pressure. Take it consistent time every day, take it randomly some other time and take it at times of concern or times of curiosity, right? What does it look like after that?

(09:31)
Then make your notes. What was the situation? What was my stress level one out of 10? Was this a retake to correct? The one five minutes ago? Is this before I took my blood pressure medication after I took my medication? We sometimes have people doing this to show how low their blood pressure gets so they can peel off one of their blood pressure medications. Doctors aren't comfortable taking you off medications like that, but if they see the data that your blood pressure is trending lower and lower and lower over time and that you're starting to have symptoms of feeling dizzy and lethargic and whatever, then they might take one of your blood pressure medications out. You continue monitoring, the blood pressure comes up a little bit into a more normal range and everything's handled right, but data is what allows that to happen. What else?

(10:19)
We talked about having the blood pressure cuff that goes on your upper arm instead of wrist or finger, and so I would do that regularly. I think every house should have a blood pressure cuff in it. I did a whole nother video on what you need to have in your home blood pressure cuff thermometer, a little auto scope to look in your ear and look in your throat, have a pulse oximeter to check your oxygen rate. Those are all things that should be in every home. You should know how to use them and you should have 'em available to you. A lot of healthy people don't mess with having blood pressure cuffs, but we do have times where they come in and they say, oh my gosh, I was at my doctor's office, I got a high reading. Everybody freaked out and I tell 'em, go get a blood pressure cuff and keep your own data and see where you are.

(11:02)
We don't know yet. It was a single reading. So anyway, I know that was kind of all over the place, but that's a quick overview of how to monitor your blood pressure over a period of time, how to gather relevant data that you can present to your doctor and have them have more context when they make a clinical decision about medications or blood pressure. One last thing, when you get an elevated blood pressure, a legitimately elevated, you come in with your log and the majority of the readings are one 60 over 98. That's an elevated blood pressure. Something's going on in the medical community. The temptation is just give a medication, make the numbers look normal and get on down the road. But I think it's more important to try to figure out why it was elevated. There was an argument that goes on to some degree between neurology and cardiology, neurology and cardiology where they basically say some of the neurologists are making the argument that we may be sacrificing brain health as we age by keeping blood pressures kind of artificially in this one 10 over 71 20, over 80 range.

(12:16)
There is an argument that as we age and our vessels become a little more stiff, we may need to have a slightly higher blood pressure to get the blood to all the different places of the body that need it and artificially lowering it. When our body tried to raise, it may not always be best if we don't know why it was elevated. If it needed to be elevated to get blood to your kidneys or your brain or some distant part of your body just lowering it, you may be sacrificing one part to try to save another. The cardiologist's response is, if they live long enough to complain about poor brain function, I did my job right, and the neurologist argument would be, there's no guarantee that that moderately elevated blood pressure would've been a problem for them, but maybe their brain needed that. So we're not great at figuring out why your blood pressure was elevated, if it was meaningful or not, if it was an appropriate compensation or not.

(13:17)
Is there a problem we can solve that would take care of this without having to take medication? People just get medication thrown at them. So I think it's valid to ask the question if you're told, look, your blood pressure is legitimately high. We want to put you on a medication, why do you think it's high? Well, just as we age, that happens, but how do you know that? What are the possible, give me five good reasons why my blood pressure might be elevated and let's go figure out which one of those five it is. They may not have any interest in doing that, that just may not be the MO of that practice, but I think it's worth asking because if your body did it for a good reason, then maybe we don't need to undo it so easily. Maybe we need to go deal with the underlying reason.

(14:07)
But that's a functional medicine approach, right? I mean, if you're one of my patients, you're used to that. We're always asking, why did that happen? You have a fever, well, why do you have a fever? My blood pressure is high. Why is it high? My pulse rate gets low. Why does that happen? We're looking for the underlying cause. That's not generally what they do, but I still think we should push 'em a little bit. Just because I'm medicating a blood pressure without understanding why it got elevated, I think is a little bit irresponsible. So anyway, that's my piece for today. I hope that helps you understand how to monitor your blood pressure and gather usable data for your doctor, whether it's a functional medicine doctor or not. If you have any questions, put 'em in the comments below or call the office and ask, and until then, have a good one.