Blood Pressure Readings: When to Start Medication and Trust Your Device

Is a blood pressure of 160/94 an indication for medication treatment? Which blood pressure reading should be considered as the standard when values differ?

Hello, at the beginning of June, I visited a family medicine clinic due to hand numbness and dizziness.
My blood pressure was measured at 160/94.
The doctor arranged for blood and neurological tests and also prescribed a short-acting antihypertensive medication.
A week later, I returned for a follow-up, and the blood test results were normal (total cholesterol/triglycerides/low-density lipoprotein).
There was slight nerve compression in my arm, and my family physician referred me to a neurosurgeon for confirmation, prescribing another month of short-acting antihypertensive medication (Amlodipine 30mg + Bisoprolol 10mg, to be taken twice daily).
At the neurosurgery appointment, further blood tests (complete blood count/biochemistry/serum thyroid function) were conducted, all of which returned normal results.
Upon returning to the family medicine clinic, my physician reviewed my blood pressure records from the past month (all taken as prescribed), which averaged between 130-145/75-85.
The doctor then switched me to a three-month supply of long-acting medication (Lercanidipine 5mg half a tablet + Bisoprolol 1.25mg, to be taken once daily), with a follow-up scheduled in three months.

This month-long medical process has raised the following questions:
1.
I recently purchased an Omron arm blood pressure monitor, which recorded 116/75, while a community public tunnel blood pressure monitor showed 136/76, measured five minutes apart.
The readings differ significantly, and the company's tunnel blood pressure monitor recorded even higher values.
Which reading should I trust?
2.
Was it appropriate to start medication after measuring blood pressure at 160/94 due to dizziness at the beginning of June? If blood pressure readings vary, should they be measured on different days before determining if I have hypertension?
3.
I found online that antihypertensive medications should not be stopped or adjusted without medical advice, but my current situation raises concerns.
Should I consider switching to a cardiologist for a reevaluation?
I have many questions, and I appreciate your patience in responding.

Janet, 40~49 year old female. Ask Date: 2020/07/20

Dr. Cai Guiqin reply Cardiology

It is recommended that you discuss the above situation further with your attending physician to determine if any additional examinations are necessary.
Thank you, and wishing you good health!

Reply Date: 2020/07/20

More Info

Understanding blood pressure readings and when to start medication can be a complex issue, especially when considering the various factors that can influence blood pressure measurements. Let's break down your questions and concerns based on the information provided.

1. Variability in Blood Pressure Readings: It's common for different blood pressure monitors to yield varying results. Factors such as the type of device (manual vs. automatic), the position of the arm during measurement, and even the time of day can affect readings. The Omron arm monitor you purchased is generally considered reliable, but it's essential to ensure that it's calibrated correctly. The community public monitor may not be as accurate due to wear and tear or improper calibration. When comparing readings, it's best to take multiple measurements at the same time of day under similar conditions and average them out. If you consistently see high readings, that’s a more reliable indicator of your blood pressure status.

2. Starting Medication After High Readings: Your initial reading of 160/94 is indeed concerning and falls into the category of Stage 2 hypertension according to the American Heart Association guidelines. Starting medication at this level is appropriate, especially given your symptoms of dizziness and numbness. However, it’s crucial to monitor your blood pressure over time. If your readings fluctuate significantly, it may be worth discussing with your healthcare provider whether additional monitoring or a different approach is needed. Blood pressure should ideally be assessed over several visits to establish a consistent pattern before making long-term treatment decisions.

3. Medication Management: It’s wise to be cautious about medication management. Blood pressure medications should not be stopped or adjusted without consulting your physician. If you have concerns about your current treatment plan or the effectiveness of your medications, it’s perfectly reasonable to seek a second opinion from a cardiologist or another healthcare provider. They can provide a fresh perspective on your treatment and help determine if your current medications are appropriate for your condition.

4. Trusting Your Device: When it comes to trusting your blood pressure monitor, it’s essential to ensure that you’re using it correctly. Follow the manufacturer’s instructions closely, and consider having your device checked against a professional monitor during your next doctor’s visit. If discrepancies persist, it may be beneficial to use the readings from your healthcare provider as the gold standard for your blood pressure management.

5. Lifestyle Considerations: Alongside medication, lifestyle changes can significantly impact blood pressure control. Maintaining a healthy diet, engaging in regular physical activity, managing stress, and avoiding excessive salt intake can all contribute to better blood pressure management. Since you mentioned experiencing dizziness, it’s also important to stay hydrated and avoid sudden changes in posture, which can exacerbate symptoms.

In summary, while your initial high blood pressure reading warranted immediate medical attention and treatment, ongoing monitoring and communication with your healthcare provider are crucial. If you have doubts about your current treatment or the accuracy of your blood pressure readings, don’t hesitate to seek a second opinion. Your health is paramount, and ensuring you have the right support and information is key to managing your blood pressure effectively.

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