Blood Pressure Readings and Heart Rate Changes: Expert Insights

Inquiry Consultation

Dear Dr.
He,
I have two questions I would like to consult with you.
Recently, I accompanied my mother to a local hospital for a consultation.
While waiting, I noticed that the hospital had "tunnel-type" blood pressure monitors.
I measured my blood pressure while wearing a thin jacket, and the reading was 134/89.
A few minutes later, I used another "tunnel-type" blood pressure monitor in the hospital, still wearing the thin jacket (the hospital volunteer told me it was unnecessary to remove the jacket, just keep my arm straight), and the reading was 161/98.
After returning home, I removed my jacket and measured my blood pressure several times with a "cuff-type" electronic blood pressure monitor, and the readings were around 120/80.
Here are my questions for you, Dr.
He:
Q1.
Given that I was wearing a thin jacket and the sleeve was not thick, but I did feel some slight discomfort during the inflation and deflation of the cuff on the tunnel-type blood pressure monitor, are the two blood pressure readings I obtained (first: 134/89 & second: 161/98) accurate?
Q2.
Generally speaking, when measuring blood pressure with a tunnel-type monitor while wearing a jacket (or clothing), is it common for the blood pressure readings to be "elevated"?
Q3.
I measured my blood pressure at home with a cuff-type electronic monitor, and the readings were around 120/80.
However, the readings from the hospital's tunnel-type monitor almost meet the criteria for hypertension treatment.
Currently, my home measurements are normal, but the hospital readings indicate hypertension, which leaves me confused about which reading accurately reflects my true blood pressure.
What should I do next, Dr.
He? Should I continue to monitor my blood pressure at home regularly, or should I seek immediate medical evaluation and treatment?
Recently, I have noticed that my heart rate has slowed down.
Previously, my heart rate was usually in the range of 70-80 beats per minute, but recently it has been around 60 beats per minute, and at night, it can drop to the 50s.
I had previously sought medical attention for chest tightness and was treated with traditional Chinese medicine.
Here are my questions for you, Dr.
He:
Q1.
Can the traditional Chinese medicine I took for chest tightness cause a sudden decrease in heart rate?
Q2.
If my heart rate decrease is not due to the traditional Chinese medicine, what conditions (or diseases) generally cause a sudden drop in heart rate?
Q3.
I currently do not experience chest tightness, and occurrences of palpitations are infrequent, but I am a bit concerned about the "sudden decrease in heart rate." What should I do next, Dr.
He? Should I just observe for now, or should I seek immediate medical evaluation?
I apologize for the numerous questions, and I appreciate your guidance.
Thank you, Doctor.

Axiang, 40~49 year old female. Ask Date: 2022/04/29

Dr. He Dongjin reply Cardiology

Hello, blood pressure measurements taken at general hospitals often tend to be higher due to insufficient rest, slight anxiety, or white coat hypertension.
Therefore, patients are encouraged to measure and record their blood pressure at home.
Just because you had one high reading does not mean you have hypertension; for example, losing one match does not mean that Tai Tzu-ying is performing poorly overall.
Your reading of 120 is normal, and there is no need to see a doctor.
Regarding the traditional Chinese medicine for treating chest tightness, will it cause a sudden drop in heart rate? You would need to ask the prescribing TCM physician, as I am not familiar with their formula.
The most important thing is your overall condition; numbers are just a reference.
Currently, your symptoms are minimal, and your condition is improving, which is a good sign.
The heart rate is determined by the brain; if it feels comfortable, a slower heart rate is sufficient.
It’s fine to just observe without needing to seek medical examination.
Take care, and Changhua Hospital is concerned about your well-being.

Reply Date: 2022/04/29

More Info

Understanding blood pressure readings and heart rate changes is crucial for maintaining cardiovascular health. Let's break down your questions and concerns regarding blood pressure measurements and heart rate fluctuations.

Blood Pressure Measurements
Q1: Accuracy of Blood Pressure Readings from Different Devices
The discrepancies you observed between the two tunnel-style blood pressure monitors in the hospital and your home monitor can be attributed to several factors. Firstly, the accuracy of blood pressure devices can vary. Tunnel-style monitors may not provide accurate readings if the cuff is not positioned correctly or if there is any obstruction, such as clothing. The sensation of the cuff feeling "stuck" during inflation and deflation suggests that the cuff may not have been applied correctly, potentially leading to inaccurate readings.
Q2: Effect of Clothing on Blood Pressure Readings
Generally, wearing clothing during blood pressure measurements can lead to elevated readings. This is particularly true if the clothing is thick or constrictive. In your case, even though you mentioned wearing a thin jacket, it could still have influenced the readings, especially if the cuff was not able to compress the arm adequately. It is always recommended to measure blood pressure with bare arms to ensure the most accurate results.

Q3: Discrepancies Between Home and Hospital Readings
The significant difference between your home readings (around 120/80 mmHg) and the hospital readings (which approached hypertension levels) suggests that you may be experiencing "white coat syndrome," where anxiety in a medical setting leads to elevated blood pressure. To clarify your blood pressure status, it is advisable to continue monitoring at home, ideally at the same time each day, and under similar conditions (rested, calm, and with bare arms). If your home readings consistently remain normal, it may indicate that your blood pressure is well-controlled. However, if you experience any symptoms or if the readings at home begin to rise, it would be prudent to consult a healthcare professional for further evaluation.

Heart Rate Changes
Q1: Impact of Traditional Chinese Medicine on Heart Rate
Certain herbal medications can influence heart rate, either by stimulating or calming the cardiovascular system. If you have recently started a new herbal treatment for chest discomfort, it is possible that it could affect your heart rate. However, the specific herbs and their effects can vary widely, so it is essential to discuss this with the practitioner who prescribed the treatment.

Q2: Causes of Sudden Decrease in Heart Rate
A decrease in heart rate, especially if it falls below 60 beats per minute (bradycardia), can be caused by various factors. These include:
- Increased vagal tone: This is common in athletes or during relaxation.

- Medications: Certain medications, including beta-blockers or sedatives, can lower heart rate.

- Electrolyte imbalances: Abnormal levels of potassium or calcium can affect heart rhythm.

- Heart conditions: Issues such as sick sinus syndrome or heart block can lead to bradycardia.

- Hypothyroidism: Low thyroid hormone levels can slow the heart rate.

Q3: Next Steps for Monitoring Heart Rate
Since you have experienced a decrease in heart rate but have no significant symptoms like chest pain or severe dizziness, it may be reasonable to monitor your heart rate over the next few weeks. Keep a log of your heart rate readings, noting any symptoms that accompany them. If you notice persistent bradycardia (heart rate consistently below 60 bpm) or if you develop new symptoms such as dizziness, fatigue, or fainting, it would be wise to seek medical evaluation.

Conclusion
In summary, continue to monitor your blood pressure at home, ensuring that you are in a calm state and using the device correctly. For heart rate concerns, keep track of your readings and any accompanying symptoms. If there are significant changes or if you have ongoing concerns, do not hesitate to consult a healthcare professional for a thorough evaluation. Regular check-ups and open communication with your healthcare provider are key to managing your cardiovascular health effectively.

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