Evaluating Blood Pressure Cheat Sheet

[Pages:5]Evaluating Blood Pressure Cheat Sheet

Person's Name: Date of Birth: Person's Age:

Sitting

Time of

Systolic BP (c Diastolic BP Pulse

Date

Reading 1 (a) )

(d)

(e)

Standing Systolic BP Diastolic BP Pulse

Sitting

Time of Reading 2 (b) Systolic BP Diastolic BP Pulse

Standing Systolic BP Diastolic BP Pulse

Notes:

a) Take reading 1 at the same time every day. It's good to do this about an hour after taking BP medications, so you can see what effect the medications are having on blood pressure.

b) It's optional but helpful to get a second reading during the day, especially if you take blood pressure medication more than once a day. c) Systolic BP is the "top number" in the blood pressure reading. d) Diastolic BP is the "bottom number" in the blood pressure reading. e) Do record the pulse (also known as the heartrate) that will be reported with the BP measurement. Doctors need to know it, in order to properly interpret your blood pressure readings.

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Daily Medications Schedule

Person's Name: Person's Date of Birth: Person's Age: Date Schedule Last Updated:

Morning Medications Time usually taken:

Mid-day Medications Time usually taken:

Afternoon/Early Evening Medications

Time usually taken:

Nighttime Medications Time usually taken:

Patches and other medications

Note: You can list medications you take "as needed" either in the time of day in which you might take them, or in the "Patches and other medications" section. This free resource is brought to you by

What the revised blood pressure guidelines mean for caregivers of seniors

By Leslie Kernisan, MD MPH

[This article is for education and informational purposes only. For your convenience, at the end I've included two sample charts to help you record blood pressure and medication use. The purpose of these charts is to help you prepare for a constructive conversation with your usual doctors.]

Are you caring for an older person with high blood pressure? Or does your parent take medication to lower blood pressure?

If so, then you'll probably want to learn more about the new guidelines for the treatment of high blood pressure, which were released by the highly respected Joint National Committee (JNC) panel on December 18, 2013.

For the first time, the guidelines recommend a different blood pressure (BP) treatment target for older adults. For adults aged 60 or older, the JNC suggests a goal BP of less than 150/90 (instead of less than 140/90, which was the target recommended in prior guidelines, published in 2003).

The guidelines also now recommend that people with diabetes or kidney disease aim for a BP of less than 140/90, whereas most previous guidelines recommended a goal BP of less than 130/80.

Why the new blood pressure guidelines matter for older adults

The new guidelines matter because they support what we geriatricians have believed for quite some time: many older adults are taking too much BP medication.

This is a problem, because BP medications can have risky side-effects in older adults. Specifically, up to 20% of older adults experience a temporary drop in BP when they stand up. This problem, sometimes called "orthostatic hypotension" can cause dizziness and potentially catastrophic falls. Furthermore, a 2014 research study found that seniors who take blood pressure medication are much more likely to experience bone-breaking falls.

Overtreatment of BP is also a problem because it can increase monthly medication costs and the number of pills an older person has to take.

Now, we do want to treat high BP because we want to reduce the chance of strokes and heart problems. But what clinical studies have shown is that treating high BP gives you the most benefit when we help people get their systolic BP (that's the top number in a BP reading) down towards around 150.

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To date, it's been hard to scientifically prove that most older people benefit from getting their BP lowered down to 140 or less.1 (Experts generally agree that in the elderly, managing systolic BP is much more important than worrying about diastolic BP, which is the lower number in the reading.)

In geriatrics, we always want to balance the likely benefits of a medication with the likely burdens and risks. Treating high blood pressure to a target of less than 150/90 brings on increased risks but usually isn't beneficial.

Most older adults want to take no more medication than is necessary to maintain health and wellbeing. These new guidelines offer a good opportunity for caregivers to check on whether their loved one might be taking more BP medication than is needed.

What caregivers can do about blood pressure

If you're caring for an older adult who has been diagnosed with high blood pressure, or who takes blood pressure medication, here's what I recommend:

Check the older person's blood pressure, and know what his/her systolic BP is. The best way to do this is to use a high-quality BP machine, and to have the BP checked at the same time of day, for 3-7 days in a row. If possible, check twice a day instead of once a day. (For more on checking BP at home, see this post.) For your convenience, a sample chart to record blood pressure is included at the end of this article.

Since blood pressure is constantly changing a bit within the body, a series of measurements gives a more accurate idea of where a person's BP usually is.

Home-based BP checks have been shown to correlate better with a person's true BP than occasional office-based BP checks.

If there have been any falls, or if systolic BP is less than 120, consider checking BP both sitting and standing. If BP is dropping a lot when the person stands, you'll want to ask the doctor to address this.

1 In September 2015 a large federal research study on blood pressure was stopped early, because participants assigned to have their blood pressure treated to below 120 were having fewer cardiovascular events. Once the official research report is released, experts will likely reassess recommendations on ideal blood pressure for older adults. This free informational resource is brought to you by

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Make sure you know what BP medications the older person is actually taking. If you haven't checked the actual pill bottles recently, now's a good time to do it. For your convenience, a sample chart to record what medications a senior takes, and at what times, is included at the end of this article.

Don't rely on a medication list provided by the doctor's office. In my experience there is often a mismatch between what people take and what their doctors think they are taking. (Some doctors will even keep increasing the dosage of BP medication, when the problem is that the older person hasn't been taking the pills at all for some reason.)

Note that some medications to help with urination, such as tamsulosin and terazosin (brand names Flomax and Hytrin, respectively) can cause drops in blood pressure.

Compare the older person's BP to the target BPs in the new guidelines: If the systolic BP is over 150: You'll probably want to discuss with the doctor. Together, you might decide that a high BP goal is reasonable for your loved one, or you might decide on an approach to get the BP down a bit further. What to do will depend on your loved one's specific medical situation and preferences.

If the systolic BP is between 140-150: This is usually a good BP for most older adults: not too high, not too low. If the older person has diabetes or kidney disease, consider asking the doctor whether a goal BP of less than 140/90 should be pursued.

If the systolic BP is less than 140: Consider discussing BP treatment with the doctor, especially if you've had any concerns about dizziness or falls. I would especially recommend reviewing treatment goals if the sitting systolic BP is less than 120.

Questions or comments? Please post these in the comments section here ? you can name yourself "Anonymous" if you want to maintain your privacy ? and I will do my best to address them. Thank you for your interest in .

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