How much should I worry: High blood pressure
November 7, 2018 7:50 AM   Subscribe

I am a 60+ female who takes Ritalin for ADHD. As part of that, I see a nurse periodically to answer questions and get my blood pressure taken. Today I asked if the nurse would mind taking my blood pressure in both arms because I had read in the Harvard medical newsletter that potential problems can show up by a difference in the arms.

Today my pulse was 77 and the pressure in my left arm was 135/91. In my right arm it was 160+/90 something the first two times then 152/91 on the third try. I have to go see a regular doc to have my blood pressure retaken. How urgent is this? I have lots of work this week and would rather wait until next week if I can. If this is as bad as it sounds, speaking as someone who knows nothing about blood pressure, then I will totally haul ass and get seen as soon as possible.
posted by anonymous to Health & Fitness (6 answers total)
I'm your age, I am not any kind of medical professional, my advice is: yes, you can wait a week, it's not through the roof, as long as you don't have any other health issues. Pulse of 77 is just fine.
posted by mareli at 8:08 AM on November 7, 2018

Hi, I'm a nurse but this isn't medical advice--rather, it's some insight into the working process of the nurse who took your blood pressure.

The nurse saw three slightly different readings on your right arm; that's normal, and the range of variation there looks like they could well be all roughly accurate readings, maybe showing some variation related to position, manual cuff technique/BP machine function, or other contextual factors. They are indeed outside the normal range, so the nurse would have considered your health history and baseline blood pressure before deciding whether to take action on that, and what to do with what level of urgency. If they had been concerned that your BP was a "oh no, get seen as soon as possible!" level of high, they might have called an MD to consult on the spot, or arranged for you to go directly to see an MD, or if not immediately then would have advised you to get, and possibly helped you to find, an appointment within the next couple of days. It sounds like they didn't do any of that--they said you should check in with your GP to follow up but perhaps didn't mention a timeline (?).

In summary: if I were you, I'd let my reaction be guided by the level of urgency expressed by the healthcare professional who saw the issue. But ultimately, do what you feel most comfortable doing.
posted by snorkmaiden at 9:50 AM on November 7, 2018 [2 favorites]

I am a nurse, I am not your nurse. Did you have your pressure taken manually (with the cuff that the nurse pumps up) or with an electronic cuff? In my experience electronic cuffs can give false high readings and are generally more error-prone. With an arm disparity like your on an automatic, I’d want to be rechecking your pressure manually. Seconding snorkmaiden that the two different right arm pressure are within a regular range of error.

Also, both of your pressures are in the range where I’d tell a patient “this is higher than it would be in my ideal world, but as long as you’re not having concerning symptoms [new onset strong headache, sweating, feeling faint, chest pain] then you’re fine until you can get seen.” Your pulse is completely fine.

I am not 100% sure why your provider is having you go immediately to a doctor after one high reading. Yes your age and stimulant use are risk factors for chronic high pressure, but one elevated reading is not a great indicator of anything. The damage from hypertension comes from the wear on your cardiovascular system over time. Getting a home blood pressure monitor (available at any drugstore) and tracking your pressures over a week or more is going to give you better data than one isolated trip to your doc, and may help put your mind at ease when you see how much variation is possible day to day.
posted by ActionPopulated at 9:52 AM on November 7, 2018 [1 favorite]

For future reference, I am also 60+ female, who has taken Adderall for years for ADD - plus, it keeps depression at bay. My blood pressure taken at my doctor's office tends to run higher than the reading I get home - my doc attributes it to "nerves" related to the appointment and says it's not unusual. (Monitor checked against equipment at doc's office to verify accuracy.)
posted by she's not there at 2:07 PM on November 7, 2018 [1 favorite]

I'd like to know whether there's anything alarming or even interesting, medically speaking, about a 20+ point difference between the systolic pressure in the left arm and that of the right. That seems like a pretty big difference.
posted by chromium at 5:29 PM on November 7, 2018

IANYD, the following is general information, not medical advice for your specific situation.

Aortic dissection can sometimes manifest as a different blood pressure level in the right versus left arm. However, this is usually associated with other symptoms, which are usually nonspecific. Relatively unlikely, but potentially worth looking for with other symptoms. This could be the reason for the note in the newsletter.

As to the level of urgency, your HCP should calculate your 10-year risk of experiencing a cardiovascular event (pooled risk cohort equation calculator) to help decide whether or not to prescribe blood pressure medication. You can purchase a good automatic blood pressure monitor (arm cuff not wrist perferably: check consumer reports for specific brands).

Specific blood pressure cutoffs for treatment with medication are controversial. Blood pressure treatment with lifestyle modification, such as the DASH diet, and modest weight loss are not at all controversial, however. These can reduce blood pressure that is elevated to healthier levels. Starting medication is a risk/benefit decision. Lifestyle modification has little risk and lots of potential benefit.
posted by metasunday at 8:07 PM on November 7, 2018

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