The Right Way to Evade This Killer

November 12, 2024

Dr. Kim Hardy found a unique answer to abnormally high blood-pressure readings... The toilet.

Family-medicine practitioner Dr. Hardy was worried she'd have to readjust her patient's medications. The in-office blood-pressure readings taken by her medical assistants kept coming in abnormally high.

But then she recalled seeing a chart posted by the American Medical Association ("AMA") on its X (formerly Twitter) feed, which detailed common reasons for inaccurate blood-pressure readings:

A full bladder
An unsupported back
Unsupported feet
Crossed legs
Cuff over clothing
Unsupported arm
A conversation or is talking

She asked if the patient had a full bladder. The answer was "yes."

After a bathroom trip, she retook her patient's blood pressure. And, success, it had dropped down to a normal reading.

Lots of people get unusually high blood-pressure readings at their doctor's office. A full bladder is just one reason. Holding your pee makes for an enlarged bladder that presses on your kidneys, which can raise your blood pressure. Not to mention, struggling to hold your pee isn't pleasant – it's uncomfortable and adds to your stress, which on its own can raise your blood pressure.

Another major cause of high readings is "white-coat syndrome." This happens when you feel anxious about being at the doctor's office. So your blood pressure goes up in response.

This is one reason why you should check your blood pressure from time to time on your own, in a relaxed environment, like your home. But if you're taking readings yourself, make sure you're doing it correctly...

According to a study published last month in JAMA Internal Medicine, how you position your arm when you wear a blood-pressure cuff makes a big difference in getting an accurate reading. Johns Hopkins researchers took blood-pressure readings of patients with their arms in three different positions: unsupported and hanging, supported by the lap, and supported by a desk.

Resting your arm on your lap overestimated the systolic pressure (the top number in a reading) by 4 mm Hg (blood pressure measured in millimeters of mercury). Just leaving your arm hanging was worse – it artificially inflated the reading by almost 7 mm Hg.

Accurate readings are a must for evading this major health problem – one affecting about 47.7% of Americans. Unlike wine, high blood pressure doesn't get better with age... From August 2021 to August 2023, hypertension affected 23.4% of adults ages 18 to 39, 52.5% for ages 40 to 59, and a whopping 71.6% for folks 60 and older.

Hypertension earned the nickname "Silent Killer" because symptoms often emerge too late to avoid dire (even fatal) health consequences. What's more, more than 40% of folks with hypertension don't even know they have this dangerous condition. It's a major risk factor for heart disease, which killed nearly 703,000 Americans in 2022.

(Retirement Millionaire members, don't forget to check out our previous issue on heart attacks and what to do if you think you or a loved one is having one. If you don't have a subscription, you can start your trial right here.)

If it takes more force to pump blood through your body, it's a sign you have excessive inflammation and dangerous blockages in your blood vessels. If one of those blockages breaks off, it can lead to a heart attack or stroke. High blood pressure also puts more strain on your kidneys, leading to disease and failure. It's also linked to bone loss and vision problems.

A reading of 120/80 was once considered normal blood pressure, but now it's more of a threshold between healthy and elevated. Here's what those blood-pressure levels look like:

You can see how a reading that's off by just a few mm Hg can result in you being wrongly diagnosed with hypertension.

To get an accurate, in-office reading, ask your nurse or doctor taking the measurement if you can get another set of readings at the end of your visit. Oftentimes, you're more relaxed at the end of the visit and your pressure will drop.

Here are all of my tips for getting the best readings:

Do have the arm with the cuff supported so it's raised at the same level as your heart.
Don't cross your legs or feet.
Do sit in a chair that supports your back.
Don't eat, drink, smoke, or exercise 30 minutes prior to your reading.
Do make sure you're hydrated, though. Chronic dehydration elevates blood pressure.
Don't consume caffeine beforehand. Depending on your tolerance, you may want to stop drinking coffee 30 minutes to a few hours before.
Do empty your bladder beforehand. A 2011 study of 172 middle-aged women found a 10- to 15-mm Hg difference between a full-bladder reading and a reading taken right after peeing. And according to the AMA, a full bladder can account for a systolic measurement that's off by as much as 33 mm Hg.
Don't talk.
Do make sure you're not wearing thick clothing under the cuff. Even better, bare your upper arm.
Finally, don't forget to try to relax.

Remember to follow these tips outside of the doctor's office, too...

As I mentioned earlier, keeping an eye on your blood pressure is the simplest medical test you can do in the comfort of your own home. And it's one of my top recommendations if you want to be proactive about your health.

You can buy a blood-pressure monitor and take readings yourself. Just be sure not to use a fingertip or wrist model – those aren't accurate and may give wildly different readings in just a few minutes. So I recommend getting one for your upper arm. Omron is a great brand – it's just one of many listed in the AMA's Validated Device Listing, which you can access here. Another option is to check it in stores or pharmacies like Walmart and Walgreens.

Also before buying, measure your upper-arm circumference and make sure the monitor you're buying has a cuff that'll fit. One recent study estimated that a standard-sized cuff doesn't fit about 7% of American adults. Run the model of the monitor by your doctor, including cuff specifications. Better yet, bring the monitor to your next doctor's visit to make sure you've got the right fit.

Some additional home-monitoring tips...

Keep a log of the readings – the more information, the better, like including the date and time and anything out of the norm that could have been affecting your blood pressure (like eating an overly salty meal or experiencing a stressful life event).
Try to take readings around the same times – twice in the morning and twice in the evening.
Wait one minute between the two readings.
Don't take it as soon as you hop out of bed, though, because cortisol (stress hormone) levels jump right after waking up.

What We're Reading...

White-coat hypertension and masked hypertension.
Something different: This dead body thrown into a well was a medieval bioweapon.

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
November 12, 2024