But overdiagnosis and overtreatment of hypertension is a big problem

All the conclusions from studies on the risks of hypertension and the benefits of treatment are based on blood pressure measurements that are taken after patients have been sitting quietly for 5 minutes or so. That’s because it takes a few minutes for our blood pressure to settle down to a steady, resting level. And that’s why every guideline recommends that patients sit quietly for 5 minutes before measurements are taken.

But in a clinical setting, like a visit to the doctor's office, a patient's blood pressure is often taken right away. Likewise, when people measure their own blood pressure at home, most do it without waiting.

Readings obtained without waiting can be 5 or 10 millimeters, or more, above our resting blood pressure level.

The result...

diagnosis and treatment of patients who might not have high blood pressure to start with and an unnecessary increase in medication for patients who have already been diagnosed and are taking medication.

Obviously, diagnosing and medicating someone for hypertension who doesn’t have high blood pressure isn’t good.

Overtreating, aside from additional cost, increases the risk of side effects, and of lowering blood pressure too much. This can cause fatigue, lightheadedness, and even fainting. 

I regularly see new patients who are concerned because their blood pressure readings have remained elevated despite treatment. I found that many of those patients were taking their readings without waiting. Many ended up with lower readings when they waited the recommended 5 minutes before taking their blood pressure.

My decades of clinical experience agree with these results. I’ve followed the blood pressure of many patients during periods of severe stress in their lives. While their blood pressure may temporarily increase, it eventually falls back into a normal range and does not directly lead to persisting hypertension.

The prevalence of faulty blood pressure readings

So how often do Americans measure their blood pressure without waiting?

In a study we published, (Nonadherence to Recommended Guidelines for Blood Pressure Measurement.  Levy,J, Gerber, LM, Wu, X, Mann, SJ.  J Clin Hypertens.

2016;18:1157), we asked patients if their blood pressure measurements were taken by a physician, nurse, technician, or themselves with or without waiting at least a few minutes.

The numbers were staggering!

• 77% reported that physician measurements were obtained without waiting.
• The proportion was even higher when measured by a nurse or technician, 96% and 81%, respectively.
• 60% of subjects surveyed who measured their blood pressure on their own at home were doing so without waiting.

I often hear how patients are brought into a room, seated, and their blood pressure is measured immediately.

In fairness, physicians are often pressed for time. But the importance of waiting a few minutes can mean the difference between diagnosis, overmedicating, or worse.

Fixing the problem

Yes, physicians should follow the guidelines, but more importantly, you (the patient) should feel empowered to check your blood pressure at home.

• When you do, sit down, put on the cuff, sit quietly for 5 minutes, and then take 3 readings, a minute apart. 
• When you see your physician, if your blood pressure is taken without waiting and is elevated, request that the measurement be repeated after waiting 5 minutes. Remind them that this is according to guidelines. 
• Share this post with friends and family.

I want to emphasize the importance of measuring your blood pressure and ensuring it is in the “normal” range. To avoid overtreatment or a misdiagnosis, make sure you are taking your blood pressure, or having it taken, per the recommendation of sitting quietly for a few minutes before taking the reading. It’s time to bring attention to this problem.