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Debbie Malewicki has never been shy about advocating for her own health.
So when the 48-year-old Monroe resident was told that her blood pressure was high enough that she needed to go on medication — after years of having blood pressure that was on “the low end of normal” — she spoke up. Malewicki was already being treated for adult onset asthma, and was still taking some medication for breast cancer.
Malewicki doesn’t know for sure why there was such a wide variance in her blood pressure readings, although she attributes it at least partly to the fact that her office had been using an automated blood pressure machine, instead of taking it “the old-fashioned way” with a manual blood pressure cuff.
However, she’s not the only one who has faced widely different pressure readings on different visits. Doctors said getting an incorrect high blood pressure reading is fairly common, and is often caused by missteps the average patient might not even notice.
For instance, talking to a patient while taking blood pressure, taking blood pressure through clothing and having a patient sit on an exam table with their feet dangling can all lead to artificially high blood pressure readings.
“I’ve had a patient walk down the hallway, climb onto the table and immediately have their blood pressure taken,” said Dr. Craig Serin, senior medical director of Western Connecticut Medical Group, and is based in Wilton. “Then I’ve come in 10 to 15 minutes, after I’ve had them sit with their feet on the floor for a while, and taken it again, and seen the blood pressure go down 30 to 40 points.”
In some cases, a mistake can theoretically lead to a patient being unnecessarily put on blood pressure medication, said Dr. Jeffrey Berman, chairman of cardiology at St. Vincent’s Medical Center in Bridgeport.
“That’s a problem,” he said. “If you overtreat blood pressure, you can have blood pressure that’s too low.”
That can lead to dizziness, falls and injuries, Berman said.
“You want to make sure you’re treating the right people,” he said.
‘An extremely important issue’
Blood pressure is defined as the pressure of blood pushing against the walls of the arteries, which carry blood from the heart to other parts of the body.
Health professionals typically use a cuff on the arm to measure blood pressure. The cuff has a gauge attached to it that measures the pressure in the blood vessels with a unit of measurement called “millimeters of mercury.”
Blood pressure is measured using two numbers — systolic blood pressure measures the pressure in the arteries when the heart beats, and diastolic blood pressure measures pressure in the arteries when the heart rests between beats.
For example, someone with a systolic blood pressure of 120 and a diastolic blood pressure of 80, would be said to have an overall blood pressure of 120 over 80.
Though the standard of what is considered “high blood pressure” has fluctuated over the years, guidelines released in 2017 state that a consistent reading of 130 over 80 or higher is considered high blood pressure.
According to the Centers for Disease Control and Prevention, about 108 million adults have high blood pressure, also known as hypertension, or are taking medication for hypertension. In 2017, nearly half a million deaths in the United States included hypertension as a primary or contributing cause, the CDC states.
Given how pervasive and dangerous high blood pressure can be, it’s crucial to properly identify and treat those who have it, said Dr. Carl Orringer, a professor of medicine in the cardiovascular division of the University of Miami Miller School of Medicine.
During a recent talk at the university, Orringer said high blood pressure is “an extremely important issue.” That’s why it’s important that health care professionals take blood pressure properly.
“It makes a huge difference in terms of treating patients,” Orringer said.
Small mistakes, big differences
Orringer provided a list of some of the errors made during doctors’ office blood pressure readings, and the difference they can make in a patient’s results. For instance, he said, talking to a patient while taking blood pressure can elevate a reading by as much as 10 millimeters of mercury.
Some errors can result in a fairly significant difference in a blood pressure reading. Putting the blood pressure cuff on a patient over their clothes — as opposed to a bare arm — can raise the reading by anywhere from 5 to 50 millimeters of mercury, he said.
“Now we’re talking about blood pressure medicines and treatments and having to come back to your doctor’s office and checking your blood — and all of this might have been due to the fact that your blood pressure wasn’t properly measured,” Orringer said.
Locally, doctors said they’re aware of protocol errors, and are doing their best to educate health providers about how they can avoid mistakes. Serin said staff in his practice are being trained on the proper procedures for taking blood pressure.
Serin and Orringer both said the time constraints faced by doctors could also be a contributing factor to blood pressure error.
One of the guidelines for taking blood pressure is to allow patients to sit quietly in a chair with their feet on their floor for at least five minutes before the reading is taken.
There is so much time pressure for practitioners to see their patients in a defined period of time,” Orringer said. “If you think of five minutes out of a 15- or-20 minute visit, it’s tough (to do) but it can be done if you’re committed to doing it.”
Meanwhile, Malewicki said she generally thinks her health care providers use best practices when taking her blood pressure, allowing her to sit before taking a reading, and not speaking while the reading was being taken. But she said they might have committed at least one blood pressure no-no.
“There wasn’t always an effort to make sure my feet were on the floor,” Malewicki said. “A lot of the time, they dangled.”