[HN Gopher] Commonly used arm positions can overestimate blood p...
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Commonly used arm positions can overestimate blood pressure
readings: study
Author : wglb
Score : 121 points
Date : 2024-10-14 17:57 UTC (5 hours ago)
(HTM) web link (medicalxpress.com)
(TXT) w3m dump (medicalxpress.com)
| crazygringo wrote:
| There's definitely a huge variance in blood pressure readings
| depending on posture, relaxation, arm position, recent activity,
| etc. If you buy a blood pressure monitor, it's really interesting
| to see how "random" a single reading at the doctors' is, and how
| large your fluctuation throughout the day is.
|
| That being said, it really makes me wonder about studies that
| correlate blood pressure with other things. Is the blood pressure
| really being measured "correctly" in all those studies? Or not?
|
| In other words, if your "true correct" blood pressure is lower
| than what the doctor normally takes, but then a lot of the
| studies are based on real-life "incorrect" higher blood
| pressures, then don't you similarly want an "incorrect" higher
| reading for consistency? Or are the studies always really done
| with far more accurate blood pressure readings, where the patient
| sits still for 5 min beforehand, keeps their legs uncrossed, is
| totally free of stress and anxiety, didn't exercise beforehand,
| etc.?
| gklitz wrote:
| > Is the blood pressure really being measured "correctly" in
| all those studies? Or not?
|
| This is why you do readings three different times a day for
| several days. And why there's instructions on how long to dust
| still before the readings, why you do three repeats with
| multiple minutes of wait in between, and finally why the
| averages of those readings aren't just simple averages. But yes
| you always have to wonder about every study using self reported
| home readings if they follow the instructions or not, because
| it is tedious to do it correctly.
| moffkalast wrote:
| The reading process itself is a constant that you can't
| filter out by doing it repeatedly. Something squeezing your
| arm with what feels like the force of a hydraulic press
| surely doesn't have any weird side effects.
|
| Anecdata, but I always get high anxiety from not being sure
| if the thing is actually still working properly or if it's
| just gonna keep pumping itself up until it explodes in my
| face or something. Not exactly rational but these sort of
| things never are. Looney toons ass machine.
| giantg2 wrote:
| "Something squeezing your arm with what feels like the
| force of a hydraulic press"
|
| It shouldn't feel that crushing. I know it's common, but it
| shouldn't be. It's lazy/rushed healthcare professionals who
| only want to take it one time suing an automated machine
| and crank it to 200mm. If you actually put it at 140mm or
| take it with a manual sphig, it would read a "normal"
| person just fine without the crushing. The problem is, the
| people who are high around 130-140 need the machine at
| least 20mm higher and would need a retake, which means more
| time.
| SilasX wrote:
| I have an automatic at-home blood pressure device, and it
| does the same thing. Not 200 mmHg, but high enough that
| I'd freak out if I didn't know it was normal and would
| let up soon enough[1]. Did the product designers do that
| intentionally while still meeting a spec of "not
| panicking the user in a way that would elevate blood
| pressure" and getting approved for sale to non-
| professionals?
|
| It seems like this is genuinely hard to work around in
| practice.
|
| [1] I recall it being a staple of 80/90s tv, at least
| Beavis and Butthead, to have a character use an auto
| blood pressure device and freak out at being so clamped.
| HPsquared wrote:
| There might be a repeatability thing. Always give the
| full pressure then at least it's one less variable to
| account for.
| epcoa wrote:
| Nah. Modern automatic cuffs are adaptive. They tend to
| first run up pretty low (like 150), see if there is
| signal. If not then they have to inflate more and more.
| They tend to determine where to start next time based on
| the last reading, so if it had the go up to 200 for the
| last reading it'll start there next time. If the cuff is
| a vise, excluding operator error the most likely cause is
| actually having high blood pressure.
| rootusrootus wrote:
| One alternative is a cuff that measures on the upswing,
| rather than the downswing. It does not tend to squeeze
| quite as hard, because it stops as soon as it has the
| systolic reading.
|
| e.g. Omron BP7000
| marcosdumay wrote:
| Just to point, it's known that a sizeable segment of the
| population reacts to the pressure measuring process with
| increased blood pressure.
| hirvi74 wrote:
| > This is why you do readings three different times a day for
| several days.
|
| What good is this if my monitor is not as accurate as the one
| at a doctor's office? It's not like my doctor would take my
| monitor's readings over his.
| devilbunny wrote:
| You might be surprised. "White coat hypertension" is well-
| known. Someone with a reliable set of readings from home
| would be more convincing than someone who says "I get it
| read at Walmart/CVS once a month and it's ok".
|
| Your doctor's office's monitor isn't incredibly accurate.
| If you want accurate, you need a mercury sphygmomanometer
| to measure the pressure. Unless fundamental properties of
| the universe have changed, it will also be comparable to
| any other readings taken with mercury.
| Mathnerd314 wrote:
| I guess it depends on the study. If it is just comparing
| between groups, the conclusions probably still hold if they
| consistently measured blood pressure in the "incorrect" way. If
| it is something like "85% of Americans have high blood
| pressure", then probably the conclusions are incorrect because
| they are comparing the "correct" baseline against an incorrect
| measurement method. There are also other ways to measure blood
| pressure, like recent smartwatches - so read the methods
| section carefully, I guess.
| hombre_fatal wrote:
| As long as blood pressure variance is randomized then you're
| getting a signal, and that happens when everyone is measured in
| a similar way (or randomized to different ways). You don't need
| perfect precision.
|
| What you don't want is to make everyone who, say, smokes wear
| the cuff while standing up while everyone else gets cuffed
| lying down.
| crazygringo wrote:
| > _and that happens when everyone is measured in a similar
| way (or randomized to different ways)_
|
| But that's exactly the issue -- that the similarity or
| randomness is one way for one study, and another way for
| another study, because of culturally different sets of nurses
| and/or patients.
|
| In other words, you're right it's not affecting results
| _within_ a study, but it makes comparison _between_ studies
| questionable.
|
| And it makes it equally questionable whether a study's
| results apply to _you_ , if your signal is 10 units off of a
| study's signal, and occurs across a cutoff that determines
| whether you should take a medication or not.
| hluska wrote:
| When my heart went to hell, I bought a blood pressure monitor.
| Before I left the hospital, I had to agree to religiously test
| my blood pressure three times a day at the exact same time.
| Anything beyond that was a bonus, but to provide useful data I
| needed those three readings a day.
|
| As my cardiologist explained, 39 year olds don't randomly end
| up spending a week in a cardiac ward so he needed better data
| to form a holistic treatment plan.
| ajuc wrote:
| My wife had a Cryo Chamber Therapy for a few weeks and had to
| measure pressure and pulse before each session so they let her
| in. After about a week she was refused entry because her
| pressure was too high (when she measured it at home - it was
| normal).
|
| Since then she had problems getting admited every time, and she
| started to fear the measurement (she had to drive there during
| work and do overtime later).
|
| She started arguing with the guy and wasted like 5 days driving
| there and back during work without having another session
| because the pressure and pulse were too high (despite both
| being OK at home).
|
| Eventually she went to another person in that hospital to
| measure her pressure. It was perfect. But when the guy near the
| entrance to the cryo chamber measured it - it was too high to
| let her enter.
|
| They tried different instruments and the difference was the
| same. When the guy measured it - it was too high. When somebody
| else measured it - it was fine. Finally they let her do the
| cryo chamber without the guy permission :)
|
| We assumed the difference was just that she was anxious and
| frustrated when she's seen the guy, but now I wonder if the
| difference was the position in which he measured the pressure.
| zifpanachr23 wrote:
| Had the exact same thing happen when I was doing a Ketamine
| therapy thing a while back, and I definitely think the
| anxiousness about the reading had something to do with it.
|
| I've always had perfectly okay blood pressure whenever I have
| it done at a regular doctor's appointment, so I think knowing
| that the reading actually matters definitely increases my
| blood pressure. Ended up getting a doctor's note saying "they
| don't actually have high blood pressure they are just
| reacting normally to possibly having to be sent home and
| reschedule" more or less.
| lysace wrote:
| I found that that the measured BP was consistently
| significantly lower if I didn't look at the device's display
| while it was doing it's thing. This at home, with a quality
| device, after doing it many many times.
| kyleee wrote:
| Yes, i experiment with eyes open/closed as well
| lottin wrote:
| Exactly, this is my concern as well. They say you have to be
| seated for 5 minutes at least, completely relaxed, not hungry,
| not having to go the bathroom, in a quiet a room, it must not
| be too hot or too cold, with both your feet on the ground,
| before you can have your blood pressure measured, otherwise the
| reading could be 'artificially' high. Really? It seems to me
| that if you do all these preparations, the reading will be
| artificially low, since such conditions are nothing like the
| conditions that you'll typically find yourself in through the
| day in your everyday life.
| BaculumMeumEst wrote:
| The goal is to get a clinically relevant measurement,
| captured at rest under specific conditions, not a measurement
| that's representative of a random moment during everyday
| life.
| makeitdouble wrote:
| Reading around (e.g. [0]) it sounds like variance isn't
| something researchers care for, probably with the assumption
| that screening with a higher value is better than missing an
| issue from a lower value.
|
| We see the same for body temperature (speed and convenience is
| usually prioritized over accuracy) and weight (2% variation is
| largely accepted). Afterall guidelines are already off as by
| definition, as they don't account for individual circumstances,
| so perhaps aiming for accuracy is useless in most settings.
|
| [0] https://www.mayoclinic.org/diseases-conditions/high-blood-
| pr...
| SV_BubbleTime wrote:
| My doctor was handing me, hypertension, pamphlets, and talking
| about medication.
|
| Finally realized, that I was habitually late, getting to my
| appointments and always taking the stairs.
|
| Don't do that.
| arcticbull wrote:
| Also doctors and nurses are known to do an abject awful job of
| measuring bp according to the defined procedure. It's usually
| way off when taken clinically.
|
| Ars article here but there's plenty in pubmed too.
|
| https://arstechnica.com/health/2024/10/your-doctors-office-c...
|
| [edit] The prep guidance is...
|
| > You must not eat, drink, exercise, or smoke within 30 minutes
| of a reading. You must have an empty bladder. You must sit
| straight up in a chair with back support. Your legs must be
| uncrossed and your feet must be flat on the ground. The arm to
| be measured must be rested on a flat surface so that it is at
| the same level as your heart, not lower, not higher. You must
| sit calmly, without talking for five minutes to relax before
| the reading. When it's time, an appropriately sized cuff should
| be wrapped around your bare upper arm, right above the elbow;
| it should never be wrapped over clothing. At least two readings
| should be taken, with the average recorded. Ideally, readings
| should be taken in both arms, with the highest readings
| recorded.
|
| When was the last time you got it measured properly? Literally
| never for me in a clinical setting. I don't know why they
| bother honestly.
| swores wrote:
| I've never looked into research on this subject, but I always
| assumed this was already well established and known - and it was
| definitely somewhat already either known or at least believed to
| be the case:
|
| - Every doctor in the UK I've ever seen do a BP test has made
| sure the patient's arm is in the right position, rested on a
| table/cushion if needed, in a way that matches the findings in
| this study (and while I've only needed my own BP tested once or
| twice, I've sat in on many, many doctors while they tested the BP
| of family members of mine).
|
| - My home BP device is a Braun wrist cuff (and is at least a few
| years old), which has a built in feature that uses an
| accelerometer to guide you to raise your arm until it's at an
| angle which means your wrist is at the same level as your heart
| (this one: https://www.cora.health/guide/best-blood-pressure-
| monitor/#1... )
| tocs3 wrote:
| Can you trick the Braun device into thinking your wrist is
| level with you heart?
| swores wrote:
| Yes - it's just a digital spirit level of sorts, that instead
| of being calibrated to align with the ground is calibrated
| such that, based on typical angles and dimensions of a human
| body leads to the wearer holding their arm up in front of
| them with the device in line with the heart.
|
| Here's what it looks like, the device won't start until
| you've got the ball to hover in the middle circle, but it has
| no way of knowing if you're doing it properly or if you're
| lying down or leaning your body forwards or whatever else
| would mean that the angles no longer put it level with your
| heart.
|
| https://imgur.com/a/pV6xcpc
|
| edit to add: so when used correctly it looks roughly like
| this - https://m.media-amazon.com/images/S/aplus-
| media/vc/573a171a-...
|
| Basically the same logic as, for traditional upper arm cuff
| devices, giving the instruction to rest your arm on something
| next to you that allows your forearm to be resting both
| comfortably and straight, parallel to the floor - which
| again, doesn't technically mean the middle of your upper arm
| _must_ be level with your heart, but since nobody would
| really be comfortable putting their forearm flat on a low
| down coffee table or a high up standing desk it works as a
| proxy that 's simpler than asking people to think about
| lining anything up with their internal organs.
| tired-turtle wrote:
| Blood pressure measurements at the doctor are the bane of my
| (medical) existence. Mix minor white coat syndrome with time
| blindness and you suddenly have high blood pressure because you
| barreled up the stairs to the second floor office moments before
| the nurse took a reading.
|
| My doctor was initially befuddled because by all other metrics I
| am in good health, but it's amazing how you can go from 90/55 at
| home to 140/75 at the office. We do the measurement at the end of
| the appointment now to varying success.
| bluGill wrote:
| Weird, I ride my bike to the doctor, my heart rate is often
| elevated from the ride and my blood pressure is still normal
| (barely above low - though I've had enough different tests over
| the years to believe that exercise is having nearly zero
| effect)
| atahanacar wrote:
| Literally the first year of medical school, we were taught to
| let the patient rest for at least 5 minutes before taking
| vitals, while also asking about recent exercises or caffeine
| intake. This reduces the likelihood of a mistake, but white
| coat hypertension is still a thing. That's why we also teach
| them/relatives how to correctly measure BP on their own and ask
| them to measure it at home, preferably after waking up before
| eating anything.
| ajuc wrote:
| My wife has one specific guy doing the measurement that she
| hates and when he measures her pressure it's like 10-20
| higher.
|
| It's also the guy that measures pressure before letting
| people enter to the cryo chamber, so she spend about a week
| rescheduling and arguing with him to let her in.
|
| When she went to another person at the hospital her pressure
| was perfectly fine, and switching the instruments didn't
| helped - if THE guy measured it - it was too high - when it
| was somebody else - it was OK, no matter the instrument used
| :)
| atahanacar wrote:
| Definitely possible. Blood pressure fluctuates during the
| day. Activation of the sympathetic nervous system causes
| the BP to increase. So technically the measurements were
| "correct", but it was misleading because when talking about
| BP we normally mean "resting BP".
| eagerpace wrote:
| I am not a doctor and this is not advice. This is a standard
| medical test I have completely given up on any doctor to perform
| accurately. I do it myself at home once or twice a month. I do it
| with the same device, in the same chair, at the same desk, the
| same time of day, after I've ate and drank the same thing. Yes, I
| still let everyone take it because it's typically a precondition
| of receiving care but my readings at home are completely
| different and give me a more accurate data point that actually
| makes me feel good about the progress I've been making on my
| health.
|
| I'm actively looking for more healthcare I can do this way. I
| trust my data and it all coming together on the safety of my
| personal device. We don't need doctors with extremely limited
| datasets to do this and try to find obscure correlations for us.
| AStonesThrow wrote:
| > typically a precondition of receiving care
|
| I've achieved exciting results by flatly refusing vitals checks
| at each and every medical appointment. Especially
| psychiatrists. The PCPs always gamely admire my self-reported
| histories and graphs, commenting how nicely the trend line goes
| down, and then completely dismiss the results in their clinical
| notes.
|
| However, I did lock horns with a particular chiropractor. I
| filled out the "pre-existing conditions" form with candor and
| honesty. I permitted a BP check. (His method was 100% manual
| sphygmomanometer.)
|
| Then he informed me that he wouldn't touch me until my BP was
| controlled and normal. Yes, a chiropractor, not a cardiac
| surgeon. Geez.
|
| In the past, I've tried to avoid submitting to blood draws and
| labs, because those are 100% fishing expeditions, and not
| actually attempting to diagnose a complaint or symptoms. (They
| love to misdiagnose hypothyroid or diabetes so they can begin
| destroying your endocrines.)
|
| Unfortunately, clinics do these orders on a schedule, so if you
| avoid labs for a while, the orders simply pile up until they
| contrive to get them all done. I couldn't win. Still putting
| off colonoscopy: 2.5 years late, and counting!
| rscho wrote:
| But why go to these practitioners if you don't trust them ?
| Nobody should be forcing you. Is it because you want access
| to treatment solely on your own terms ?
| atahanacar wrote:
| >Still putting off colonoscopy
|
| I hope you won't regret putting it off.
|
| >They love to misdiagnose hypothyroid or diabetes so they can
| begin destroying your endocrines
|
| Yes, my favorite pastime when I'm bored of treating "actual"
| diseases.
|
| I fail to understand how a well-educated group of people
| (aka. HN) can be this against the scientific method.
| kaycebasques wrote:
| > after I've ate and drank the same thing
|
| My doctor recommended doing it first thing in the morning,
| before eating or drinking anything. That's probably an easier
| way for the general population to establish a consistent
| baseline
| atahanacar wrote:
| It's not only easier, but the actual correct way of doing it.
| That's why your doctor recommended it.
| atahanacar wrote:
| >This is a standard medical test I have completely given up on
| any doctor to perform accurately. I do it myself at home once
| or twice a month. I do it with the same device, in the same
| chair, at the same desk, the same time of day, after I've ate
| and drank the same thing.
|
| You are assuming the average patient is this careful about
| measuring their BP, or anything about their health. You are
| also assuming the average patient measures their BP correctly,
| which is obviously untrue as evidenced by some other comments
| on this post. You are also assuming patients always tell the
| truth about their own measurements.
|
| >We don't need doctors with extremely limited datasets to do
| this and try to find obscure correlations for us.
|
| I don't understand what you mean by this. None of us finds
| obscure correlations with limited datasets. We don't diagnose
| someone over a single BP measurement.
| rootusrootus wrote:
| > We don't diagnose someone over a single BP measurement.
|
| Yeah I feel like no doctor of mine has ever been the type to
| do that. My current PCP wouldn't prescribe meds for
| hypertension until after I took my own BP at home for a month
| (it was not catastrophically high when measured at his
| office, he might have taken a different approach in that
| situation).
| atahanacar wrote:
| Even with a catastrophically high measurement, no doctor
| would diagnose with a single data point. At worst, they
| would ask the patient to measure at home multiple times a
| day, after teaching the correct method of measurement. At
| best, they would do an ambulatory monitoring.
| Spivak wrote:
| Honestly I'm not sure what a single point-in-time reading even
| accomplishes. I've been hooked up to a continuous blood pressure
| monitor a few times and it's always fun to see how low I can get
| it. It seems pretty useless without seeing where it fluctuates
| over time not in a doctor's office.
| iwaztomack wrote:
| How do these work? You can't stay compressed all the time? Is
| it intravenal?
| Spivak wrote:
| The ones I've been hooked up to just compress every few
| minutes so not terribly fancy.
| aidenn0 wrote:
| Once, when hospitalized, I had an arterial BP monitor that
| was continuous. The last systolic number I remember seeing
| before passing out from sepsis was in the 70s.
| WarOnPrivacy wrote:
| Automated BP cuffs painfully over-inflate; my BP is 20+/15+
| higher when they're used.
|
| I ask nurses to take my BP manually.
| SirMaster wrote:
| Hmm, I find that the tighter the cuff goes, the lower my
| reading goes...
| elric wrote:
| I had a similar issue, which was remedied by getting a larger
| cuff. In retrospect it makes sense that one size does not fit
| all, and apparently my biceps are on the larger side.
| rscho wrote:
| Cuff sizes are targeted to a range of arm sizes. The range
| should be stated either on the cuff or in the manual. Using
| improper sizes over/underestimates the pressure values.
| BenFranklin100 wrote:
| I've never seen a discussion how 'reactive' one is
| physiologically either when discussing BP. That is, is one the
| kind of person who is generally calm throughout the day, or is
| one who has larger swings based on various stimuli? I've had
| readings as high as 155/95 when stressed rushing to a doctor's
| office visit and readings as low as 105/62 when calmer. I suspect
| blood pressures varies wildly through the day, and this variation
| depends on a person's physiology.
| hluska wrote:
| I had a major heart scare when I was 39 so I'm quite obsessed
| with my blood pressure. This is anecdata based off of my own
| experience with my heart, brain and body.
|
| (Note that this is based off of someone capable of developing a
| heart problem in his late thirties so hopefully none of this
| will apply.)
|
| Before I started running for fun, running up to a doctor's
| office would absolutely spike my blood pressure. That was a
| combination of anxiety (which is/was an issue), cardiovascular
| health and basic physical reactions to exertion. Since I
| started running for fun, that relationship has completely
| changed. I don't get the anxiety based blood pressure changes
| because I find running really fun and rewarding.
|
| When I lift weights, my blood pressure will read a little
| higher for at least 24 hours after. The heavier I lift, the
| more my blood pressure will lift. I see a similar relationship
| with volume, but it's not as linear as weight. So if I have to
| do fifty total reps to failure my blood pressure will be
| higher, but not as high as if I had done ten total reps to
| failure.
|
| Food and alcohol have tremendous impacts. Cannabis has an
| impact but nowhere near the impact of either food or alcohol.
| Armed only with blood pressure data, I could make a good case
| for fast food and beer to be illegal. My case wouldn't be as
| strong for cannabis. Caffeine is really fucking weird - it
| increases blood pressure up to the point of addiction. Then,
| not feeding the addiction will spike my blood pressure even
| more.
|
| And I haven't even begun to talk about how heavily my brain is
| involved. I dealt with undiagnosed ADHD through developing some
| very obsessive habits. As a consequence, I can quite literally
| obsess my way back to blood pressure medication.
|
| Judging by how much personal data I have on my blood pressure,
| I'm sure you're very surprised that I tend to be obsessive. :)
|
| So anecdotally, you are 100% correct. But I can add some more
| anecdotes to hopefully ease your mind. When I got out of the
| hospital, I had to promise my cardiologist three perfect
| readings a day; meaning that I would religiously check my blood
| pressure at the same three times each day. Needless to say, I
| checked it way more than that. But there is an awareness that
| different levels of need require different levels of scrutiny.
|
| The only part I still wonder is if my cardiologist knew that
| giving an obsessive person metrics would lead me into running.
| This may have just been a way to get me back into shape.
| atahanacar wrote:
| >I've never seen a discussion how 'reactive' one is
| physiologically
|
| Then you have never looked for it. This is pretty basic stuff
| taught in the very first year of the medical school.
|
| >when stressed rushing to a doctor's office visit
|
| Even has a name: white coat hypertension.
|
| >I suspect blood pressures varies wildly through the day, and
| this variation depends on a person's physiology.
|
| Yes it absolutely does. Just like your heart rate varies
| throughout the day, your BP keeps changing as well. That's why
| we like to measure it over 24 hours before any diagnosis.
| iwaztomack wrote:
| 4~7 mmHg isn't going to make or break a hypertension diagnoses.
| 20~30 mmHg definitely.
| aksss wrote:
| This shouldn't be downvoted.
|
| If you're +-7 in your reading, don't panic yet. If you're there
| with a stage 1 or 2 hypertension diagnosis (130-140+ systolic),
| the margin of error discussed in this article isn't necessarily
| meaningless, but remarkably close to it - you need to address
| an issue there.
|
| More as a PSA for you hardworking programmers and IT managers
| out there: if you have chronic hypertension, address it sooner
| than later. If you think to yourself that you'll start jogging
| daily starting next week, and your doctor is giving you the
| option for meds, just get on the damn meds. If you start an
| exercise regimen that can quantifiably manage it without the
| meds later, great. Don't let the perfect be the enemy of the
| good. Hypertension is the silent killer, and before it kills it
| contributes to all sorts of other bad problems and conditions.
| kayodelycaon wrote:
| Hypertension can also make you feel like crap. It made my
| chest feel tight, which did not help my anxiety.
| aksss wrote:
| Yeah, I empathize. Glad you're doing better now, assuming
| you are. I would get awful headaches and nausea (like hide
| in a dark room, photophobic, overly sensitive to sound,
| smells, wishing I could chop my head off). For years I
| didn't connect the two. Felt like getting the worst two-day
| hangover without having drank anything, but if I had
| measured my blood pressure at the time it would have been
| well over 150. I clocked in at 170 during one of those
| episodes when I went to urgent care. For years I had just
| dismissed as having overdid it the prior week and just
| needed to rest. Even if you can put up with the pain like a
| badass, it's not healthy for your system to be redlining so
| often. It does its damage in the aggregate.
| aranchelk wrote:
| As a just-in-time bordering on chronically late individual
| (typical engineer), sprinting on foot or bicycle to the doctor's
| office has led to some unusually high reading.
| btilly wrote:
| I've never seen a nurse not insist on the right position.
|
| However I've always wondered how much of a difference my long
| torso makes when my blood pressure is measured. I'm 6'3", and
| it's mostly torso. The result is that a table that is the right
| height for most people, is low for me. And adjusting the table to
| match my body is something that I've seen a lot of variation on.
| reneherse wrote:
| Seems it would be easy to equip exam rooms with a set of basic
| foam blocks that could help with patient positioning for this
| and other routine procedures.
|
| Can any medical professionals chime in on how it's usually done
| for tall folks?
|
| "Long torso body type" is, in general, an under-appreciated
| factor in ergonomics and product design, IMO.
|
| A couple of off-the-cuff examples:
|
| -The longer your torso, the worse a laptop computer affects
| your neck and posture. For long folks, upright posture requires
| keyboard and monitor to be vertically separated even more than
| most off-the-shelf monitor/desk/keyboard trays will allow. So a
| monitor hinged directly to a keyboard is the worst of all
| possible configurations.
|
| -Most recent automotive seats seem to force the head forward,
| excessively curving the spine, and the longer the torso the
| worse the effect.
|
| On the opposite side of the bell curve, a safe driving position
| is hard to achieve for drivers around 5ft tall and under.
| Correct/safe distance from airbags and pedals seems to be
| overlooked for those of shorter stature.
|
| I wish solving problems experienced by body proportion outliers
| was a higher priority for product companies.
| rootusrootus wrote:
| Add clothes to that list. It's such a pain in the butt to
| find shirts made for people who are long torso without ending
| up with a shirt that's larger in every other dimension too.
| Even ones specifically labeled 'tall'
| mise_en_place wrote:
| I was also fed up with inaccurate readings, and was trying to
| prototype a medical device that would have an adjustable cuff
| based on arm size. I ran it by my concierge doc, but apparently
| the latest tech is to use light waves to measure BP, similar to
| how wearables are doing pulse OX and Heart Rate. The technique is
| known as Photoplethysmography (PPG).
| rscho wrote:
| There are devices that are sold with various swappable cuff
| sizes.
| modeless wrote:
| I can lower the results by 10-20 points just by breathing deeply
| during the reading.
| rscho wrote:
| Yes, everyone can do that to some extent.
| floam wrote:
| Only time I ever recall a nurse that insisted on doing BP
| measurements wrong was .. in jail. And not like all the nurses
| there, just this one person who did not care about anything
| besides flirting with corrections officers and getting the hell
| out of there ASAP.
| bonoboTP wrote:
| Real-life medical practice is basically going through the
| motions, then intuitively guessing the issue, prescribing
| something common since most cases are so banal and next patient
| please.
|
| Engineer-minded people can discover lots and lots of such
| "obvious" issues in healthcare and of course the answer isn't
| that nobody would've guessed it, it just doesn't matter.
| Healthcare (outside of very specific diagnosable illnesses) is
| 90%+ medicine theater. People expect some pills, they want a few
| words with someone in a white coat, and their problem goes away
| usually by itself. Chronic persistent issues without obvious
| cause befuddle docs and they often don't find anything even after
| lots of tests.
|
| Our better health and longevity today is more due to better work
| conditions, better food, better sanitation and food preservation,
| basic vaccines, basic disinfectants, basics like penicillin,
| smoking less etc. And the low hanging fruit to improve further is
| lifestyle: eating/drinking fewer calories (especially less sugary
| stuff), exercising/sleeping more and having better social
| connections. None of it is particularly arcane or in need of
| precise measurement.
| rscho wrote:
| > Engineer-minded people can discover lots and lots of such
| "obvious" issues in healthcare
|
| It is a defining characteristic of "engineer-minded people" to
| think they understand better than others. Amusingly, they won't
| pretend to repair their car engine better than a mechanic, but
| they will strongly believe they understand all the bad tricks
| and failings of doctors. They almost never understand that
| current medicine is mostly experience and not hard science.
| Future medicine is science. 2024 medicine is not, and cannot
| be.
| quantadev wrote:
| I'm convinced most people take BP wrong.
|
| Here's how:
|
| Lie down on a bed on your back, and put the cuff on your arm and
| get the 'button' within reach of your finger to turn it on. Then
| completely relax (and DO NOT move) with soft music or whatever.
| Then without moving your body at all, after 10 minutes (at least)
| push the button to start the pressurization and reading.
|
| This gives an accurate reading and is often DRAMATICALLY lower
| than if you don't do it this way. I was convinced I had super
| high potentially life-threatening BP until I learned this.
|
| Now if you want to see I'm right, get up and walk around some and
| then sit back down and take another reading. It will be
| noticeably higher, because your heart starts pumping harder even
| from minimal movement.
| geye1234 wrote:
| I don't disagree, but wouldn't the counterargument be that the
| 120/80 and 140/90 thresholds (or whatever they've redefined
| hypertension as) apply precisely to sitting rather than lying,
| and after only a minute's stillness, rather than ten? And also
| that you spend 16 hours out of 24 not lying down?
| epcoa wrote:
| You don't live your day to day life listening to soft music,
| lying down ready to doze. If your BP is elevated due to stress
| throughout the day it's elevated, you will accumulate the
| harms. Idealizing conditions also gives a misleading reading.
|
| > Now if you want to see I'm right, get up and walk around some
| and then sit back down and take another reading.
|
| This doesn't prove you're right, just demonstrates normal
| physiology. Kind of like saying when you dyno an engine you
| should do it at idle. That is a valid measurement, just not the
| one that's interesting.
|
| In a healthy adult you will see a more significant increase in
| systolic pressure, but mean pressure shouldn't rise nearly as
| greatly.
|
| What you're trying to observe is not the minimum ideal (your
| method) nor the short term maximums but an average of normal
| activity.
|
| There's a reason why ambulatory BP monitoring is the gold
| standard for diagnosing hypertension.
| atahanacar wrote:
| >This gives an accurate reading and is often DRAMATICALLY lower
|
| Just because it gives lower results doesn't mean it's more
| accurate. I can raise my arm during measurement or use a
| tourniquet above the cuff and get a lower result. That doesn't
| mean the measurement is accurate at all.
|
| There are standardized procedures on how to measure BP. Your
| "accurate" method is not one of them.
| rootusrootus wrote:
| I've heard that for some people it's exactly the opposite.
| Standard procedure, IIRC, is to have the arm resting in a
| position that puts the cuff right about even with your heart.
| But some people get really big jumps in BP when supine, and
| I've heard it suggested that doctors might want to start doing
| their BP tests in that position because those people may not
| get diagnosed correctly despite spending a third of every day
| with high blood pressure.
| geye1234 wrote:
| Quite a few people here report getting anxious even when taking
| their BP themselves:
|
| https://www.innerhealthstudio.com/phobia-taking-blood-pressu...
|
| I'm one of them. I bought a device with memory and covered the
| screen with a piece of card. Then I take BP for two weeks and
| ignore the first few days' readings. I seem to get used to it
| after a few days. This gets me readings that are very close to
| 120/80.
|
| I've had anxiety about blood pressure ever since running for an
| appointment, while being on the first day of a new job when I was
| really amped up, and so (of course) had a dangerously high
| reading. I still remember the guy's eyes widening as he looked at
| the screen. Ever since then I've hated having BP taken and I can
| feel my BP and pulse increasing the moment I step into a doctor's
| office. Fortunately my doctor understands and doesn't try to push
| pills on me.
|
| I wish there were some way of measuring BP without knowing it's
| being done. The act of measurement can greatly affect the result,
| which is counter-productive in several ways (not the least of
| which is un-needed anxiety).
|
| York Cardiologist on Youtube is good on BP, and why apparently
| high BP should not automatically mean pills, although undoubtedly
| it _sometimes_ should. (Usual disclaimer: this is not medical
| advice, ask your doctor about your specific situation.)
| johnfn wrote:
| I remember when I was a kid, the doctor thought that my blood
| pressure was too high. Of course, I was just anxious because I
| knew they were going to give me a shot. What kid wouldn't be??
| He took it again after I got the shot and it went back down to
| normal.
| jeffreyrogers wrote:
| Wearing a waffle pattern shirt can also make the reading high. My
| blood pressure is 20 points higher if I wear a waffle pattern
| shirt than if I take it off.
| sieste wrote:
| That sounds like the guy who thought he had a leather allergy
| because whenever he woke up with his shoes still on he had a
| terrible headache and felt nauseous.
| unsupp0rted wrote:
| > "If you are consistently measuring blood pressure with an
| unsupported arm, and that gives you an overestimated BP of 6.5
| mmHg, that's a potential difference between a systolic BP of 123
| and 130, or 133 and 140--which is considered stage 2
| hypertension,"
|
| Okay, but that's a small and borderline difference?
| atahanacar wrote:
| Yet another medical topic being discussed on HN, with comments
| full of disinformation and skeptics that think they've noticed
| something new that doctors have missed. Remember people, don't
| take medical advice from HN.
| rscho wrote:
| Those topics are fascinating. They reflect how a pretty well-
| educated population subset thinks about healthcare. It's almost
| always entertaining!
| atahanacar wrote:
| Definitely increases my BP though. Imagine someone ignoring
| their own health problems because they believed what a HN
| commenter said.
| rscho wrote:
| Well, it's clearly an echo chamber. There's very little
| actual transmission of knowledge in those topics. It's
| almost always about confirming pre existing beliefs. I'm an
| MD too, but I've been raised by scientists. Scientists in
| my own family entertain the same beliefs exhibited by
| HNers, to surprising extremes such as dismissing the effect
| of even very well understood drugs.
|
| Last year, my father stopped his blood pressure meds and
| was very surprised when I could guess he'd stopped just by
| looking at him, then proceeded to explain how the drugs
| acted, and got even more surprised when he got much better
| 15 min after taking them again. Since then, he totally
| forgot about this event and is in complete denial. You
| can't change beliefs by explanation. People have to get to
| their own conclusions, otherwise you're just fighting
| windmills all the time.
| atahanacar wrote:
| Nice to see a fellow MD (very possibly older and more
| experienced than me) on HN.
|
| >he totally forgot about this event and is in complete
| denial.
|
| I can never understand this, especially with well
| educated people like your father or mine. I can't get
| mine to agree to go see a doctor (other than me - he
| doesn't believe me when I tell him something about
| medicine) for anything, even when there are obvious
| problems with his health.
| Dove wrote:
| I am a skeptic about the diagnostic criteria for hypertension,
| and especially about low targets for management. Cochrane did a
| meta review not long ago that made it sound like the signal was
| pretty weak below about 160/100 (as you might expect, if the
| measurement wasn't very accurate, which I don't think it is). I'm
| not saying it's not dangerous at much higher levels, but if
| you're freaking out at 140/90 because a chart says STAGE TWO, imo
| you can take a chill pill.
|
| https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
|
| (Disclaimer - I am not A doctor, and I am definitely not YOUR
| doctor, just an interested party who thinks the science smells
| funny.)
| rscho wrote:
| Pressure cuffs are sensitive to many factors outside blood
| pressure and are are pretty imprecise: news at eleven!
| m463 wrote:
| every time I get my blood pressure measured, my arm hangs on some
| scaffolding thing the blood pressure cuff hangs from. not even an
| armrest. Height is also not really standard.
|
| that said, arm was not in my lap, and not hanging freely at my
| side.
| crtified wrote:
| Putting aside the implementation technicalities, which I know
| nothing about, I'm convinced that markedly superior outcomes will
| be driven by something (e.g. watch-like devices) that captures
| entire weeks worth of regular BP readings across all times of day
| and night to provide a significant body of data.
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