Field Notes #20: Blood pressure measurements at home, indispensable idleness, & a poem by Courtney Martin
This week's collection includes a quote of note by essayist Tim Kreider and the surprise that your blood pressure measurement at home — taken regularly — can be more accurate than at a doctor's office
Hello, friends! Happy Wednesday and Happy June.
Summer feels underway here in the Hudson Valley of New York. It’s not officially summer (not yet June 21), but the temperatures are rising (it was 91°F/33°C yesterday) and school is down to a week and a half. I do love summer. The cozy buzz of the sun, the daylight that stretches astonishingly into the near night hours, the lure of the beach and its lapping waves. I admire how many Europeans take a whole month off in the summer. How glorious! How lovely! How healthy! How do you think of this season? Do you have any breaks planned?
Now onto this week’s Field Notes, a collection of health-related items of curiousity and interest that has crossed my path recently:
1} Quote of note: Indispensable idleness
In honor of time off, I share with you this splendid quote from essayist Tim Kreider. I spotted it in the terrific book Deep Work by Cal Newport, but it originally came from a 2012 NYT blog post titled “The ‘Busy’ Trap”:
“Idleness is not just a vacation, an indulgence or a vice; it is as indispensable to the brain as vitamin D is to the body, and deprived of it we suffer a mental affliction as disfiguring as rickets. The space and quiet that idleness provides is a necessary condition for standing back from life and seeing it whole, for making unexpected connections and waiting for the wild summer lightning strikes of inspiration — it is, paradoxically, necessary to getting any work done.”
2} Best way to take your blood pressure — at home
Do you take your own blood pressure at home?
I don’t, I admit. Most of us don’t, according to research, even those with hypertension (high blood pressure) who were told by their doctor to monitor their blood pressure at home.
But it turns out, taking your own blood pressure at home, regularly, can often be a more accurate reading than the reading at the doctor’s office. Who knew?
As Dr. Cara Litvin wrote recently in Health Affairs:
Despite more than a decade of guidelines calling for the adoption of HBPM [home blood pressure monitoring], blood pressure continues to be measured at most office visits, and these potentially inaccurate readings continue to be those typically used for clinical decision making about hypertension.
Many different factors can affect your blood pressure reading. Being anxious in the doctor’s office can lead to “white-coat hypertension” — high blood pressure only when you are in a clinical setting. “Masked hypertension” is the reverse — when your blood pressure is lower in a clinical setting.
Little things matter, too: Crossing your legs can raise your blood pressure significantly! What?! Huh!
Eating less than 30 minutes before a BP reading makes a difference. Having a full bladder makes a difference. Drinking coffee (or any caffeinated beverage) makes a difference. Resting quietly for 5 minutes before makes a difference, too.
(Maybe health systems marketers should put up new posters in the appointment rooms: “We are giving you at least 5 minutes to wait quietly and rest, so your blood pressure reading will be more accurate.)
OK, let’s say you are on board with taking your own blood pressure at home. You are thinking: YES, I want an accurate measurement, especially for a number that can lead or not lead to lifelong medications and other treatments.
How do you take your own blood pressure correctly? Here are guidelines pulled from the American College of Cardiology/American Heart Association (AHA), a policy statement from AHA and American Medical Association, and a helpful “How to accurately measure blood pressure at home” AHA article:
First, get a validated cuff blood pressure monitor, which usually costs between $30 and $100. Go https://www.validatebp.org for a list of tested and validated devices. Wrist monitors are not as accurate.
Make sure the cuff fits well. If it’s too small or too big, the reading will be off.
Take your blood pressure twice a day: 1) in the morning, before you take any meds, and 2) in the evening, before dinner.
Do not smoke, drink coffee or other caffeinated beverages, or exercise 30 minutes before you take your blood pressure.
Go to the bathroom before you take your blood pressure.
Sit with your back straight and supported by a chair (not slumped on a comfy couch).
Make sure your feet are flat on the floor. Uncross your legs.
Sit quietly for 5 minutes before you take the readings. (I know. Are you thinking what I am thinking? I have never had my blood pressure taken under these specific circumstances!)
Keep your arm on a flat surface, like a table.
Place the bottom of the blood pressure monitoring cuff directly above the bend on your elbow. (This surprised me. Most of the time, when I’m in the doctor’s office, the cuff is put on much higher.)
Take 2 readings, at least 1 minute apart.
Write the measurements down. Here’s a printable blood pressure tracker (PDF) from AHA.
When I look at this thoughtful, evidence-based plan, I realize: This will take 8 minutes or so in the morning, and 8 minutes at night to get the most accurate numbers. No wonder most people don’t bother.
But then I think, well, driving to and from the doctor’s office is much more of a hassle. Hypertension is MUCH more of a hassle. Maybe this is worth a try. Maybe it’s worth scheduling into your day.
Tracking your own blood pressure is especially recommended the 1) week before a doctor’s appointment (so you can share the most accurate, recent numbers) and 2) two weeks after any change in treatment (such as a new medication).
If you try this out, I wonder what you’ll find. Is your blood pressure lower or higher than it is in a one-time doctor’s office reading?
3} Knee Sounds: A Poem
I ran across a poem today from the wonderful writer Courtney Martin, about noticing our own aging It is called Knee Sounds and begins:
The older I get the more I notice knee sounds
The end, though, is what I really needed this week:
When the violence is too much
I touch a lot of tree trunks
eat some more bread.
watch my kids sleep their sweaty sleep
and try not to let any of it
tragic or tender
feel inevitable.
Read the whole poem here and subscribe to Courtney’s newsletter, the examined family.
I hope your week ahead is full of poetry, delicious spells of idleness, and only accurate measurements that help.
To our journeys,
Brianne
p.s. To my fellow Wordle fans, I recently found Wordosis, in which you guess a medical term. It’s pretty tricky! I am enjoying how these silly puzzles bring back the kid joy of figuring something out, like tying your shoes or playing Tic Tac Toe — or cracking this Wordosis (yay!):
