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Blood pressure measurement - automated vs manual method
I am not finding any information on my specific problem, but thought that someone here might understand.
I admit that I'm overweight. My upper arms are quite fleshy and flabby. I have also been a regular blood donor for my entire adult life. I've donated blood about 150 times.
The problem started about 10 years ago. I went to donate blood, as usual. But, for the first time, the donation center was using automated blood pressure machines, rather than the hand-pump and stethoscope method. During the measurement, the machine paused, released some pressure, then increased the pressure enormously - to the point I was almost in tears from the pain. For the first time in my life, I was about to be deferred for high blood pressure. But my blood pressure had always been on the low side, never even approaching a high number The nurse took my BP manually, and it was easily in the normal range. And the difference was not small. The manual method said my BP was something like 107/75, the automated machine said it was something like 185/105.
I continue to have the same problem with automated BP machines. If I go to the doctor's office or to a blood donation site where the machine is automated, the reading is extremely high (after crushing my arm). If my BP is taken manually, it is in a normal range. Again, not a small difference - readings of 180-200 for the upper number with an automatic machine, readings of 115-130 with a manual cuff.
Nobody believes me that this happens, unless I'm in a place where both methods are available. It always surprises practitioners that the automated machine is so inaccurate. Please remember that the practitioner can actually hear my heartbeat with the manual measurement, so it's clearly the automated machine that is wrong. It seems that the automated machines have a hard time detecting my pulse, which is why the machine increases the pressure to the point of extreme pain.
To answer the obvious questions - yes, they use a bigger-sized cuff. Yes, I sit with my feet flat on the floor. Yes, my arm is resting at heart level. No, I'm not talking while the measurement takes place. Yes, I do get frustrated when the person taking my BP doesn't believe me that the machine is wildly incorrect. No, this is not white-coat syndrome, or why would it not appear when I'm about to donate blood?
Fortunately, I can donate blood through the Red Cross, who still uses manual cuffs. If I go to another local blood donation organization, I'm turned away for high BP.
Has anyone else ever experienced this problem with automated BP machines?
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I looked this up, and you're absolutely right. Being overweight causes problems when using a standard blood pressure cuff.
https://clinicalview.gehealthcare.com/article/one-size-does-not-fit-all-stock-special-cuffs-accurate-nibp-readings-obese-overweight-and
No, I have not experienced this, and cannot give blood because I had typhoid when a child and living with my family out of the country. However, what you posit makes perfect sense, and it 'should' be well understood by now in the medical field. It may be that you'll just have to calmly tell those relying on the automated cuffs that they do not render a veridical reading with your body type, and that this is ongoing between you and automated cuffs. Tell them that a manual reading always gives numbers 60-70 points lower, and that the Red Cross or whichever agency it is has continued to accept you as a donor based on manual exams. You can show them a donor card, if such a thing is still done.
@z1kate
Could not distinguish if the 1 is a l.
Stress and anxiety will cause your BP to rise dramatically. You mentioned extreme pain. Your BP is going to sky rocket if you are under intense pain. Did any of your doctors comment on this?
You already know your manual device is accurate and the automatic one causes you extreme pain and a resulting spike in your BP. I use an automatic BP monitor. I took my automatic one into my doctors office and had them check the accurace of the manual and automatic one.
Now I notice Mayo Jacksonville is using automated ones. I do not have the spike in BP you do. However I noticed that the auto ones squeeze tighter. This is probably to get the sensor tight and then start reading it. It does get tight. I use relaxation techniques when having BP check not because of any pain (even though very tight) it is the white coat syndrone. I tent to tense up in doctors offices.
Yes and I have small arms. It will sometimes do exactly what you describe and reinflate, squeeze too tightly and I know that reading will be high.
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2 ReactionsI have the same problem in Dr office. My cardiologist takes mine manually as he holds my arm at heart level. BP is always 120/77. Any other Dr. office walks me down a hall and and I step on and off a scale then go to another room and automatically take BP with arm hanging down. And my BP is always 180/95. I tell them about the difference and get a hateful look.
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2 ReactionsThere are published reports of scientific comparisons between automated and manual blood pressure measurements that show:
* lower readings from automated (https://pmc.ncbi.nlm.nih.gov/articles/PMC5515188/, https://pmc.ncbi.nlm.nih.gov/articles/PMC8031494/)
* no differences between them (https://www.academicmed.org/Uploads/Volume5Issue4/281.%20%5B1288.%20JAMP_Arpita%5D%201409-1411.pdf)
* higher readings from automated (https://pmc.ncbi.nlm.nih.gov/articles/PMC4843288/#sec9).
Manual measurements require equipment calibration and proper training of the operators. They are not fault-free.
I have been obtaining normal blood pressure readings weekly since 2021 using an automated instrument, which I share with my cardiologist.
First - great on you for being a long term blood donor!
Second - perhaps it's time to consider the new class of weight loss meds - semiglutides ( GLP-1) to take care of you so you can continue to take care of all of us!
Thanks for bringing up the topic of accuracy of blood pressure data. I too do not know which readings are correct. A 24 hour monitor said my blood pressure was perfect. I had no problem. I noticed, however, that when I had symptoms, the monitor turned itself off and no data was collected. The device clearly detected something in order to shut itself down.
My home BP machine data shows my blood pressure all over the place, sometimes crisis level too high as defined by the cardiologist, and sometimes far too low, Many doctors over the years agreed that my bp is « volatile » or « labile », that is highly variable and they ask me about my bp, whether it is high or low during symptoms. I am old but never fat, but my arm may possibly be too small for the cuffs they use. Maybe they don’t have smaller cuffs? Who or what should we trust about blood pressure data?
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1 ReactionYou might try a smart watch if you are able to. My own Galaxy 4 and 6 versions of the Samsung Galaxy smart watch can record sleep stages, blood pressure, oxygen saturation, pulse, and even detect atrial fibrillation.
Or, if you prefer to use a cuff: https://www.theemtspot.org/best-blood-pressure-monitor-for-small-arms/
I measure my BP first thing in the morning, before turning over a single time and getting out of bed (which is where the Galaxy watch is always handy because I wear it to track sleep). Just like your morning pulse rate is a good indication of heart health and your corporeal health overall (a pulse rate five or more beats above a running average might indicate a virus or over-exertion the previous day, maybe you have arthritis acting up or some other intrusive pain, or even a poor night's sleep), your just-awakened blood pressure is a veridical measure of your overall health. During the day, though, hormones and diet and obligations, worries, physical exertion, and any stimulants such as teas or coffee might put you in the 'caution' or 'watch' range. Then, you go see your family doctor and he'll raise an eyebrow and say you should be checking your BP daily and report back in a week because it looks high. I hope I'm being clear: taking a BP and pulse almost anywhere else but as you awaken is likely to be 'confounded,'* and probably misleading.
*In research, a 'confound' is any factor influencing the measurements you're interested in taking, but which you fail to take into consideration. https://www.scribbr.com/methodology/confounding-variables/
@scottbliz
I really hate to read posts like this. A tech taking blood pressure should know that he arm needs to be level with heart as much as possible.
I know at Mayo Jacksonville they will move my arm around to get it as level as possible with my heart. They also will get on me if I have my legs crossed (not figured out that one but maybe hinders blood flow).
BP is important and why it is know as the silent killer. If I had such a provider who took my BP with arm hanging down and then the dirty looks would find another provider.
Too bad as I said to have such care like this.