When Is the Best Time to Check BP?

Q: What is the right time to measure the blood pressure? I am a 40 years old banker, having tendency of high blood pressure since my young age. My mother is having high blood pressure and my father has just been diagnosed as Diabetic at the age of 72. I am not taking medicine, but trying to control BP through low sodium, exercise etc. When I measure blood pressure at office doctor during 3-4 P.M., readings always come 140-160/90-110. But after going home at night, it comes 120-130/80-90. My queries are:

• Can two standard instruments show different readings at same time?
• What is the right time to measure BP?
• Which reading should I take more seriously?
• I am a borderline case, so, what would be the right time to take medicine to control high BP?
• Is elevated BP a symptom of other problems in the body?
• Can high blood pressure lead to Diabetes?

Additional Details: I am a pure vegetarian, height 5.5, weight 68-70 kg. I don’t smoke or use tobacco. My elder brother at 43 is also diagnosed with high BP and diabetes recently. Please advise how can I measure my BP during office hours. Whenever I go to office doctor, it comes high but after office hours it remains on the lower side. What is the way out? After how many times BP comes high that I need to start medicine.

Reply:

This is an absolutely normal situation. Blood pressure varies throughout the day. It is physiologically (normally) different, at different times of the day. This is so because blood pressure depends upon many factors like –

• Activity level – B.P. is more after vigorous exercises
• Stress – It is more when you are mentally engaged in some work
• Diet – Some food like tea, coffee, tobacco tend to increase it. Also, it is less when you are empty stomach, as in the morning hours.

Since blood pressure varies throughout the day, a standard practice is measuring it twice daily, once in the morning and once in the evening. The morning reading would be low and the evening one high. The average of these two readings is used for diagnosis.

Let us take up your questions one by one.

Can two standard instruments show different readings at same time?

Yes, this is possible. Ideally the same instrument should be used each time to measure B.P.

What is the right time to measure BP?

A standard practice is to measure B.P. twice daily, once in the morning and once in the evening. The average of these two values is recorded for the day. A blood pressure chart is made for a period of time. However, if it is inconvenient for you to take the measurements at these timings, you may measure your B.P. at your convenience. Choose any two timings. Let these timings be consistent  each day.

Don’t measure your B.P. very early in the morning as soon as you wake up.  However, it is recommended to record your B.P. before having breakfast and any exercises.

Which reading should I take more seriously?

The average of the morning and evening B.P. is taken for diagnosis.

 I am a borderline case, so, what would be the right time to take medicine to control high BP?

For borderline cases, management by diet and exercises is recommended. If required, a single pill in the evening is given. The exact way of administration of the drug would depend upon the medicine prescribed.

Is high BP a symptom of other problems in the body?

High blood pressure is a symptom. It may indicate some subclinical state like cardiovascular problem, kidney disease or metabolic disorders. But, without investigations, no inferences should be made. Just control your B.P.

Can elevated BP lead to diabetes?

No, high blood pressure does not lead to diabetes. However, these two conditions are often associated. The two conditions may together proceeds towards what is called as metabolic syndrome.

People who have high blood pressure often present with high blood sugars. However, this is not always true.

Take Care,

Buddy M.D.