It’s Enough to Raise My Blood Pressure

Millions of Americans are misdiagnosed with hypertension. What to do if you are one of them.

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Nearly half of American adults are currently living with a diagnosis of hypertension. And 80 percent of them are treated with medicine for that hypertension. However, study after study have shown that these numbers are overstated because medical professionals are checking our blood pressure incorrectly. And if you’re told to keep track of your blood pressure at home, chances are you’re doing it wrong as well.

How can something so simple go so wrong?

Let’s start with the basics. What is hypertension? It’s having a consistently high blood pressure (BP) reading. The American Heart Association says your BP is considered high if the systolic reading – the top number – is 130 mmHg or more, or the diastolic reading – the bottom number – is 80 mmHg or more. High blood pressure is a risk factor for heart disease, heart attacks and strokes.

Hypertension can be concerning. It’s not something you want to get wrong. While many studies have shown our BP is improperly measured at the medical office and at home, this October 2023 study published in the medical journal The Lancet, says that millions of Americans are misdiagnosed with hypertension.

What’s the issue? A significant reason for inaccurate blood pressure readings is that the medical professional measuring your blood pressure has developed bad or lazy habits or they were poorly trained. They have you positioned the wrong way, or seated incorrectly, or they have the wrong size cuff or they do just one arm and not the other. (See Sidebar)

Think back to your last appointment with your doctor or visit to a specialist or a hospital. At some point, a nurse or medical assistant placed a cuff on your arm, filled the cuff with pressurized air, and measured your blood pressure as the cuff deflated. Are you sitting on the exam table in your crinkly paper gown with your legs dangling? Are your legs crossed? Are you holding your breath? Is your arm relaxed and straight or is it unsupported? Are you talking? My mother loved to chat with the nurses as they took her pressure, which is one way to get artificially high numbers.

What should I do? There are some things you can do for yourself in the moment (or if you are testing your blood pressure at home.) Relax. If you need a moment to do that, ask for it. Take a few deep breaths before and during. Make sure you are comfortably seated with both feet flat on the floor. Don’t chat.

Did the nurse take your blood pressure twice, left and right arm to record the higher of the two? If not, politely ask her to do that. Getting both sides measured helps ensure the result is accurate. It’s also a great early warning diagnostic test for some circulatory conditions.

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According to the American Heart Association, here are the do’s and don’ts of an accurate Blood Pressure (BP) measurement:

1. Select the proper size cuff;

2. No clothing under the cuff;

3. No talking during BP assessment;

4. Keep your legs uncrossed with feet flat on the floor;

5. Have your back supported;

6. Support your arm with the cuff at heart level;

7. Let the patient sit relaxed for at least 3–5 minutes before the first reading;

8. Measure the BP of both arms and use the higher number of the two.

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What if they don’t listen to me? Let me be honest, just because you now know the right way to get your BP measured, doesn’t mean it will be easy to get the nurse to change her ways. If you’re there for some serious symptoms or have been told you have hypertension, it’s worth saying, “Wait, let me sit in that chair so you can get the real number.” Then, sit correctly and request nicely that they check both arms.

Personally, my BP is very low, but even I have had unhappily high numbers when the nurse takes my blood pressure just after weighing me (I mean, c’mon!), or if I’m in a rush or I was doomscrolling in the waiting room. I had an emergency dental procedure this morning. It wasn’t a big deal, but they did take my blood pressure at the start. I was reclining in the dental chair, my feet up, hyperventilating, because the traffic was heavier than expected, and the dental assistant stuck a BP cuff on me and pressed the button. “Wait, wait, wait,” I said. “I wasn’t ready. Let’s start over.”

I sat up, put my feet on the floor, took a few deep breaths and nodded. The first reading showed a systolic number that was a full 22 points higher than the second reading. If I hadn’t said something, the assistant would have marked up my charts with the first reading and the word “hypertensive.” The second was normal. It was so different, that before I could ask, the assistant requested taking it again on my other side. My medical records are now accurate and aligned with my generally low BP.

As an advocate for patients, I will always speak up when I see a potential for medical error. Even if it’s not essential for my own health, it might prevent a problem for someone else. I was lucky this morning but I’ve gotten real pushback when I have asked to have both arms tested or suggested I’m not in the right position. Usually, I hear, “This is fine.”

You’re not required to do the same. If you are mainly healthy, have low cholesterol or a history of healthy blood pressure, and aren’t being offered unnecessary drugs, arguing with the nurse is rarely worth the effort. Just tell the doctor you wish it had been done correctly when you’re alone with her later.

Does it really matter? It does. If you are already diagnosed and under treatment for high blood pressure, please ask to speak with your primary care practice before your next appointment. See if you can get retested under ideal conditions and without any medication that artificially lowers your blood pressure in your system.

If this is a new topic for you, remember this article when you next see your primary care doctor. If, despite feeling fine, your clinician says she’s concerned and wants you on a medicine that lowers those numbers (see Medications below) uses the words “borderline” or suggests it’s time due to your age or weight or both, ask her if you can get retested following the American Heart Association guidelines (See Sidebar).

Hypertension medications. For most, medicine for hypertension is life-saving and essential. But we now know that for millions of us in the United States, what we take and whether we need it, may be something to review with your physician at the next appointment.

Basically all hypertension drugs work by making the heart’s job easier either by reducing its workload or by preventing your blood vessels from constricting. Blood vessels can get clogged like old rusty pipes and the narrower they are, the harder the heart has to work to push the blood to every organ.

 Some of the most common prescriptions for hypertension are:

• Beta-blockers work by reducing the heart rate, and lowering the strain on your heart and its production of blood, which lowers blood pressure.

• ACE inhibitors (angiotensin-converting enzyme inhibitors) help the body produce less of the chemical that can narrow blood vessels, which helps the vessels relax and open up, which, in turn, lowers blood pressure.

• Calcium channel blockers stop calcium from entering the muscle cells of the heart and arteries. Calcium can narrow blood vessels, increase your heart rate and thereby raise your blood pressure. By the way, this has nothing to do with taking calcium supplements or eating dairy foods.

• Blood vessel dilators (vasodilators) relax the muscle in the walls of the blood vessels, allowing the vessel to widen. This allows blood to flow through better.

All drugs have side effects or can interact with other medications you are already taking. The last thing you want is to be inaccurately diagnosed with high blood pressure and given medicine to treat it that harms you.

The takeaway is simple. Before you join the ranks of millions of Americans
misdiagnosed with hypertension, make certain the test is done correctly.

Stay healthy.

Helene