Hypertension Diagnosis and Testing

Most people find out they have high blood pressure during a routine doctor visit. For your doctor to confirm that you have high blood pressure, your blood pressure must be at least 140/90 on three or more separate occasions. It is usually measured 1 to 2 weeks apart. You may have to check your blood pressure at home if there is reason to think the readings in the doctor's office aren't accurate.

Home Blood Pressure Monitoring
The two general types of blood pressure monitors commonly available are manual and automatic. The manual model is called a sphygmomanometer, andincludes an inflatable arm cuff, a stethoscope or microphone, and a gauge to measure the blood pressure. Electronic battery-operated monitors use a microphone to detect blood pulsing in the artery. The cuff, which is attached to your wrist or upper arm, is connected to an electronic monitor that automatically inflates and deflates the cuff when you press the start button.

Using a manual blood pressure monitor
Sit with your arm slightly bent and resting comfortably on a table so that your upper arm is on the same level as your heart.
• Expose your upper arm, and wrap the blood pressure cuff snugly around it so that the lower edge of the cuff is about 1in. above the bend of your elbow.
• Place the stethoscope earpieces in your ears and the bell of the stethoscope over the artery, just below the cuff. The stethoscope should not rub on the cuff or your clothing, since this may cause noises that can make your pulse hard to hear. If you are using a cuff with a built-in stethoscope bell, be sure the part of the cuff with the stethoscope is positioned just over the artery. The accuracy of a blood pressure recording depends on the correct positioning of the stethoscope over the artery.
• Close the valve on the rubber inflating bulb. Squeeze the bulb rapidly with your opposite hand to inflate the cuff until the dial or column of mercury reads about 30 mm Hg higher than your usual systolic pressure. (If you don't know your usual pressure, inflate the cuff to 210 mm Hg or until the pulse at your wrist disappears.)
• Now open the pressure valve just slightly by twisting or pressing the valve on the bulb. The pressure should fall slowly at about 2 to 3 mm Hg per second. Some blood pressure devices have a valve that automatically controls this rate. As you watch the pressure slowly fall, note the level on the dial at which you first start to hear a pulsing or tapping sound through the stethoscope. This is your systolic blood pressure.
• Continue letting the air out slowly. The sounds will become muffled and will finally disappear. Note the pressure when the sounds completely disappear. This is your diastolic blood pressure. Finally, let out all the remaining air to relieve the pressure on your arm.

Once a diagnosis of hypertension is confirmed, the next step is to determine whether target-organ damage has occurred and to rule out any disorder that could be to blame for your high blood pressure. Expect to undergo a thorough evaluation, including a medical history, physical examination, laboratory tests, and possibly other diagnostic exams such as a chest x-ray, echocardiogram, or exercise stress test. Mention any recent changes in weight, physical activity, alcohol consumption, or tobacco use. Also, list all the prescription and over-the-counter medications, herbal products, and even any illegal drugs you're taking or have recently taken. Some of the substances found in these products can raise blood pressure or interfere with blood pressure medication.

Pulmonary hypertension is more difficult to diagnose early because it's not often detected in a routine physical exam. Even when the disease is more advanced, its signs and symptoms often mimic those of other heart and lung conditions. An echocardiogram is usually used to diagnose pulmonary hypertension. However, your doctor may do one or more tests to rule out other possible reasons for your condition.

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