Lots of stroke survivors joined the stroke club due to high blood pressure. I'm one of them.
The biggest challenge with high blood pressure is that it doesn't hurt. Most people will feel no symptoms unless something goes terribly wrong. Or they might learn they have the condition if they get an annual physical.
Because of the danger of high blood pressure directly, and because of the danger of other conditions that manifest as high blood pressure, it's important to check it regularly, and that doesn't mean you have to go to the doctor every week.
You can find home blood pressure meters all over the place -- from Amazon to Costco to the corner grocery store. But which one is best? And what do you need to know if you've already had a stroke?
This week, I'm joined by Carol Lucarelli of Omron Healthcare. Omron is a leading manufacturer of home blood pressure meters. In fact, one of their devices is sitting on the table next to me as I type this. It was that very device that gave me the 210 over 160 reading that kicked off my stroke story several years ago. More recently it read 134 over 77 -- not perfect, but still much better than the condition that collapsed my right middle cerebral artery.
One reason I wanted to talk with Carol was that I heard about Omron's Going for Zero mission. The other reason is that I like tech and gadgets, especially when they can save lives.
IMAGINE A HEALTHIER WORLD
We believe the next generation won’t be defined by age, but by a world without heart attacks or strokes. This is a world-changing mind-set we call Going for Zero™. We do our part through technology supporting personal fitness, heart health, healthy lungs and freedom from pain. You bring this commitment to life by understanding and sharing heart health with every step.
Carol joins us to talk about how these devices work, how they compare to the doctor's office, and why we should trust devices from Omron from wrist devices to upper arm cuffs to smart watches.
If you don't see the audio player below, click here to listen to the conversation on the original site.
Who is Carol Lucarelli?
Carol Lucarelli is the Executive Director of Marketing and Ecommerce at OMRON Healthcare, the global leader in personal heart health and wellness technology.
Lucarelli is a seasoned marketing professional with over 25 years of experience in the consumer packaged goods space. During her time at OMRON, Lucarelli has led the marketing initiatives for numerous product innovations, including the launches of HeartGuide Complete as well as VitalSight, OMRON’s first remote patient monitoring service.
Wrist vs Arm
Home blood pressure monitors typically come in two types -- wrist or upper arm.
The wrist mounted devices are typically smaller. You simply put it on your wrist, secure it, press a button, and raise your hand to get it at the appropriate level.
The upper arm models will typically wrap around your bicep or upper arm. Some will have the guts of the device on the cuff; others will have a hose that goes to a device on your desk, table, or lap.
In the past, I assumed the upper arm would be the more reliable device because that's what many medical facilities use. Over the past few years, though, I've seen more medical teams using the wrist versions for convenience.
Carol also explained that whether it's wrist mounted or upper arm mounted, the devices are held to the exact same standard of accuracy. As long as a device is on the Validated Device List, you can assume the model is accurate.
Ask your doctor if they have a recommendation. There are all sorts of health reasons why one style might work better for someone than another style. Different deficits after stroke may impact the choice. While cognitive, language, sensory, and pain challenges can all have an impact, hemiparesis - or limb paralysis - is probably the bigger factor.
Once you choose your device, it's also a good idea to bring it with you the next time you go to the doctor. This way your doctor can double-check its accuracy against their own blood pressure equipment. While the Validated Device list ensures your model is generally accurate, this process ensures your particular meter is accurate.
Hemiparesis recommendations
Typically, we take blood pressure measurements on the left arm. It's closer to the heart and will provide a more accurate reading for non-stroke folks.
After stroke, a stroke affected limb, however, doesn't have the same muscle activity of a non-affected limb. And that muscle activity affects blood pressure readings. That limb may also experience more edema or swelling due to less effective circulation, lymphatic draining, and other things. That can also impact the blood pressure readings.
So, to correctly read blood pressure, you should take a reading on the unaffected side. A difference of 10 points between the sides is not uncommon.
The other issue that impacts readings is arm position. The cuff where the reading takes place should be level with the heart. With an upper arm cuff, that's easy. With a wrist mounted device, it's more challenging. You have to be able to lift the wrist to the same height as the heart.
Your arm is also supposed to be relaxed when you take the reading so it should be on a bed, table, shelf, or some other item to hold it at heart level. To get an accurate reading, the arm should not be held up under its own power.
If you have a care partner who can fasten the device, great. Then an upper arm device can be easy to use. You don't need to worry about arm height because it's naturally at heart level. If the main unit connects via hose to the cuff, you can even use the unaffected hand to push the ON button.
If you're by yourself, the problem is fastening the cuff in the first place. It took me several years after stroke until my left arm had enough strength and dexterity to tighten the cuff on my upper arm. Sometimes I still don't get it right and have to try again.
Fighting with that costs energy and aggravation, which raises my blood pressure so now I have to take extra time to make sure I relax adequately to get an accurate reading.
Once the cuff is set and I chill out a bit, I can get a good reading.
A wrist cuff is easier to put on. It still requires a certain amount of dexterity and strength in my affected hand, but it's much less. And it's easier to reach the strap with my teeth, so I can use my bite to help tighten the straps.
Then the trick is to get it at heart level. Sitting up can be tough because I have to use my affected side to lift my unaffected arm so I'm not messing with the reading by using the strength in the arm with the monitor.
One solution to that which works with both types is to take readings in my recliner our lounge chair. I can get strapped in and then lay back with my arms in neutral positions and the device naturally at heart level, relative to the ground.
So, putting the device on is likely easier with a wrist device. Getting an accurate reading is likely easier with an upper arm device.
Of course, that all assumes I'm doing this by myself. If someone is able to consistently help, it changes that calculation a bit.
Consider your goals, your deficits, and your doctors' recommendations. Try some different devices to find the one that you will use most consistently to generate the most accurate readings.
Though the Omron Heart Guide wrist monitor / smart watch does activate my technolust…
Getting Good Data
Carol gave four recommendations for getting an accurate reading.
First, sit upright in a hard-back chair. No slouching. This will give you a good base to start from, assuming your deficits allow you to do this.
Second, be seated for 5-10 minutes before taking your reading. If you've been moving around from place to place or doing your sit-to-stand exercises for the day, your blood pressure will likely be elevated from that activity.
Third, keep the cuff at heart level. If it's an upper arm cuff, that's easy. If it's a wrist cuff, you may need to support the arm that's wearing the device.
Fourth, keep your feet flat on the ground, assuming tone and spasticity allow that. Crossing your legs or ankles will restrict the flow of blood and reduce the accuracy of your readings.
These tips will help you get readings, but more important than your exact posture is taking your readings in the same (or similar) posture each time to ensure consistency. Often the trends over time are more important than any particular reading.
Validated Device List
Whichever style of meter you choose, you want it to be accurate. And a good place to start is the Validated Device List.
The Validated Device list is maintained by the American Medical Association. The devices on it have been evaluated by a third party to ensure they meet the standards for accuracy that doctors can trust. While Omron has a bunch of devices on this list, it includes plenty of other manufacturers, too. All of these devices will meet the minimum standards for accuracy.
Consistency
We end up talking about consistency a lot on this show.
Carol talks about the importance of taking blood pressure readings consistently. The actual result often matters less than the trends over time. And the only way to spot trends over time is to consistently collect that data, like brushing your teeth.
Consistency isn't just about blood pressure. Consistently executing a PT, OT, or SLP home exercise program is one of the keys to recovery. We talk about the thousands of reps needed for neuroplasticity over time, but it's the consistency that will make that happen. Doing 100 reps a day, every day will yield better results than doing 1,000 reps once a week.
The core call to action for every episode of the show is, "Don't get best…get better." You don't have to become the best at anything to be successful; it's likely to be a fool's errand. Instead, just try to get a little better every day. Consistent work to improve just a tiny bit can add up to huge gains over time.
What consistency lacks in flash and drama, it makes up for in long-term results.
Hack of the Week
Carol shared a couple tips and I have one of my own this week.
First, use electronic reminders around the house. That could include smart phone alarms. Or it could be devices like the Amazon Alexa or the Google Home devices. Set those devices to remind you to check your blood pressure, take your medication, do your exercises, or whatever.
Your brain is doing enough in recovery. If you can outsource some routine stuff to robots, go for it.
When there are things about your devices that you don't like, let the manufacturer know. When enough people make suggestions or point out problems, then they may realize changes need to be made. If they don't hear from customers, or customers whose business they lost, it's a lot harder to make the most appropriate changes to the products.
And, while I could be wrong (and hope I am) I don't think most medical device companies have folks with hemiparesis working in their engineering departments.
Finally, my biggest struggle with an upper arm blood pressure cuff is tightening it adequately with my affected hand. My strength and dexterity are improving, but I still have a long way to go.
One trick I have is to tighten it around my elbow and lower arm. I still can't tighten it all the way; it will be loose there. Once I have that secure though, I can slide it up to my upper arm (with effort). While it was loose on my lower arm, because my upper arm is bigger, it is now tight enough to get a reading without the machine throwing an error message.
Links
Where do we go from here?
- If you don't already have one, get a home blood pressure monitor from the Validated Device list and check your blood pressure consistently. The magic numbers you are looking for are 120/80.
- Share this episode and article with someone you know by giving the, the link http://Strokecast.com/Omron
- Subscribe to the Strokecast newsletter at http://Strokecast.com/News
- Don't get best…get better.
More thoughts from Carol Lucarelli
![A person uses a wrist mounted blood pressure meter at sa table The text over the image read: You need to monitor your ups, your downs, the ebbs and the flows [of your blood pressure] and all of that with consistency. - Carol Lucarelli](https://strokecast.com/wp-content/uploads/2023/04/Carol-Lucarelli-Omron-04.jpg)
![A picture of the Omron BP 7000 upper arm blood pressure cuff/meter The text over the image read: [At Omron] We actually hold ourselves to a higher standard than the FDA requires of us so we try to tighten up that accuracy measure of 3 to 5 millimeters of mercury plus or minus. - Carol Lucarelli](https://strokecast.com/wp-content/uploads/2023/04/Carol-Lucarelli-Omron-08.jpg)
![A picture of a wrist mount Omron blood pressure monitor sitting on a surface reading 118/78 The text over the image read: If you're holding [the cuff] above heart level, you're going to get a lower reading than reality. If it's below heart level, you will artificially increase the reading. - Carol Lucarelli](https://strokecast.com/wp-content/uploads/2023/04/Carol-Lucarelli-Omron-10.jpg)
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