Choosing & Using a Home Blood Pressure Monitor (Omron version), & What to Ask the Doctor - Better Health While Aging

In a previous post, Ive written about some of the key reasons that I recommend older adults and their caregivers have a blood pressure (BP) monitor at home.To very briefly recap:Many of the problems of older adults (including falls) can be related to blood pressure.Home blood pressure measurements can help:evaluate for drops in blood pressure with standing (a common cause of dizziness in elders)check for serious illness, since these often (but not always) cause the blood pressure and pulse to be very different from usualfollow-up on blood pressure after a change in medication, which can help doctors and families figure out the best medication dosing for an older person much faster.This is safer for elderly people.In this post, Ill share some tips on choosing and using a home BP monitor.Now dont worry, I wont tell you that you have to plan on checking every day for the rest of your lives.Although there are times when its great to check daily like the week after a change in medication you can get plenty of benefit from a home BP monitor by checking occasionally, and then also when an older person seems unwell.Tips for choosing a home blood pressure monitorHere are the most important criteria to consider when choosing a BP monitor:Is it easy to get accurate readings? Accurate and reliable readings are key.

To find an accurate BP meter for home:Get an automatic digital monitor.Although manual cuffs are available, these require more training to use properly.A good quality digital monitor will be usually be more accurate and easier to work with over time.Choose a monitor with a cuff that measures at the upper arm.Wrist and finger cuffs tend to give inaccurate readings if the body position isnt just-so.Pick a BP monitor that has good reviews from Consumer Reports or another reputable non-profit organization.Customer ratings at Amazon and other big online stores can also be helpful.Plan to bring the BP monitor to the doctors office, so that staff can compare the monitors reading to their own clinic monitor.This is a good way to check the cuffs accuracy.Is the arm cuff properly-sized?Its absolutely essential to have a cuff that is the right size for the persons arm.

Cuffs are usually available in sizes small, standard, and large.A cuff that is too small will give readings that are falsely high, while a cuff that is too big will give readings that are falsely low.According to the Mayo Clinic: The inflatable part of the blood pressure cuff should cover about 80% of the circumference of your upper arm.The cuff should cover two-thirds of the distance from your elbow to your shoulder.To purchase a cuff, start by measuring the older persons arm around the bicep area, using a cloth measuring tape.7-9 inches > small cuff9-13 inches > standard cuff13-17 inches > large cuffmore than 17 inches > ask the doctor for help finding an extra-large cuff, or even a thigh cuffIs it easy to log the readings and share with the doctor?Remember, youll get much more benefit from a home BP monitor if its easy to log the readings and share the information with doctors or nurses when necessary.Most digital BP monitors will store a certain number of readings in the monitor; some can even store readings for two different people.But readings stored within the monitor can be hard to share with the doctor, so families often still log the blood pressure readings by hand.Some BP monitors can connect to your home computer, so that the readings can be downloaded.Check user reviews to make sure that most people have found this feature easy to use.A few BP monitors can connect via Bluetooth to a smartphone, which is very convenient when it works well.You can Google bluetooth blood pressure monitor and pick a one that has good user reviews.In general, there seem to be more monitors available for connecting to iPhone/iPad than to Android phones or computers.Can the older persons doctor recommend a home BP monitor?Although in my own experience most doctors arent prepared to recommend a specific kind of home BP monitors, some primary care clinics are starting to regularly recommend home BP monitoring and may be able to suggest a specific home device that they are used to working with.A home blood pressure monitor that I recommend (with caveats)For a long time, I didnt recommend a particular home blood pressure monitor to readers or even my own patients.

This was mainly because although a number of well-reviewed digital BP monitors were available, most of them did not connect to phones or computers very easily.However, Ive recently been testing an Omron Bluetooth-enabled home BP monitor, and although it has some flaws, I feel its good enough to recommend.The particular model Ive been trying is the Omron 786N, and its currently available on Amazon for $65.Features I like:Omron is a reliable well-known brand of BP monitors, and their professional line is often used by doctors.I checked this digital monitor against my manual BP cuff and got the same reading.TruRead features checks blood pressure three times in a row and then presents an average of the three readings.Since blood pressure is constantly changing a bit, this probably gives a more accurate measurement to record.

Of note, this approach was part of the study protocol for the SPRINT study of standard vs intensive hypertension management in older adults.(I recommend setting the machine to allow 60-120 secs between each check.)BP monitor transfers readings to smartphone app (iOS or Android) via Bluetooth.Once the readings have been transferred to the Omron Wellness app, the readings can be emailed to another person.

For those with an iPhone, the Wellness app can reportedly be configured to send results to your phones Apple Health app.Last but not least, BP and pulse data can also be viewed online, by logging into OmronWellness.com.Easy-Wrap ComFit Cuff is easy to put on and position correctly.This BP monitor comes with a preformed cuff that accommodates arms 9-17 inches in circumference.

I found the preformed cuff easy to put on, and the size range means this cuff should accommodate most older adults.(People who are extremely thin or quite obese may need to order a different cuff.Flaws and problems with this Omron 786N monitor:No option for adding comments to a reading.This is a problem with the Omron Wellness app rather than the device itself itself, but it still seems an important issue to mention.

It would be much better if users could add notes to a reading.Important contextual information to note includes:Whether the person was standing during the BP measurement, as we often recommend people check BP sitting and standing if were concerned about orthostatic BP changes.(This means BP drops signficantlywhen a person stands, and can increase fall risk.)Whether a BP medication had recently been changed.Whether the older person was feeling unwell at the time BP was checked, or whether the person was having palpitations or other heart-related symptoms.No easy integration with personal health record systems.Although the Omron Wellness app apparently can transfer data to an iPhone Health app, this particular BP monitor does not easily transmit data to Microsoft Healthvaultor other health information systems, as best I can tell.Data export feature does not yield data that can be imported into other programs.

Omron does offer the option of exporting the BP/pulse data as a .csv or Excel file.But when I tried this, I was unable to import it into a program like Microsoft Healthvault.When I reviewed the export files, I noticed that the export mixes numbers and letters in the same cell.

(This is a no-no in data management.)I am disappointed by the fact that one cant add notes to a reading or export the data in a meaningful way.Still, the Wellness app does allow one to print a table of results or even email it.So even though one cant import the BP data to another computer, at least this device should make it easier to share readings with ones family and clinicians.Tips for using a home blood pressure monitorNow that weve covered the characteristics of a good home BP monitor, lets address how to use it.In general, when I advise families on using a home BP monitor, we cover three key topics: proper technique, when in the day to check, and how often every week to check.Proper technique:The most important things to keep in mind are the position of the arm, and relaxing.The upper arm with the BP cuff should be positioned at about the level of the heart (upper chest).

A good way to do this is to have the older person sit in a chair, and rest the arm on a table nearby.The back should be supported, and the legs should not be crossed.Dont have the person hold their arm up and out.The arm with the cuff should be fairly relaxed.

This sometimes means another person has to hold the arm up at the level of the upper chest.Check the blood pressure when the person is quiet and relaxed.Talking, exercising, or getting revved up can increase the blood pressure.When in the day to check: The conventional wisdom often suggests checking in the morning, before taking medication.However, because overtreatmentof high blood pressure is such a common problem in older people, I often suggest that people check BP about an hour after taking any blood pressure medication.If the older person is taking blood pressure medication, consider checking BP about an hour after the medication is taken, especially if there has been any concern about falls, dizziness, or poor balance.Also consider checking the blood pressure sitting and standing if there has been any concern for falls.

(See this post for more details on the common problem of blood pressure dropping with standing.)Be sure to record what time of day the BP is checked.If you are monitoring BP regularly for a few days or weeks or even indefinitely, try to check at the same time(s) every day.How often to check: You could certainly check every day, or even several times every day.But I find that caregivers and older adults often find checking BP tiresomethey usually have lots of other things to do! So how often to check depends on a) whats going on with the persons health, and b) whats feasible for the elder and caregiver.If the health issues seem stable and there have been no recent medication changes, consider checking BP once a week.

This will provide some baseline information, so that when a health issue crops up, the doctors will be able to tell if a change in blood pressure seems related to the new or worsened symptoms.If a blood pressure medication has been changed, or if you are worried about an older persons health, try checking at least once a day for 7 days.What to discuss with the doctorJust how should you use a home BP monitor to improve an older persons health without too much hassle? The best approach is to ask the doctor for some advice, because in the end it really depends on the particular health circumstances of every patient.The goal, after all, of collecting BP data at home, is to gather information that can help the doctors help you.(And to help the doctors spot problems like postural changes in blood pressure that they might not otherwise notice in a busy clinic visit.)Here are some questions you can ask the doctor:We have a home blood pressure monitor.How often would you recommend we check my mothers blood pressure?What time of day do you think it would be most useful for us to check her blood pressure?Do you think its likely to help if we check her home BP every day indefinitely? Or would it be ok if we just check once per week?Were a little concerned because she occasionally falls or feels unsteady.

Do you think its possible that she might be on a little higher dose of blood pressure medication than she needs? Would it be helpful if we checked her BP sitting and standing for a few days?For more on what doctors should check, see this article:8 Things to Have the Doctor Check After an Aging Person Falls.Weve been checking her BP sitting and standing over the past few days, and we noticed that the standing BP is often quite a bit lower.Couldnt this lead to falls? Would it be possible for us to try lowering her BP medication a bit?Were having trouble checking the BP every daywere just a bit overwhelmed by things.How much should we prioritize checking BP every day? Could we perhaps check less often?Key Take-AwaysA home BP monitor is a very useful tool for the caregivers of elders, and I always recommend families get one and learn to use it.When choosing a home BP monitor, look for a well-reviewed digital BP machine that measures BP in the upper arm.

Be sure to get a properly sized arm cuff, and have the accuracy of the machine checked at the doctors office.Do think about how you will log the BP readings and share with the doctor.Consider a BP monitor that can send the readings to your smartphone or computer.At the very least, you may need to write down the BP numbers on a paper log (easier for you to do) or in a spreadsheet (easier for the doctors to assess).In this post I offer some suggestions on what time of day to check, and how often.

But the best is to talk to the older persons doctor, to set up a plan that is a good fit for the older persons medical situation (and still manageable for you!).For more on better blood pressure management in older adults, see my post What the New Blood Pressure Guidelines & Research Mean for Older Adults.