Correct arm position for taking standing BP for HyperPots?

[Sam4877]

I have undiagnosed HyperPots since about 9-10 years and I have not been taking any medication.

I have had all the tests done several times to check my heart and everything has been clear. (ECG, ECHO, 24  hr Holter etc)

When I walk a little my BP shoots up to 150 - 160's Systolic and 100+ Diastolic.

But here is where it gets complicated, when I take the BP with my arm down the BP is 160/108 and if I rest my arm at heart level standing it is 130/90.

Which of these measurements are more accurate? If the one pointing arm down is correct then does that mean I can have a stroke by just walking a little?

I have been booked for a 24hr BP Monitor, does that mean if the arm down method is incorrect the measurements for everyone on 24hr BP Monitor is incorrect as well?

Thanks in advance!

[Pistol]

@Sam4877 - the correct way to measure your BP is with your arm resting at heart level and relaxed. I assume that the 24 hour BP monitor takes that in consideration, it is probably a different device. 

[Sam4877]

@Pistol Would it be normal to get such a big difference?

[Pistol]

The readings depend on what type of measuring device you use as well as your arm position. So yes - it is normal to have such vastly different readings depending on the type of device you use. Digital readers are commonly less accurate and also more sensitive to positions, especially the wrist type. Old fashioned pump-up meters are the best ( I use one ) and they are less affected by arm position. 

[Sam4877]

I currently use an Omron digital one for the arm. That's interesting to know because if the position is wrong then you can be hypertensive.

[Pistol]

11 hours ago, Sam4877 said:

That's interesting to know because if the position is wrong then you can be hypertensive.

That is correct. When I worked in hospital we used automatic BP readers, but if the readings came back extremely high or low we would double check with an oldfashioned manual cuff - those readings were more accurate and often showed normal BP whereas the automatic readings were abnormal. I found the same to be true for me with home BP measuring devices - the manual readings were often quite different and b/c I used to run high BP's I went with only manual. 

[Goldfinch]

This is really interesting. I'm about to have 24 hr BP testing. BP has suddenly gone high but shoots up when I stand, I've been testing it at home with an omron too and sometimes I let my arm hang down on standing, other times bent but still relaxed. Sam, when you say your tests are clear for hyperpots do you mean your heart rate doesn't shoot up enough? I have quite disabling symptoms (also have hEDS) but on standing my BP shoots up, especially diastolic, but my heart rate doesn't always. However if I walk a few steps, then it does. I'm about to have tests to rule out other stuff but from researching I'm suspecting hyper pots or a mild version, from a comment from an ooh Dr who suspected dysautonomia when my diastolic went up to 150 and then lowered again when I sat down. 

[Sam4877]

45 minutes ago, Goldfinch said:

This is really interesting. I'm about to have 24 hr BP testing. BP has suddenly gone high but shoots up when I stand, I've been testing it at home with an omron too and sometimes I let my arm hang down on standing, other times bent but still relaxed. Sam, when you say your tests are clear for hyperpots do you mean your heart rate doesn't shoot up enough? I have quite disabling symptoms (also have hEDS) but on standing my BP shoots up, especially diastolic, but my heart rate doesn't always. However if I walk a few steps, then it does. I'm about to have tests to rule out other stuff but from researching I'm suspecting hyper pots or a mild version, from a comment from an ooh Dr who suspected dysautonomia when my diastolic went up to 150 and then lowered again when I sat down. 

Hi @Goldfinch Standing BP should always be measured with your arm resting at your heart level relaxed.  I learnt this because I did alot of experimenting and whenever I would let the arm hang it would be extremely high eg 150/100 and next minute I took it arm resting at heart level and the BP was 125/85.

I suspect I also have a mild version of HyperPots, when I stand up from a sitting position both my HR and BP increase, however its not as extreme as some other people on this forum.

I haven't been tested for HyperPots yet because it is very difficult to find a Dysautonomia specialist where I live in Melbourne, Australia.

I have been tested for the following below.

- Echocardiogram (Normal)

- ECG/EKG (Normal)

- Full Blood Evaluation and Blood Tests for Vitamin D, Iron, B12, Folate, LFT, Cholestrol and FE (Normal)

- 24 Hour Catecholamines Urine Test (Results Pending)

- 24 Hour Holter Monitor (Normal)

- Brain MRI (Normal)

 

 

 

[Pistol]

7 hours ago, Goldfinch said:

when you say your tests are clear for hyperpots do you mean your heart rate doesn't shoot up enough? I have quite disabling symptoms (also have hEDS) but on standing my BP shoots up, especially diastolic, but my heart rate doesn't always.

@Goldfinch - I have HPOTS and in my case BOTH HR and BP shoot up when upright or triggered, as in 160/110 BP and 150 HR. Here is an article about HPOTS that may clear up any confusion: 

 

[p8d]

I have an Omron device that I took to two visits with my dysautonomia neurologist to compare it to her digital one and had a 24 hour BP test because my BP was elevated (150-160/80-90s) supine or sitting consistently at home and at office visits. Arm position is critical. In my ortho vitals at the neuro office I rest my arm on the device at heart level when standing or sitting as I do at home. Because the readings between my monitor and all my Drs electronic monitors were similarly high we tried the manual one and then my Omron. Sitting they matched almost exactly. Ortho readings were off by similar amounts to her electronic device (10-30).. She said manual devices are more accurate. The 24 hour device is *extremly* tight and sensitive to body movement. If I was walking when it went off I always got an extremely high reading or an error. Otherwise it read much, much lower than my Omron (20-30 points), back into normal/mild HTN and even quite low in the morning (90s/70s). The only high readings that seemed credible was the 149/83 at the office when they set up and when out on a short walk while a bit upset. I did it on a very quiet day at home though. I have questioned the results with my cardiologist twice and he just said everyone’s BP fluctuates a lot and while it clearly documented hypertension when doing something “stressful” (reading something difficult, concentrating, phone calls etc), which is also well documented at every single Dr appointment for the past three years (I am home bound), that I can take an extra beta blocker or try carbidopa (haven’t been brave enough to do that yet) beforehand. He also said because my BP also goes down not to worry about it, it’s sustained hypertension that’s more concerning. After that I mostly just stopped checking at home unless I am changing meds or feeling awful which is clearly related to hypotension. 

[Sam4877]

@Pistol have you also noticed a difference in blood pressure for the right and left arm? I have a bp of 137/90 in left arm and 121/79 in right arm. I read online that this could be due to peripheral artery disease, however I'm only 25. Do I need to be concerned or is this normal with dysautonomia?

[Pistol]

@Sam4877 - I too have different readings in each arm. I was quite concerned about that but both my PCP and my cardiologist said not to worry. I trust both of them - so I don't. Generally speaking they say a difference of over 10 mmHg could be a blocked artery, so if you are concerned that this might be the case I would tell your doctor. It also could simply be the device you are using. Usually they recommend you use the arm with the higher reading as the one you always measure. 

[Sam4877]

47 minutes ago, Sam4877 said:

@Pistol have you also noticed a difference in blood pressure for the right and left arm? I have a bp of 137/90 in left arm and 121/79 in right arm. I read online that this could be due to peripheral artery disease, however I'm only 25. Do I need to be concerned or is this normal with dysautonomia?

Is yours under 10 mmHg or more? Mine seems to be more than that.

[Pistol]

@Sam4877 - yes, mine was around 12 mmHg, but still they did not recommend any treatment. In my case it is taken manually, so the readings are not influenced by any device-specific discrepancies )