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Written by Dr Katie Stephens, GP
Dr Katie graduated from the University of Manchester in 2007 (MBChB) and completed her GP training in the West Midlands in 2012 (MRCGP).
For anyone else though, readings taken from home are actually preferred to ones taken in a doctor’s office, provided your machine is accurate.
The best way to check your device’s accuracy is to see if it is on the British and Irish Hypertension Society’s list of validated blood pressure monitors. It’s also important that, if it wasn’t a recent purchase, to ensure it hasn’t extended the calibration time recommended by the manufacturer.
How to take blood pressure at home?
Once you are set up with a reliable machine, the next best step in getting an accurate picture of your blood pressure is to follow a seven-day Home Blood Pressure Monitoring process:
This is where the blood pressure is checked by the user themselves at home, morning and evening, every day for at least four days, but ideally seven.
Each time it is done, it should be repeated after at least a minute spent sitting quietly, with both readings written down.
The readings from the first day are discarded and all of the rest are used to work out an average. This average is then used to see if someone has a diagnosis of high blood pressure or not.
The benefit of sticking to a regime like this is that it avoids the ‘let’s put it off for another day’ attitude that can sometimes happen when people check their blood pressure at home and see that it is a bit raised.
If it’s not sky-high, it’s easy to be falsely reassured that it’s okay to leave things as they are and carry on just monitoring the situation.
This is actually quite dangerous, as even a mildly-raised blood pressure left untreated and just monitored can still cause serious damage and lead to conditions like strokes, heart attacks and dementia.
Another benefit of checking for just 7 days then making a plan with the final average is that it takes away the feeling of needing to continually check blood pressure daily. For some people this sort of long-term daily checking can actually cause anxiety which then raises the blood pressure further, leading to a vicious cycle.
Once you have an average, put it into our chart Blood Pressure Calculator to get feedback.
If your average blood pressure is above your target (for those under 80y with no other medical conditions, your target is likely to be less than 135 mmHg on the top and less than 85 mmHg on the bottom; for those with other medical conditions, your target may be lower), it is vital that you book an appointment with your NHS GP to discuss next steps.
Provided your blood pressure isn’t at an immediately dangerous level like >180/120 mmHg, it is not urgent for you to be seen right away (provided you don’t put this off, of course!). If you find it hard to get an appointment, I would suggest sending a copy of your readings, including your average, to your practice. If your machine is on the BIHS approved list and not too old, make a note of that on your paper or e-mail too, as this is helpful for your GP to know.
You could also even write something like ‘Dear GP, my average reading is >135/85. Please may you help me book a routine appointment to discuss next steps? I wasn’t able to book an appointment when I rung reception.’ As mentioned above, this appointment doesn’t need to be urgent and waiting 2-4 weeks to speak to your GP is very unlikely to cause any real problems.
When you do end up speaking with your GP, if your blood pressure is not high enough to need medication, please make sure you agree on a plan of what will happen next. This should include what lifestyle changes you are willing and able to make, what date you will repeat your seven day monitoring, and when your follow up appointment should be.
If your blood pressure IS above 180/120 mmHg, this does need more urgent attention. I would recommend repeating this after sitting quietly for a full 5 minutes. If it is still above 180/120 mmHg, please call your GP surgery if within office hours, or ring 111 if out of hours. If it is this high AND you are feeling unwell (e.g. if you have new changes to your vision, new confusion, chest pain, ankle swelling or breathing difficulties), please go to A&E immediately.
Blood pressure high home remedies
If your blood pressure is high, there are things that you can do at home that can help. This can be especially helpful if your blood pressure is only raised a little and not enough for you to need medication yet.
However, even if you are already taking medication, you could still benefit from adding in some or all of the following. Please keep taking your medication while you do this. Stopping medication without your doctor’s input can be dangerous and is not recommended.
Dietary Changes
- Reducing salt in your diet (provided you aren’t pregnant – this can be dangerous for your baby).
- Reducing any excess caffeine or alcohol (including having at least 1 – 2 days/week that are alcohol-free).
- Reducing intake of foods high in ‘bad cholesterol’ (bacon, sausages, cakes, anything fried).
- Increasing heart-healthy foods such as oats, whole grains (e.g., whole-wheat bread), seeds, nuts, oily fish, fruit and vegetables. For more information, see this helpful leaflet from the British Dietetic Association.
- If your BMI is raised (pop your height and weight in our bmi calculator to check it), try reducing portion sizes a little, or make other modifications to your diet that can be sustainable. I’d avoid against any fad diets or restricting to just a few ‘superfoods’. Making healthy swaps that you are happy with tends to lead to longer-lasting changes. For more information on healthy ways to lose weight, visit this article from patient.info.
Lifestyle Changes
- If you smoke, quit. Not only does this lower your blood pressure, but it also reduces your risk of some of the serious complications of having raised blood pressure.
- Increasing exercise. If you are after one lifestyle change that can reap a whole host of benefits (apart from quitting smoking), increasing your exercise may be it: Not only can it reduce high blood pressure, it also has a direct effect on boosting the health of the heart and the blood vessels. What’s more, it can also help to improve your cholesterol, reduce stress, and burn more calories, therefore helping reduce excess weight. Ideally, aim for 30 minutes/day of moderate to vigorous activity. If this is a big jump up from your current activity levels, please don’t be put off from starting – make small, achievable goals, like a 10min walk around the block daily or weekly. If you can, try to review and adjust your goals every 2 – 4 weeks. Bottom line, whether you adjust things or not: any increase in exercise is going to be beneficial.
- Reducing stress. How this is achieved will probably look somewhat different for each person reading this guide. You may well already know what works best for you, but if not, here are some ideas to get you started: breathing exercises, yoga, prioritising good sleep hygiene, staying connected with others, and analysing sources of stress (e.g., workload) for possible changes.
Low blood pressure emergency treatment at home
Finally, a blood pressure less than 90 mmHg on the top, or 60 mmHg on the bottom, is considered ‘low’. This can be normal for some people, especially those who are slim and athletic.
However, if your blood pressure is normally much higher than this and suddenly drops, this could be due to a serious cause, such as sepsis or severe dehydration.
If your blood pressure has suddenly dropped to less than 90/60 mmHg, and you are feeling newly unwell (e.g., if you are lightheaded/faint, or feel confused or short of breath), please seek urgent medical attention. You can do this by ringing 111 for non-life-threatening symptoms, or attending A&E for life-threatening symptoms.
If this is not a sudden thing, but you have never spoken to a doctor about it, and do often get symptoms such as dizziness or fainting, please speak to your GP. There are potential causes that may need looking into, as well as lifestyle changes and medications that can help.
For more information, please see the NHS advice here.
Home Blood Pressure Monitoring (HBPM)
This is where the blood pressure is checked by the user themselves at home, using a blood pressure machine.
NICE recommends that it is done in the following way:
- Blood pressure should be measured twice daily, ideally in the morning and evening.
- This should be done over at least 4 days but ideally 7.
- Each time the blood pressure machine is used, there should be 2 readings taken with at least a minute between them. (So, if done ideally, this would result in 4 recordings per day, 2 in the morning a minute apart, and 2 in the evening a minute apart, which would give 4 x 7 = 28 readings total at the end of the process.)
- The user should be seated while checking their blood pressure.
The readings from the first day are discarded and all of the others are used to work out an average.
Rather than carrying on constantly monitoring readings, this average reading is then used to assess if the person does indeed have hypertension or not. The cut-off for this will depend on other factors such as age and medical history, but most often a level of 135/85 is used.
If you are at this level or higher, please speak to your GP and make a plan together regarding next steps.
