I wish medical professionals would take blood pressure more than once. It happens occasionally, but typically it’s one measurement and on to the next thing. Most medical offices are like assembly lines. They really don’t seem to have the time to do anything twice, even if it means your blood pressure might be read higher.
Why is the first blood pressure reading typically high? The first blood pressure reading is typically high because the patient hasn’t had an opportunity to relax for 3-5 minutes prior to the blood pressure measurement. In addition, anxiety and white coat syndrome can contribute to a higher 1st reading. The first reading may be high at home for many of the same reasons.
High blood pressure is a serious issue and the silent killer cannot be taken lightly. I wish more preparation and thought was considered when taking blood pressure at medical offices and home. Failure to prepare properly for the first reading, can make you and your doctor think your blood pressure is higher than it really is.
This blog post will go into complete detail why your 1st readings are higher than your 2nd. In addition, I’ll tell you what to change, so your first reading can get lower and give you a more accurate picture of your blood pressure.
Reasons Why The First Blood Pressure Reading Is Always High
Lack Of Relaxation Time
If everybody’s doctor office visit is like mine, this is how it typically happens. First, you are asked to wait in the waiting room. There, they have a TV on and the channel is set to a news channel. There are other people waiting, sick, coughing, talking about problems or chatting on their cell phone. In addition, you’re checking your watch because your appointment is now late and you have other places to go.
Second, your name is finally called and you walk into the office with a medical assistant or nurse. They ask for to step on the scale and may check your height. After that you’re asked to sit on the exam table, which is like hiking up a small hill but backwards.
Third, the nurse immediately checks your blood pressure. They check it once and walk over to their chart to enter your information.
What’s wrong with what just happened? For obtaining an accurate blood pressure reading, EVERYTHING! The blood pressure guidelines recommend you sit still, in a supported chair, feet flat on the floor for 5 minutes. These 5 minutes shouldn’t involve waiting room time, stepping on a scale, answering questions, climbing up on an exam table, sitting unsupported. In addition, the time it takes to walk from the waiting room to having the BP cuff wrapped around your arm is probably 5 minutes or less.
The guidelines say you should take 2 or 3 measurements and average them together (r). All three of those measurements are after 5 minutes of quiet time. In the doctor’s office, they are typically taking one measurement without quiet time. If they took a second measurement, it would be more likely it would be lower because you’ve had a few more moments to actually relax.
In 2015 during the American Medical Association meeting, 159 medical students were given a blood pressure check challenge. Only ONE of the 159 students performed all of the 11 elements they are trained to do. An average of 4.1 steps out of the 11 were performed.
Can you guess what was one of the biggest mistakes by the medical students? Failure to have the patient rest in a chair for 5 minutes! Only 11 of the students performed the element (r). And remember, this test was not conducted in a medical office (business) where patients are rushed through the whole process. It doesn’t take a genius to know the failure rate will be higher in an office setting.
Lack Of Relaxation Time At Home
This reason for a higher first blood pressure reading is the same as in the doctor’s office, but for slightly different reasons. The common denominator is the failure to relax for 5 minutes prior to taking your measurement. Reasons here may include at home distractions like cooking, texting, talking to others, watching tv, pets or children.
If you are taking the recommended 2 or 3 measurements, the 2nd and 3rd are likely to be lower. This is because you’ve had more time to relax than you did prior to the first reading. It’s difficult to accomplish, but try to plan 5 minutes of quiet time before starting the measurements. If you’re looking for an affordable, good quality home monitor, you can check out my recommendations by clicking here.
White Coat Syndrome
This occurs when stress or worry about being at the doctor’s office causes a temporary spike in blood pressure (r). This may affect your first blood pressure reading and make it higher. Some people may experience nervousness immediately entering the office, but may calm down after a few moments. This can result in the second measurement being lower than the first.
This is the opposite of white coat syndrome. Some people may experience nervousness at home (r). It’s possible you can get nervous when beginning your first blood pressure reading making it higher. After relaxing for a minute, your second reading may be lower.
A Full Bladder
Don’t laugh, but I’ve had people tell me while at home, after taking their first reading, they realized they needed to use the bathroom. Prior to taking their 2nd and 3rd measurement, they relieved themselves causing their body to relax more after the first reading.
Changing Body Positions
It’s extremely important to have your body in the proper position on all measurements. I have heard of people crossing their legs on the first reading which makes it higher (r). Then during the pause between readings, they uncross their legs and put them into the proper position.
In addition, your arm position has to remain in the appropriate position on the first and second readings. Lowering your cuff height or raising it, will change your blood pressure readings. I wrote a blog post dedicated to arm positioning only. You’ll want to check it out and avoid this common but costly error. You can read it by clicking right here.
Distractions While Taking Blood Pressure
A common occurrence is getting distracted while taking your blood pressure. I’ve seen people sit down at home to take their first blood pressure reading and do something they shouldn’t be doing. It can be a text that couldn’t wait, checking the stock market or continuing whatever it was they were doing right before taking their blood pressure. Then after taking it and relaxing for the second reading, they have finished the activity that was making their first blood pressure reading higher.
Studies: Why The First Blood Pressure Reading Is High
This study was conducted at the Preventive Cardiovascular Nurses Association annual symposium. They studied 100 adults who were giving two different blood pressure measurements.
The first one was sitting the patient on an exam table, with their feet dangling, and taking their blood pressure immediately. The second measurement was taken 5 minutes after the patient walked in. In addition, for the 2nd reading the patient was sitting in a chair, feet flat on the floor and back supported.
The results showed systolic blood pressure was 14 mmHg higher when the measurement was taken immediately on the exam table. The diastolic pressure showed no difference (r).
Researchers studied 73 patients who were diagnosed with high blood pressure. They took 2 different blood pressure measurements with a median of 16 minutes between both readings. The first blood pressure readings were higher than the 2nd by 11 mmHg systolic and 5.2 mmHg diastolic (r).
This was a huge study that covered more than 38,000 patients at more than 80,000 physician visits. The researchers noted in most busy primary care practices, blood pressure is often measured only once. They evaluated the effect of a second BP measurement.
The study showed systolic BP was 8 mmHg higher for the first blood pressure reading. In addition, when systolic pressure was much higher in the first reading, a larger reduction was seen in systolic for the 2nd reading (r).
If you found this Blood Pressure topic interesting check out these related blood pressure articles also found in this same website:
- Blood Pressure Cuff Placement
- Causes Of False Blood Pressure Readings
- Checking Blood Pressure Too Often