Blood Pressure Variations at Home. In general, everyone's blood pressure varies in the same way throughout a given day. In monitoring at home, it is important to note these changes:
- Blood pressure is usually highest at work.
- It drops slightly at home.
- It then normally dips to its lowest level during sleep. There are important exceptions. Certain people have a condition called nondipper hypertension, in which blood pressure does not fall at night. Postmenopausal women appear to be at particular risk for this phenomenon, and it may pose a special danger for heart disease and stroke (particularly in older African American women). It has also been linked to salt-sensitivity and insulin resistance.
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- Upon waking, pressure in most people typically increases suddenly. In people with severe high blood pressure, this is the highest risk period for heart attack and stroke.
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Some studies have reported that when patients record and report their own blood pressure, they are unreliable and don't always tell the truth. Despite the difficulties and controversy surrounding this issue, home blood pressure monitoring has been shown to encourage patients to use measures that control their blood pressure and thereby reduce the risk of cardiovascular events.
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Physical Examination for Complications of Hypertension
If blood pressure is elevated, the doctor will check the patient's pulse rate, examine the neck for distended veins or an enlarged thyroid gland, check the heart for enlargement and murmurs, and examine the abdomen and the eyes.
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Medical History
If hypertension is suspected, the doctor should obtain the following information:
- A family and personal medical history, especially incidence of high blood pressure, stroke, heart problems, kidney disease, or diabetes.
- Risk factors for heart disease and stroke, including tobacco use, salt intake, obesity, physical inactivity, and unhealthy cholesterol levels.
- Any medications being taken.
- Any symptom that might indicate so-called secondary hypertension (that is, caused by another disorder). Such symptoms include headache, heart palpitations, excessive sweating, muscle cramps or weakness, or excessive urination.
- Any emotional or environmental factors that could affect blood pressure.
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