Dr. Roach: Cuff should remain at heart level for accurate BP reading

Keith Roach
To Your Health

Dear Dr. Roach: I have always read that when you are having your blood pressure taken, your arm should be elevated above your heart. When mine is taken this way, it is normal, around 120/70. When I go to the doctor, my blood pressure is taken with my arm hanging at my side. I often get a much higher reading taken this way, say, 140/90. Is there a correct way to take it, and does it affect the reading? My doctor said the position doesn’t matter and wants to prescribe medication.

— U.P.

Dear U.P.: When taking the blood pressure, the goal is to approximate the blood pressure in the heart. That means that the blood pressure cuff should be at the level of the heart. If the blood pressure cuff is above the heart, then the blood pressure reading will be artificially low. If the blood pressure cuff is dangling below the level of the heart, the reading will be high.

For every 10 cm (about 4 inches) above the heart, the blood pressure will be about 7 mm of mercury too low. If I stretch out my arm as high as I can above my heart, I can get it about 30 cm higher than my heart, which would be enough to explain the difference between the 140/90 and 120/70 you have observed. However, for most people when sitting up straight, a properly placed cuff on the arm will approximate the same level as the heart. Although you are right the position matters, it sounds like the doctor’s office is taking the reading correctly.

I should also note that the feet should be resting on the floor, not dangling, which can artificially raise the blood pressure. The arm should be supported while taking the blood pressure. I recommend taking the blood pressure three times and using the average.

Given how important blood pressure is, correct technique is essential in order to properly recommend who should get blood pressure treatment. Evidence is increasing that a 24-hour home blood pressure device is more accurate at determining who might need medication, especially in suspected white coat hypertension, where the readings are artificially high just because a person is in the office (even if they don’t feel nervous).

Dear Dr. Roach: I was receiving testosterone injections for a diagnosed low testosterone level (96, with the normal 300-720). I received testosterone injections for a number of years, as directed by my doctor at that time. Ultimately, I changed doctors and the new one prohibited the testosterone injections as “too dangerous to continue.” I objected then and am about to object again, since my symptoms in the past year continue to point to low testosterone, in my mind. I have low energy level, low libido and erectile dysfunction.

— M.J.

Dear M.J.: If a person with normal testosterone takes a large amount of extra testosterone, such as athletes looking for a performance boost, there are significant risks. Scientists used to worry that a similar issue would be the case if a person with low testosterone took a replacement dose to get him into the normal range, but the fears of testosterone replacement therapy have been proven largely unjustified.

Given your symptoms and your definite low level, experts would agree that you are a good candidate for long-term testosterone replacement therapy. The risks and benefits are not known with certainty, but the evidence so far suggests no serious risks and some potential benefits on heart health even beyond improvement in symptoms. I would a suggest consultation with an expert on testosterone replacement, such as a urologist.

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