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Comment by Buttons840 | Hacker News Reader

What you say is true, but at the end of the day blood pressure readings in the flawed doctor's office setting are still correlated with medical outcomes.

I just want to speak against a trend people have to dismiss bad medical news by finding excuses. "The blood pressure reading doesn't count because I was nervous in the doctors office"; it's true, but the guidelines have probably accounted for that. "That medical study doesn't apply to me because it was done on the general population, but the general population is overweight and I'm not"; "that study doesn't apply to me because I do yoga, they didn't study people who do yoga"; etc.

I know it's hard, I'm in the middle of excusing some bad medical news of my own right now, trying to decide what's best for me.

Medicines have risks, untreated conditions have risks, choose your risk, but don't live in denial that the risk exists.

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>but the guidelines have probably accounted for that

They have not. The guidelines are against controlled studies with strict protocols on how to take the measurement.

To know your blood pressure relative to the guidelines, you want to be as close to the guideline protocols and possible. That can be a 20/10 point difference or more.

The average physicians office doesn’t follow those protocols unless you deviate significantly. e.g you walk in with 140/90 and they aren’t going to bother. 160/95 and they will recheck you with more care given to the proper measurement technique.

This isn’t to say one should dismiss the numbers when taken properly; I’m just pointing out that calibration is necessary.

I'm a nervous person. There have been several times where they had to recheck, because my rate was so high. My watch says my resting rate is 40 to 50 lower. Whatever protocols probably didn't have me in mind.

We're talking about blood pressure. Does your watch measure blood pressure?

I think this might be an example of what I was talking about: you think blood pressure guidelines might not apply to you because of something your watch says.

My point was to give an example of situational sensitivity. My pulse is easiest/the most fun to see, because it's...on my watch. See [1]. And, they loosely don't apply, which is why I've been told to take measurements at home, before coming in, with an automated cuff. The measurements in the office are not useful.

[1] https://my.clevelandclinic.org/health/diseases/23989-white-c....

You can't point at nomel conflating blood pressure with heart rate and say, therefore nobody can consider themselves to fall outside the guidelines of traditional medical guidance.

On average, men are taller than women. That doesn't mean every man is taller than every woman. If a woman is taller than a man and says she needs specific treatment because of it, she may be 100% right.

It’s called white coast hypertension, I don’t think of myself as particularly nervous but I get this too. I’ve had blood pressure readings in various medicals etc. from 145-160/90, and endured several stern lectures about salt and exercise and alcohol. Finally did a 24 hour ambulatory test and I’m < 130/60 or something in a non-clinical setting.

After this experience I did some reading and as far as I can tell, blood pressure is the least consistent, least rigorous test you can do in mainstream medicine. The “normal” range spans ~10mmHg and yet readings can vary by 10-20mmHg according to each of: stress level, standing up in the last 15 mins, recently having a drink of water (as you do in a doctor’s waiting room), whether your legs are crossed, etc. Without controlling for all of these (which is almost never done properly) they might as well be reading your tea leaves.

I think the purpose of taking BP in a regular doctor's visit is also just screening, not to make a final diagnostic decision. If it's normal they can move on, if not they can do some followups to determine whether it's genuinely an issue. Very many basic screening tests work like that: they're effective at determining something is not an issue, but not at definitively saying it is.

Personally I definitely have some degree of "white coat" syndrome, doctors offices just put me on edge for whatever reason. Several years ago as a healthy 30 year old at a routine office visit, the doctor found my blood pressure to be right on the upper bound of normal. She didn't immediately take any action on it, she just told me to stop by a local pharmacy and use their automatic machine a few times over the following weeks, and to enter the numbers in her organization's medical chart app. I did, it was normal, she sent me an email "thanks, looks good!". Case closed.

I was specifically told, by my doctor, to take my BP first thing I wake up and have sat down for a while.

My Withings BPM Connect takes 3 measurements automatically at intervals and takes the average of those + saves them to Apple Health.

Before I was taking my BP when I was feeling "weird" and of course it was through the roof, by taking it in the mornings my BP is still a bit high, but not Hypertension Level 2 high.

My issue is that blood pressure is being used by many corporations/health insurance plans to determine your premiums. So adding yet another layer of nervousness - you will be paying extra money over the course of the next year if your blood pressure is a little high (threshold is 120/80).

In the US, your health or medical history can't affect your health insurance premiums.

https://www.healthcare.gov/how-plans-set-your-premiums

It absolutely can affect your life insurance. Understandably that’s a problem of privilege but it’s a truth.

High blood pressure can be quite manageable with medications for most people and one should qualify for life insurance after that.

I know very much about the issue because I had kidney failure due to an autoimmune disease and had to deal with years of dialysis and just recently got a kidney transplant. High blood pressure is a very common issue in kidney failure and even that with the right combination of medications it was mostly manageable.

Its much hard to get life insurance after kidney disease. The best shot is through an employer group life insurance plan. And with my last employer I was able to covert it to an individual plan after I left.

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