It is important to manage your blood pressure yourself

Today, everyone who has high blood pressure should regularly test the effectiveness of their treatment themselves. There are many measuring devices available that can be used at home to determine the blood pressure in the upper arm or wrist without any problem.

An important instrument for assessing blood pressure is the long-term or ambulatory blood pressure meter. This measures and records the blood pressure at certain intervals over 24 hours. These intervals are usually 20 minutes during the day and 30 minutes during the night. Blood pressure measurement at night can be irritating, but it provides important information concerning the behaviour of the circulatory system. In some people, and particularly those with diabetes, the blood pressure does not fall overnight in the normal way, which imposes a much higher burden on the body. This phenomenon occurs especially often in people with kidney disease. In some, the blood pressure even rises overnight, instead of falling

In someone withType 2 diabetes, the blood pressure can rise at night instead of falling

Systolic blood pressure

200 160

80 TI IP171 n [TT IflTT F Diastolic blood pressure

14 16 18 20 22 0 2 4 6 8 10 1 2 Time (24 ho jr clock)

Figure 4.10 Ambulatory 24-hour blood pressure monitoring of a 58-year-old with Type 2 diabetes and microalbuminuria. Because of the hypotensive treatment, during the day the blood pressure stays within an acceptable range but at night it climbs steeply - which over the long term causes organ damage, including to the kidneys.

(Figure 4.10). Detecting this and initiating the right treatment to correct it can be a deciding factor in successfully delaying the progression of nephropathy. Therefore, the ambulatory blood pressure should be measured repeatedly at regular intervals in patients with renal failure.

Measurement is not the only part of blood pressure management: blood tests are also required to monitor for side-effects of the drugs. The treatment is very complicated, especially when several drugs are given concurrently. It is therefore usually not a good idea for patients to change their medication or even the dose of individual drugs themselves. Self-responsibility for the patient resides in controlling his or her blood pressure and in knowing about the medicines being taken, both of which can be learned during an appropriate course of education in diabetes and hypertension.

Practical tips for before you start managing your blood pressure yourself:

• Have the operation of your blood pressure meter explained clearly when you are relaxed and able to concentrate, for example at the hospital, pharmacy or clinic.

• Test whether your blood pressure is the same in both arms. Differences of up to 15 or 20 mmHg in the systolic value are normal. You should always measure the arm with the highest value.

• To be able to compare the values, you should try to take the readings at the same time of day, such as in the morning, after getting up, and in the evening before supper - preferably before taking your blood-lowering drugs. You may of course test your blood pressure more often.

• During the measurement, follow the rules given above (page 35).

• Write the measured values down straight away. Your doctor can give you good advice only on the basis of good documentation.

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