Dear Doctors: Blood pressure machines at doctors' offices often cause me extreme pain. During a recent surgery, the repeated readings left me with bruises and caused burst capillaries. Often, my arm isn't even supported. What can I ask them to do differently?
Dear Reader: A blood pressure reading is meant to be a diagnostic tool, not a test of endurance. Many people do find the pressure in the cuff to be momentarily uncomfortable. However, it should not be painful. The fact that you experience not only discomfort but actual pain, as well as tissue damage, strongly suggests that the technique being used is not appropriate for you.
A blood pressure reading measures how hard blood is pressing against the walls of the arteries. In order to measure that force, the blood pressure cuff is wrapped around the upper arm. As the cuff expands, it briefly stops the flow of blood through the brachial artery. Then, as the pressure gradually releases, two different measurements are taken. The first is systolic pressure, which is the upper blood pressure number. It reflects the force of blood during a heartbeat. The second is diastolic pressure, the lower number. It measures blood pressure between heartbeats.
Several factors can make a blood pressure reading painful. These include improper placement of the cuff, excessive inflation and a cuff that is too small. While the blood pressure cuff is meant to be wrapped firmly, it must not be too tight. It should be possible to slip two fingertips beneath the edge. Proper inflation is also important. In order to stop the flow of blood for a moment, the cuff must inflate higher than the person's systolic pressure. Equipment malfunction, calibration issues, arm movement, high blood pressure or a weak pulse can lead to excessive inflation. Just as important, these problems can lead to inaccurate readings.
Any of these problems could be compounded during a surgical procedure, when blood pressure is measured repeatedly. The fact that you developed bruising and damaged blood vessels suggests the cuff placed excessive stress on your arm. It is also important to consider individual factors that can make a person more susceptible to pain and bruising. These include older age, thin or fragile skin, low body weight and medications that affect blood clotting.
To make sure that future blood pressure readings are both physically tolerable and also accurate, become your own advocate. We know it can feel daunting, but do discuss the problems you are having with your healthcare provider. Ask that they check that the cuff is the right size for you, and that it is properly positioned. You are correct that your arm should be supported at heart level during the reading.
If a future blood pressure reading becomes painful, ask that it be stopped and the cuff and technique be reassessed. You also have the option of asking that your blood pressure be measured manually. And with your history of bruising and blood vessel damage, it would be wise to discuss this with your doctor.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
