Blood pressure review form

Home Blood Pressure monitoring is useful addition to clinic blood pressure (BP) readings in the diagnosis of high blood pressure and in the monitoring of those with high blood pressure. To get an accurate representation of your BP, it is advised to take two readings both morning and evening for a minimum of four days, but ideally seven. The surgery will then calculate your average BP, omitting the results from day one.

Instructions for home BP monitoring

  • Cuff should be placed on upper arm with lower edge about 2cm above elbow joint. Forearm should be supported on a firm surface at chest level.
  • BP readings should be taken after having been sat quietly for 5 minutes in a chair with a supported back and legs should not be crossed. If you are already taking antihypertensive medication, readings should be taken prior to the tablets.
  • Avoid caffeine, smoking, eating and physical activity in the 30 minutes prior to measuring BP.
  • Take two readings, one minute apart. *NB only upper arm BP monitors are considered reliable for home BP monitoring*
  • There will be 2 numbers on the screen. Record both numbers – the upper number (systolic) in the grey shaded box and the lower number (diastolic) in the white box. Some machines give a third number which is your pulse rate, this may be ignored.

IF HOME BP READINGS ARE REGULARLY ABOVE 180/100 MAKE URGENT APPOINTMENT WITH GP PLEASE

Smoking status

Your blood pressure

Please provide a minimum of one blood pressure reading, up to a maximum of seven.

Day 1

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 2

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 3

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 4

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 5

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 6

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 7

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80