Dr Joshua Wolrich: ‘It’s time for blood pressure measurement to get an upgrade’.

Last reviewed:
18 Jul 2022,

Medically reviewed by:

Dr Joshua Wolrich: ‘It’s time for blood pressure measurement to get an upgrade’. - 1
Dr Joshua Wolrich

We have been working with Dr Joshua Wolrich, NHS Accident and Emergency Doctor and Nutritionist, who has written extensively about how diet and exercise affect health, and follows a ‘health at every size’ approach.

In this article, Dr Joshua describes some of the challenges in measuring and treating high blood pressure, his experience of using Aktiia to measure his own blood pressure and how this could help others to take control of their condition. He also provides some top tips on how people can lower blood pressure and better manage hypertension, starting today.

As a doctor working in the emergency department, I see the impact of high blood pressure on a daily basis, yet it’s not something that we routinely measure or keep an eye on ourselves outside of a healthcare setting. This feels like a problem to me. Let me explain.

Persistently high blood pressure can increase a person’s risk of having both heart attacks and strokes. The good news is that we have effective medication that can help to bring it back down into a normal range, and there are also a number of lifestyle changes that people can make:

  • Top tip: Staying active helps lower your blood pressure. Exercise strengthens the heart lowering the amount of effort it takes to pump blood around the body
  • Top tip: Basing your diet around vegetables and cutting back on your salt intake both have an impact on lowering your blood pressure

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High blood pressure can cause serious health complications, and there are ways to bring it under control, so identifying who would benefit from intervention and treatment shouldn’t be sniffed at. But how do we accurately do this?

Blood pressure is taken as a routine observational measurement almost every time someone attends the hospital or their doctor’s surgery, but it can be frustratingly unreliable at diagnosing someone with hypertension (high blood pressure). Research suggests that about one in five adults exhibit what’s known as ‘white coat hypertension’. This is a phrase used to describe the phenomenon where the stress related to being in a healthcare setting and sat in front of a medical professional leads to a higher blood pressure than normal. As such there’s a bit of an attitude among doctors of not worrying too much about slightly high readings, which makes sense, but how do we make sure we’re not missing the need to correct things?

  • Top tip: the first step to managing your blood pressure is to measure it. Regular monitoring can help you identify certain triggers which may cause your blood pressure to fluctuate, meaning you can take the action needed to keep it under control. If you are diagnosed with hypertension, your GP may prescribe medication to help lower your blood pressure

If you picture measuring your blood pressure, the uncomfortable inflatable cuff is pretty much the only thing that comes to mind. I’m sure almost everyone reading this will have had their blood pressure taken via that method at least once in their life; if you have, you’ll likely remember it getting super tight before finally deflating and the feeling of relief as the blood rushes back to your hand. This is fine as a one off, but how many of you would enjoy a full day of that at regular intervals?

When someone’s blood pressure is high with a doctor, the most reliable way of seeing if this is a one off due to pain/stress/exercise or a long-standing issue is to carry out ambulatory (24-hour) blood pressure monitoring. This allows us to see what’s happening at different times of the day and give a better reflection of the true blood pressure. A reading is taken every hour during the day and every four hours at night. I haven’t personally ever had to wear one, but I’ve had several patients report it waking them up overnight as a result. I’m sure that’s likely to have had a negative impact on their readings!

Luckily, there is now another option to enable closer monitoring of blood pressure, and I’ve recently been trying it out:

When I heard about the home blood pressure monitoring device from Aktiia I was genuinely sceptical of the fact that it worked just like a smart watch on your wrist. No continuous inflatable cuff?! That’s not something I realised was possible. You only need to calibrate it with the included inflatable cuff once a month – the rest of the time it records your blood pressure via an optical sensor on a bracelet that you’d have no idea was even doing anything. It was fascinating to see how my blood pressure varied depending on my activities during the day, especially when I had a particularly stressful morning on one of them, and reassuring to know that my average is in the healthy range. Wearing it overnight was a breeze.

This isn’t just a useful device for someone like myself who happens to have a normal blood pressure, but I can see this being incredibly useful for my patients who are already on medication to help manage their blood pressure. The difficulties that exist with traditional blood pressure monitoring aren’t just with initial measurements but are also related to tracking whether medication is being taken at the right dose. Having overnight readings can also be especially useful to see if medication timing might need changing.

I’ve already lent the device to a family member to see if their blood pressure medication is working well and would have no hesitation recommending it as an option to my patients in the future.

  • Top tip: Using a 24/7 wearable device like Aktiia allows you to manage your treatment around the information provided by the 24/7 monitoring, whilst feeling informed about your own health
Dr Joshua Wolrich: ‘It’s time for blood pressure measurement to get an upgrade’. - 2

Medically Reviewed

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Traditional blood pressure cuff vs. Aktiia


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Day-Time Blood Pressure
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Night-Time Blood Pressure
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