T Nation

Blood Pressure - Electronic vs Manual Cuff

Being new to TRT, one of my main concerns has been my blood pressure. It was up when I began and has only gotten higher since then. However, an odd thing happened to me the other day, and I just wanted to mention it here, in case others might encounter something similar.

So my BP was running as high as 180/103 and was refusing to come down, even with increased cardio exercise and weight loss. Eventually, I was started on 5mg of lisinopril, which seemed to make me feel better. However, I kept monitoring my BP at home (Omron machine), and my bloop pressure seemed to stay almost exactly the same. Then, on Friday something odd occurred. First, I was in a Sam’s Club and used one of their BP machines by the pharmacy for a check, reading was something in the 180’s/mid-90’s. About an hour later, I went by a different clinic (I was not in my hometown) just to have a thyroid panel done to satisfy my own curiosity. The nurse doing my vitals came in with a manual cuff, no machine. She checked my BP, and I asked her what it was. This time my reading was 150/85, not great but way better than anything I had seen in a while. While I was waiting to do the blood sample, I recalled a visit I had at my regular provider a couple of years ago when I also had a high blood pressure reading on the machine in the initial vital sign triage or whatever area. The doctor came in herself with a manual cuff and used it to check. I can’t remember the number, but she said it was fine, and she always confirmed with a manual check, if the machine read it as high. I had totally put the experience out of my mind, as before this TRT thing, I didn’t really frequent the doctor and once she said the word “fine,” I devoted no more mental attention to it. I want to say at the time, the doc (being not petite herself) mentioned something about the machine and folks with bigger arms (translation: fat guys like you). However, since that time I had been using a different provider in the clinic and all she has used was the machine reading.

I call my wife on the way home and told her I had stopped by a clinic on the spur of the moment to get the thyroid stuff. Knowing I’ve been watching the BP, she asked about it, and I told her the experience. In high school she was “checked off” on using the cuff, when she was taking a class for a possible career in healthcare. I decided to buy my own manual cuff and would get her to check it. Both Friday night and Saturday, my BP has consistently been in the 135-155/80-85 range, each time she has taken it manually.

Anyway, I just thought someone in this group might encounter a similar issue or possibly had already encountered it. I am suspecting it might have something to do with the size of my overweight arm. However, while my BP is still nothing to brag about, I am optimistic that it is better than I thought and possibly has been improving. On my next visit, I plan to ask for a manual check, then ask to use the machine immediately afterward. I think this should tell me if my suspicion about the machine reading different is right.

This probably doesn’t help you but I went to the doc and consistently had 140/80 or higher twice in a row. She said many people get that just because they are in a doctors office. I’m thinking to myself I don’t care that I’m here at all so why would I have anxiety induced high BP. Anyways, went to a cvs and checked with their machine and it came back 116/60. So I bought a high tech personal use BP monitor and have since come back less than 120/65 on every BP check I’ve done in the years since.

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Using the wrong sized cuff and improper positioning of the cuff are the most common mistakes when checking BP.

Next, improper patient positioning.

Everyone who lifts should have issues with BP measurement. They have to use a leg cuff on me, and have had to do this for years. Of course, I can’t get to my elbow at the machines at places like CVS so it would be taking my BP on my forearm. The machines sold in normal pharmacies are meant for small people, not people with muscle dysmorphia.

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Naw, I can use a regular cuff… I think so long as you’re upper arm circumference is under 17 inches (which many lifters will never acquire, esp if you’re my height)… 17 inch arms on my height/frame would be like… IFBB pro size arms (or getting pretty close)

Even 15 inch arms on a 5’5 individual with 6 inch wrists looks jacked. Had a friend in America who had 14 inch biceps, but was 5’2, had a very low BF percentage + small bone structure… he had a very good physique (was an athlete), track sprinting, lifted weights on the side

You’re hypertensive and overweight… the numerous cascade of potential health problems you’re looking at down the line are enormous if you don’t get this in check… quickly… if you’re BP is reaching 180/100 during the day, that’s (systolic at least) diagnostic criteria for hypertensive crisis… meaning you require immediate medical attention, get on some meds asap… Ace inhibitors (like Lisinopril) are very good at lowering blood pressure and reversing the adverse adaptations regarding cardiac morphology that occur in response to prolonged hypertension

also, get the glucose control issues fixed… take metformin if you have to… do whatever

Obesity/overweight + hypertensive + diabetic… get this under control or you’re heading towards a vastly premature death… all of these ailments are strongly correlated with one another and are honestly 100% related to being overweight for a prolonged period of time

What’s you’re current diet/exercise routine like? If you say “I have no diet or exercise routine” then you shouldn’t be on TRT… maintaining a sedentary lifestyle whilst being obese, hypertensive and diabetic will increase risk factors (regardless of what one says, androgens are not indicated for use in individuals with such ailments as they do increase blood coagulability)… actually it isn’t to say he shouldn’t’ be on TRT… but the dosage should be kept minimal in his situation… shooting for high levels in this case could very well end badly

White coat hypertension. I have it as well.
A lot of doctors and nurses will use the small cuff, when they should be using a larger one on a substantial number of folks.

I dunno, my arms are tiny and I always get a higher reading with an electronic monitor, regardless of where I take it.

Standard cuff is for up to 14" (Sometimes 14.5") in any of these pharmacy machines. The readings are all over the map. If you have 8" wrists, you are unlikely to find a friendly machine. Manual with the correct cuff is going to be considerably more accurate for a lifter.

That’s tantamount to saying a diabetic should get it all together before he resorts to insulin. \good luck with any of it if your hormones are out of whack.

They are not super accurate. They are mostly just good for keeping an eye on whether or not you are going up or down as a trend, not for an accurate number.

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Exactly my situation as well. Some of the machines at Wal-Mart and the like are tight on my arm, not from muscle as much as fat in my case. However, my machine at home was a pretty spiffy Omron with the extra-large cuff and the one at the doc’s is a professional unit, both have consistently run high with me.

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Unreal, man I would like to go into detail about your advice and my situation. However, I don’t really have time. Needless to say, I have posted several times and you have read several of them, if you are interested, please feel free to review them.

Have you noticed that you kind of have a tendency to correct literally everyone in your responses and/or tell them firmly how they are going about things all wrong? Again, meaning no harm, but in some cases you actually sound as if you are borderline accusing people of being untruthful in whatever they post. I’m not speaking here about my posts alone, but all the ones I’ve read that you respond to. I appreciate your input, but maybe it’s just you are extremely zealous about your opinions, and it inadvertently comes across that way.

Take care!

  • I corrected it to (when I posted this) “use the minimum dose required”… someone in his situation needn’t be dosing 200mg weekly

And no, people with hypogonadism can lose weight, especially if serverly out of line. It’s frequently made out as if one with hypogonadism is physically incapable of losing weight or improving lifestyle related choices… that’s not true at all… whilst certain mechanisms relating to being able to lose weight may be blunted, it isn’t to say that it’s impossible

That being said, no reason for him to go off entirely, but if you’re BP Is hitting 180/100 that’s incredibly dangerous

I don’t have the tendency to correct people… I have the tendency to talk within a realist manner… the truth is

You’re overweight, potentially diabetic and hypertensive… these three are a dangerous combo to be hanging around with

That being said, upon reading you’re initial post (testosterone and glucose/BP)… you’re doing the right thing. You’re on metformin, you’re dieting (intermittent fasting), you’re exercising (walking)… props to you

Do you track macros? I’d be consistently aiming for slightly under you’re estimated caloric maintenance. As for exercise, HIIT burns more calories in a shorter space of time, it may be harder, but it’s far less time consuming

Possible is one thing. Motivation, metabolism, the list goes on. At this point I don’t remember how long he’s been on, but there’s a good chance it’s related to initial E2 spike. Which goes away. 180/100 is not really that dangerous. A bottom number of 100 is the important part. If it was 120, maybe he should worry.

“ A hypertensive crisis is a severe increase in blood pressure that can lead to a stroke. Extremely high blood pressure — a top number (systolic pressure) of 180 millimeters of mercury (mm Hg) or higher or a bottom number (diastolic pressure) of 120 mm Hg or higher — can damage blood vessels.”

I can link medical literature (not simply this quote) that indicates a systolic of 180 in itself has the potential to be incredibly dangerous… isolated systolic hypertension isn’t something one can just brush off, perhaps it’s not quite as important… but it still HEAVY correlates directly to increased risk of stroke, myocardial infarction, cardiac enlargement etc

AAS induced hypertension typically doesn’t relate to E2 solely, otherwise nonaromatising compounds wouldn’t have the predispensity to cause hypertension

It’s the systemic vascular resistance, RAAS modification (adrenal effects) etc that increase blood pressure. A diabetic, overweight individual (not meaning this as an insult, I’m merely stating facts) would be more sensitive to these changes. Hence the dose of 200mg initially is probably too high, for someone in his case I’d drop to 140-150

200mg when I had 30 extra pounds of body fat was a completely horrible experience while 200mg with much less body fat has been amazing.

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Bottom number is 100, not 120 on this guy. IF the arm is too big for the cuff, your reading will be falsely high. It really doesn’t matter if it’s fat or muscle that is making the arm too big for the cuff.Worrying about the number is likely to do more damage than the number, especially short term and with it being the top number elevated.
I’m sure he didn’t feel good with low test levels, so not feeling good with high test really only means he will gradually feel better as the body composition changes. As he gains muscle and loses fat, all of his risk factors go down. Assuming his test levels are normal range with that dose, why screw with it?For the sake of a temporary elevation in BP number that isn’t going to bother him in any way short term? That doesn’t seem reasonable.