The Hypertension Clinic was established in 1990 by cardiologist Frans Leenen, MD, PhD, to see patients requiring diagnosis, treatment and/or management of high blood pressure. Patients with very low blood pressure are also seen at the clinic. Nephrologist Marcel Ruzicka, MD, PhD, (specializing in kidney-related hypertension) joined the clinic in 2002. Referrals are made by family physicians and other specialists.
What to Expect
Your initial appointment will last approximately 1.5 to two hours. During this first visit, the clinical nurse will measure your height, weight and abdominal circumference. The size of your arms will also be measured. This is to ensure that the proper cuff size is used when measuring your blood pressure. If the cuff is too small, the readings will be higher than the true measurement. This is very important because many people have larger arm sizes.
Blood pressure measurements will also be taken in both arms while you are seated, not talking and alone in the room. In some people, one arm may have a higher reading. If so, the nurse will indicate that you should use that arm for future blood pressure measurments. Standing blood pressures will also be taken.
Your thorough medical history will be documented, including any current and past hypertension medications you have used and possible side effects. You are asked to bring all your current medications in their original containers to your appointment.
The accuracy of your home blood pressure machine can also be tested at this time.
The doctor will then conduct a brief physical and discuss a plan of action for your treatment. Appointments will be made for possible diagnostic tests to assess your heart and/or kidneys, and a follow-up appointment is usually booked.
Common tests that may be ordered to help your doctor diagnose hypertension include:
- Blood tests to measure your electrolytes, blood sugar, lipids, and kidney function
- A urinalysis to detect blood, sugar or protein in your urine
- An electrocardiogram (ECG) or echocardiogram (ultrasound of the heart) to check for evidence of a previous heart attack or for damage to your heart from high blood pressure
- Kidney tests such as abdominal ultrasound, CT scan and renal angiogram
- 24-hour ambulatory blood pressure monitoring automatically reads your blood pressure every 20 to 20 minutes to better assess changes throughout the day and your risk for future cardiovascular disease
At follow-up visits, your blood pressure and body weight will be measured, results of tests will b reviewed and lifestyle changes will be discussed. Medications will be added or modified as required.
Home Blood Pressure Monitoring
Before a diagnosis of high blood pressure is made, you may be asked to measure your blood pressure at home.
- Sit in a quiet room alone with no distractions, back supported comfortably and feet flat on the floor. Three readings with one to two minutes between readings should then be done with your arm supported at heart level on a table or a pillow.
- This should be done for several days. Bring the list of the second and third readings brought to your next appointment.
- Recommended times for measurements are 10:00 a.m. and 3:00 to 4:00 p.m. If possible, try to measure your blood pressure at work.
Once the diagnosis is confirmed, you may be asked to take blood pressure measurements two to three times a week to assess the effects of treatment.
For home blood pressure machines, we advise using either Omron or Life Source equipment. We recommend that you buy an arm cuff model and avoid the wrist models, as they tend not to be accurate. It is important to note that you need to buy the proper size cuff, especially if you have big arms.
Factors that May Increase Blood Pressure
It is advisable not to measure blood pressure under these circumstances:
- Pain, cold, stress and anxiety
- Full bladder or bowel
- Smoking (wait a minimum of 30 minutes before taking readings)
- Coffee (wait a minimum of 30 minutes before taking readings)
- Showering or bathing (wait a minimum of 30 minutes before taking readings)
- Use of some over-the-counter medications (particularly non-steroidal anti-inflammatories (NSAIDs such as Advil/Ibuprofen, Aleve/Naproxen and Celebrex)