May 20, 2013

Control High Blood Pressure: The Category Chart (Cockpit Chart #5)

XXMM MEASURES MED P Chart displayChartImage

1. Systolic and diastolic blood pressure are combined into a point

A blood pressure measurement usually consists of three numbers: the systolic and diastolic blood pressure and the pulse. The systolic blood pressure ranges usually from 80 - 220 mmHg, the diastolic pressure from 60-120. Therefore the two blood pressure values can be combined into one point and plotted in a 2 dimensional plane. When all measurements within a observation period are plotted into a chart, the distribution of measurements can be appreciated easily by visual inspection.

2. Color coded background reveals blood pressure category

The canvas of the category chart uses a color coded background which applies the same colors used in the other blood pressure charts to depict the category of measurements. If a blood pressure measurement consists of a normal systolic and a normal diastolic value such as 125/83 the point (83, 125) lies in the light green region which denotes the normal range.

3. Category chart delineates patterns

The information about clustering of blood pressure values gives a different view on the current state of blood pressure control. This category chart is particularly helpful, if a series of these charts are compared with each other. If the paths of points are mostly within the green or yellow regions, blood pressure control is achieved.

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Note: To generate your individual blood pressure chockpit, go to www.medmobile.at, register for a free account and enter your measurement values: You will then be presented with your version of the medmobile blood pressure cockpit that delineates your current state of health concerning high blood pressure and tells you whether you have achieved blood pressure control.

(The graph shown at the top of this post was generated using the monitoring tools from www.medmobile.at)

April 24, 2012

Control High Blood Pressure: The Daytime Variations Chart (Cockpit Chart #4)

XXMM MEASURES MED P Chart displayChartImage

1. Daytime variation: From morning to evening

Blood pressure varies throughout the day. In some people it is higher in the morning, in some people it is higher in the evening. When the blood pressure is higher in the morning or even early morning, the risk for stroke and heart attacks is higher. Therefore it is important to find out whether blood pressure increases have a pattern and tend to occur at specific times of the day. This information can be obtained from the chart showing daytime variations.

2. Daytime variation: lines collect all values from a single day

It is a little difficult to present a chart that highlights daytime variations. The medmobile daytime variation charts do this as shown above: Measurement values are plotted in relation to the time of the day when they were obtained. Thus, measurements that were taken in the morning are shown at the left side of the graph, measurements that were taken in the evening are shown on the right side of the graph. Measurements that were obtained during the same day are connected by a line. So each line collects all measurement of a specific day. If only one measurement was taken on a single day, only this point is displayed.

Values there were taken early in the month are shown with dimmed, gray symbols and lines, measurements that were taken later in the month are shown in more bright colors. Therefore, the saturation of the color reflects the approximate time in the month that the measurements were taken. Thus, the time progression through the month is captured in the color saturation.

3. Example chart: morning higher than evening

The chart displayed above shows a slight decrease of systolic blood pressure from morning values to evening values. The red lines for the most part decline slightly to the right side which indicates that blood pressure at the evening is lower than blood pressure in the morning. This details about blood pressure regulation are very difficult to discover when looking at a table of measurement values. However, a chart display makes it obvious that there is a trend to having lower blood pressure values in the evening.

The information about daytime variations is important to assess the risk for strokes and heart attacks in the morning and also to make recommendations concerning the use of medications in the morning or at nighttime. If the blood pressure is always high in the morning, medication needs to be adjusted at night so that morning blood pressure values are still controlled by drugs taken the previous evening.

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Note: To generate your individual blood pressure chockpit, go to www.medmobile.at, register for a free account and enter your measurement values: You will then be presented with your version of the medmobile blood pressure cockpit that delineates your current state of health concerning high blood pressure and tells you whether you have achieved blood pressure control.

(The graph shown at the top of this post was generated using the monitoring tools from www.medmobile.at)

April 23, 2012

Cotrol High Blood Pressure: The Time Chart (Cockpit Chart #3)

XXMM MEASURES MED P Chart displayChartImage

1. An entire month of data

The time chart shows the blood pressure measurements as three curves covering an entire month. The systolic blood pressure is shown in red, the diastolic pressure in blue and the pulse in green. As you go in the chart from left to right you seen the development of the three measurement values from the beginning of the month to the end of the month.

2. Each single measurement is displayed

The time chart shows each single measurement value. So it can be appreciated how many measurements were obtained in the month, how much time elapses between measurements and whether measurements were obtained in regular intervals. In contrast to the time chart, the blood pressure watch and the bar chart (Cockpit charts #1 & #2) display a summary information about blood pressure control without giving single measurements. From the blood pressure watch and the bar chart it cannot be determined whether 3 measurements or 300 measurements were used to draw the charts. The time chart however gives a more detailed view on the data and thus complements the other charts.

3. Trends are easy to detect in the time lines

The time chart is particularly useful to assess the trend of the values and also the variations between the measurements. If the blood pressure control improves, the two lines for systolic and diastolic blood pressure should show a decline from the left to the right. If the blood pressure control worsens, the lines will go upwards from left to right. If measurements vary, the lines will show many wiggles, if blood pressure is rather constant, lines will be smoother.

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Note: To generate your individual blood pressure chockpit, go to www.medmobile.at, register for a free account and enter your measurement values: You will then be presented with your version of the medmobile blood pressure cockpit that delineates your current state of health concerning high blood pressure and tells you whether you have achieved blood pressure control.

(The graph shown at the top of this post was generated using the monitoring tools from www.medmobile.at)

March 12, 2012

Control High Blood Pressure: The Bar Chart (Cockpit Chart #2)

XXMM MEASURES MED P Chart displayChartImage

1. Bar chart displays the distribution of measurements

The bar chart reveals more detail about your blood pressure. A first impression of blood pressure control is usually obtained through the blood pressure watch (Cockpit Chart #1). After viewing the average values in the blood pressure watch the bar chart (Cockpit Chart #2) is able to reveal more detail by presenting the distribution (or the spread) of the measurement values.

2. Colors are linked to categories

Thus, the bar chart extends the information from the blood pressure watch: There are two displays contained in the bar chart. The left chart shows the distribution of systolic blood pressure values, the right chart displays the distribution of the diastolic blood pressure values. Both charts use color coding to represent the classification of blood pressure values into 6 categories: optimal (dark green), normal (light green), borderline (yellow), high blood pressure stage 1 to 3 (light red, dark red, very dark red).

3. Column height depicts percentage of category

Each bar in these charts shows the percentage of values in the respective class. So if you look at the chart below on the left side you can derive the following information: about 37% of systolic values are optimal, about 55% are normal, about 8% are borderline, and none are in the hypertensive range. In the chart on the right you see that more than 90% of diastolic values are in the optimal range.

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Note: To generate your individual blood pressure chockpit, go to www.medmobile.at, register for a free account and enter your measurement values: You will then be presented with your version of the medmobile blood pressure cockpit that delineates your current state of health concerning high blood pressure and tells you whether you have achieved blood pressure control.

(The graph shown at the top of this post was generated using the monitoring tools from www.medmobile.at)

March 5, 2012

Control High Blood Pressure: The Blood Pressure Watch (Cockpit Chart #1)

XXMM MEASURES MED P Chart displayChartImage

1. Blood pressure control relies on a complete diary

Blood pressure control relies on a blood pressure diary of high quality: You should measure your blood pressure 2-3x per day and then record the values in a table. However, the wealth of information contained in the blood pressure diary is not self evident: You need to convert the long list of numbers into color coded charts to extract the critical information for treatment. A visual display is much more revealing than naked numbers.

2. Blood pressure watch displays average blood pressure values

A first impression of the state of your blood pressure can be gained from the blood pressure "watch" - this color coded chart presents the average systolic pressure and the average diastolic pressure as obtained within a measurement period. This period can be rather short such as several days or a week or can be longer such as a month or a year.

3. Color coded chart reveals the stage of blood pressure

The two average values are displayed as a blood pressure watch: The left half of the display shows the systolic average value, the right half the average diastolic value. The color at the dial reflects the stage of your blood pressure:

  • dark green - optimal blood pressure
  • light green - normal blood pressure
  • yellow - borderline blood pressure
  • light red - high blood pressure stage 1
  • dark red - high blood pressure stage 2
  • very dark red - high blood pressure stage 3

If any of the two pointers of your chart points toward one of the red regions - please see your doctor or nurse practitioner. You may be at an increased risk for a stroke or heart attack.

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Note: To generate your individual blood pressure chockpit, go to www.medmobile.at, register for a free account and enter your measurement values: You will then be presented with your version of the medmobile blood pressure cockpit that delineates your current state of health concerning high blood pressure and tells you whether you have achieved blood pressure control.

(The graph shown at the top of this post was generated using the monitoring tools from www.medmobile.at)

February 1, 2012

Your blood pressure cockpit - Colour coded charts to control high blood pressure

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If you want to control high blood pressure you first need a good understanding of your blood pressure values. You need to be able to answer these critical questions:

1. What is my blood pressure?

Blood pressure varies, sometimes quite a lot. But you still want a single number that tells you your "blood pressure state of health". For that we take the average of the blood pressure values. The average summaries all values obtained within a period (such as a week or a month) into a single number. The average is calculated for both the systolic blood pressure and the diastolic blood pressure.

2. What is the overall variation (distribution) of my blood pressure?

Your blood pressure may show only little changes between measurements and thus be rather constant. However, measurements may also vary a lot with many high values and many low values. The average values between these two situation may be very similar, but the distribution of values among low, normal or high values is quite different. The distribution of values elucidates the variation of measurements values.

3. What is the time course of my blood pressure?

Blood pressure is not constant, it changes over time. Treatment of high blood pressure is a long term strategy. Therefore you need to observe blood pressure values over longer time periods such as weeks and months to see how effective therapy is.

4. What is the daily variation of my blood pressure?

Some people have high values in the morning, some people have high values in the evening. Blood pressure medication is usually taken in the morning and the evening, only in rare cases is medication taken during the day. You need to know at what time of the day your blood pressure tends to be high. With this information your nurse or physician can advise you whether you better take medication in the morning or in the evening.

5. What is the appearance of all my blood pressure measurements?

You want to get an idea whether your blood pressure measurements cluster into different groups or spread evenly. You also want to assess the relation between systolic and diastolic blood pressure values. When your blood pressure is high is it because systolic values are high, is it because diastolic values are high or because both systolic and diastolic values are high.

Easy answers to questions 1-5: Your blood pressure cockpit

You measure your blood pressure regularly, you have a long list of measurement values. But when you look at these columns of data, you cannot easily answer your critical questions. This is were colored graphs come into play. Graphs can be of a tremendous help to elucidate relationships between data points. A visual representation of data is much easier to understand than columns of digits. Color coded graphical charts can highlight important aspects of your blood pressure values: They can help you to answer all the questions from above. Once you understand these color coded graphs you can evaluate your "blood pressure state of health" with a single glimpse of your eye.

The blood pressure cockpit presents different views of your blood pressure data in an easy format: 5 graphs arranged in two rows. The graphs in the cockpit will be explained in further blogs. The cockpit was generated using the monitoring tool www.medmobile.at

March 2, 2011

Blood Pressure Measurement - Left or Right Arm?

Let us focus on measuring blood pressure in the arteries of the arms. First the side for the measurement, the left or the right arm, needs to be determined. Occasionally people think that measurements need to be taken at the left arm as the heart is situated in the left side of the chest. But this is not a valid argument. The side of the blood pressure measurement has nor relation to the position of the heart in the chest. It is more related to the character of the "tubing" that connect the aorta as the central vessel in the chest to the arms.

In most people the pressure from the aorta (the large main artery in the chest) is transmitted equally to both arms so that is makes no difference whether you measure on the left or the right arm. However, in some patients there is a slight obstruction to blood flow either on the right or the left arm so that pressure is actually lower at the side with the obstructed flow. If there is a consistent difference between the measurements obtained on the left and right arm, always the side with the higher value needs to be used. The side with the lower measurements does not accurately reflect the central aortic pressure and thus should not be used.

When pressure measurements on both sides are equal, right handed people usually prefer to measure on the left arm. It is easier use the right hand to place the blood pressure cuff unto the left upper arm. It is the other way around for left handed people.

February 24, 2011

Blood Pressure Measurement - Invasive or Noninvasive

There are several methods to measure blood pressure - invasive methods which use a catheter introduced into the vessel and noninvasive methods using cuffs placed around the upper arm or the wrist. In daily life  noninvasive methods are the preferred way. But just for educational purposes let us first have a quick look how the more accurate and invasive way to measure blood pressure works.

The invasive way of measuring blood pressure uses a needle or a small tube filled with saline that needs to be poked into an artery to directly record the blood pressure. While this is the most accurate method for getting at the blood pressure it is invasive and can lead to complications. Therefore it is only used under life threatening situations in very sick patients in intensive care units. The invasive measurement is based on the transmission of the pressure exerted by the blood through the fluid filled catheter to a pressure gauge located outside the body. While the pressure signal gets slightly altered while travelling from the blood stream through the fluid filled tube to the gauge, the measurement at the gauge nonetheless reflects rather accurate the pressure inside the vessel.

The noninvasive way of measuring blood pressure cannot use any pressure sensor placed inside the body. So clever ways have been devised that give an indication of blood pressure by relying on external maneuvers. First a site for pressure measurement needs to be found. We really would like to measure the blood pressure that is generated by the pumping heart in the chest. But we have no access to this site. But the blood streams from the chest through the arteries to the arms and the hands and at these sites pressure can be assessed. Of course blood pressure could also be measured at the legs or the feet, but this is not really feasible in a routine setting.