The cheapest reliable way to determine your BP is to take your blood pressure yourself. You take frequent measurements throughout the day-at home, at work, wherever-for two to four weeks until your next doctor visit. Then you can combine your doctor’s office readings with those you take on your own and average the whole works. If you already know that you have hypertension, home monitoring lets you keep tabs on your blood pressure so your doctor can better adjust your medication regimen.

Here’s how to get the best home-monitoring results:

Select the right equipment. Be choosy about a home monitor. Impulse purchases are always tempting, but don’t decide until you hash over the options with your doctor. He or she can recommend the type and features you’ll want. (See “Your Monitor Options” on page 25.) Keep a diary. Take as many as 30 readings in the course of a few weeks and record the pressures as carefully as you would entries in your checkbook. Include the dates and times and, while you’re at it, pen a few words about the way your body feels at the time. What kind of mood are you in? You could be agitated at the kids, mad at the dog or just frustrated because the washing machine broke down again. All the better, says Dr. Norman Kaplan, M.D., chief of the hypertension division at the University of Texas Southwestern Medical Center, Dallas. “It’s when you have a headache, when you don’t feel well, that we can find out if you really have hypertension.”
Master the technique. “Without hands-on training, measurements are frequently done wrong, which is bad news since decisions about your health are based on that information,” says Dr. Grim. Review the proper technique (for the specific monitor you have) with your doctor or nurse. To become an ace at the manual monitors (those using hand pump and stethoscope), work with your doctor to personalize the following gcneral instructions (adapted from American Heart Association procedures for health professionals).

1. Sit in a straight-backed chair, even though you may be tempted to pump up while sprawled on the couch. An unsupported back makes muscles contract, thereby raising your pressure as much as five mm Hg. “It may not sound like a lot;’ says Dr. Grim. “But if everyone in the United States were to add that to their readings, we’d double the number of people with high blood pressure in this country.” The sitting approach alone doesn’t work for some people over age 65, however. “That’s because the blood-pressure-regulating mechanism in some older people doesn’t work like it used to;’ says Dr. Pickering. “Their pressure may actually fall when they stand up. It’s important to be aware of that drop, because if you treat them and make their blood pressure fall even further, they could get dizzy and fall and break a hip or something:’ These people should have their blood pressure measured while seated and while standing up.

No matter how old you are, it’s best to take the reading in a quiet place and do it after you’ve given yourself at least five minutes to relax.

• 2. Position the cuff on your bare upper arm so that the bottom of the cuff is about one inch above the elbow. The inflatable portion of the cuff should be centered over the artery that’s located on the inside of your upper arm (the brachial artery). “The cuff should be snug enough that you can slide two fingers under it,” says Dr. Grim. “If you can’t, it’s too tight.”
• 3. Position the stethoscope’s earpieces in your ears and plant the stethoscope head on the bend in the elbow below the cuff. The right spot is the one where you hear your pulse the best. That might mean moving the head of the stethoscope from the bend in the elbow up toward the cuff.
• 4. Inflate the cuff 30 mrn above the systolic pressure you got at the doctor’s office and very slowly deflate. “Most people rush this part, and they get poor readings;’ says Dr. Grim. His advise:
• Drop at the correct rate of 2 rnm to 3 mm per second.
• 5. Listen up. After a few moments of silence, you’ll begin to hear the blood surge. It might tap or swish; it could be loud or soft. Your doctor can help train your ear. (If you hear these sounds as soon as you begin to deflate the cuff, try inflating again to a pressure that’s a little higher.) Note the reading on the gauge at which these sounds first appear. This is your systolic pressure. To find your diastolic pressure, continue to deflate and note the reading at which the sounds disappear.
• 6. Wait 30 seconds, repeat the procedure and average the results. If the two measurements are more than five mm apart, take a third and average the last two. And remember: “Patients who take their own pressures get more serious about trying to lower it;’ says Dr. Pickering. You just might find it easier to exercise more, drop excess weight, stop smoking and just say no to fats and alcohol.

Nobody’s blameless. And patients make mistakes, too. The two big ones in blood-pressure treatment are both what doctors call “compliance” problems.

Avoiding Lifestyle Changes.

“The likelihood that a patient will comply long-term with nondrug therapy is pretty dismal;’ says Dr. White. “Somebody will be really great for four to six months-they’ll lose weight so their pressure goes down. You see them the next year and they’ve gained weight back and stopped exercising. The next thing you know, the pressure’s back up. Then the physician is likely to resort to prescribing medications to control blood pressure:’
Before you and your doctor reach that point, though, there arc a few other tactics you can try:

•  Ask your HMO or local hospitals and health groups where to find hypertension support groups.
• Look in your local newspaper for heart-healthy cooking classes. They’re cropping up all over.
•     Use a home blood-pressure monitor regularly to get feedback on how well lifestyle changes arc working for you.

Not Taking the Medication.

Sometimes people don’t take the drug that can help them because they regard even an aspirin with distrust. Often it’s because they’re having side effects with one drug, which makes them dismiss all drugs in the bloodpressure arsenal. “It’s very difficult to convince people to take medication for the rest of their lives. Often, people feel well, so they tend not to take medication,” says Harry Gavras, M.D., vice-chairman of the American Heart Association’s council for High Blood Pressure Research and chief of the hypertension and atherosclerosis section of Boston University Medical Center.
If the idea of taking a pill every day of your life turns you off, you need to do a little research on why it’s so necessary. Ask your doctor to point you in the direction of information. If it’s side effects that have understandably put you off pill taking, be aware that there arc six very different classes of drugs for blood pressure and many medications in each class. “You really need to get on different medication. It shouldn’t produce side effects,” says Dr. Pickering.