The current coronavirus pandemic has made it impossible for many patients with chronic neurological illnesses to leave their homes and visit a doctor. With telemedicine video chats becoming mainstream, patients that have problems with the autonomic nervous system are finding new ways to safely stay connected and receive their clinical care.

Here we provide top tips for measuring your blood pressure at home for a virtual autonomic clinic.

Find a decent blood pressure cuff. The first thing to consider is buying an accurate home blood pressure device. There are some excellent options, but it is important to keep in mind that most commercially available devices have been validated to measure stable blood pressures in the normal range. They might struggle to take accurate readings, particularly if blood pressure falls in the low range or is changing rapidly.  The arm cuffs are better than the wrist cuffs, because then you know you are measuring blood pressure at heart level. It’s not necessary to buy an expensive device with many features, but it probably makes sense to stick to well-known brands like Welch Allyn or Omron.

Place the cuff properly. Wear a short-sleeved shirt so you have access to the arms. The cuff has to be able to pick up the force of the blood being pumped through the arm, therefore, it’s important to place the cuff on bare skin. You want to follow the instructions to align the cuff above the elbow crease (at the level of the heart). Often there is an arrow or line so that you can position the cuff over the artery on the inner side of the arm. It should be tight enough so that it doesn’t fall down. If you’re writing down the values or need to hold on to something for balance, use the non-dominant arm. Cuffs give you a lot error readings caused by motion artifacts if the arm is moving or tense. It’s important to remember that when the machine is taking a reading the arm with the cuff should be still.

Take your blood pressure in different positions. Patients with autonomic failure are well aware that their blood pressure changes depending on their body position and even fluctuates throughout the day.  It’s important to measure it in different position. You should lie down for 5 minutes, measures your blood pressure 2 or 3 times while you are flat. Then sit up and remain sitting to allow your blood pressure to accommodate, while you take another reading. Then stand up slowly and carefully. Remain standing for 3 successive times with a short interval in between.  After the third and last reading sit down again. This is what we do during a standardized active standing test in the clinic. At home, patients find they can best do this on the edge of the bed or using a reclining chair. Be sure you have someone to help you or something to hold on to if you feel unsteady when standing or shifting positions.

Write down the numbers. Blood pressure is measured at peaks and troughs in the cardiac cycle, so it’s important to note down both the systolic and diastolic numbers (the top and bottom numbers). You also want to also write down heart rate values so you can see how the heart is responding.  Be sure to keep a track of the position you are in too. You end up with a lot of numbers on a page and it’s easy to forget which ones are flat, sitting or sitting. In patients with autonomic failure, the top systolic and bottom diastolic measures usually move in the same direction, so if one goes up a lot and one goes down, it’s likely to be an error, and you should take it again.

Take your blood pressure at different times of the day. It’s important to get used to how your blood pressure behaves in your home environment. Sometimes, blood pressure can be lower in the morning or after meals, so you might want be asked to repeat these measurements at specific times.  Other times, patients have predictable symptoms with certain activities. Sometimes we ask patients to walk around for a bit and repeat the measurements to see if it’s lower again. If you struggle from diarrhea and you think fluid losses might be making your symptoms worse, it can be useful to take your weight in the morning and keep a note of it together with your blood pressure readings.

Trust your symptoms. If you need to sit, you should. It’s important to avoid falling from fainting which could result in you needing the emergency room. If you feel your blood pressure is really low and you’re on the verge of fainting, don’t wait for the reading and sit.  Likewise, if you get a really very low reading and you’re are feeling no symptoms whatsoever, restart the machine and repeat the measurement.

Ask for help. If you are still confused about how to measure your blood pressure at home, call the autonomic service. Many of our nursing staff are ready to guide patients though how to monitor their own blood pressure at home.

Set your telemedicine visit up for success. Be prepared and have your blood pressure cuff close in case your doctors want you to measure your blood pressure again on the video call. You can place the machine by the camera so they can see the numbers live. Make sure you are in a position where you can safely stand up.  Try connecting to the video call in advance so you can trouble shoot any problems and you don’t use up time on your call solving technical issues. You can also email your blood pressure log to your medical team in advance so they can look over your patterns. Prepare as you would for a usual visit to the doctor, by having a list of your current medications ready and writing down any pressing questions you want the doctor to answer. You are still after all, seeing your doctor.