Assessing blood pressure when it cannot be measured using a cuff device

Posted on Wednesday 8th April, 2015

We are grateful to the Thalidomide Trust for providing this information - it is primarily intended for a UK audience but the general guidance will be universally applicable.

Why is blood pressure important?

BP monitoring is important as people age
BP monitoring is important as people age

All adults aged 40 or more are recommended to have a "cardiovascular risk assessment" to assess their risk of heart attack or stroke.  Several factors affect our risk of these events such as cholesterol levels (good and bad cholesterol), blood sugar, family history, smoking, exercise, diet and alcohol. 

Blood pressure is a major risk factor for strokes and heart attacks. 

Blood pressure, blood cholesterol and blood sugar levels are all tested as part of the assessment. 

To test cholesterol and sugar levels, a sample of blood will be taken from the arm if possible.  Your blood pressure will be measured in the arm ideally, but if not it can be measured less accurately in the leg. 

If a reliable blood pressure reading cannot be obtained from your arm or leg there are other ways of assessing your cardiovascular health and estimating whether your blood pressure is too high without taking your blood pressure.  If you are in the UK, your doctor can refer you to the new specialist blood pressure clinic at University College London Hospital or to your local cardiology unit.  This is particularly important for your first assessment. 

UCL Hospital London - Professor Williams. 

Prof Bryan Williams
Prof Bryan Williams
UK citizens who are prepared to travel and whose GP is willing to make a referral should approach one of the foremost experts in blood pressure, Professor Williams at UCL Hospital London.  Prof Williams can provide individuals who have difficulty having their blood pressure taken with a comprehensive assessment. 

Referrals to this clinic are available on the NHS. 

Having an assessment more locally to where you live

If you live outside the UK, your local cardiology unit will still be able to give you an opinion as to whether you need to take blood pressure tablets or a tablet to lower cholesterol.  It will not be as detailed an assessment as by Professor Williams, however.  They will do this by looking at your general health and the health of some of your organs. 

Eye examination can indicate high BP
Eye examination can indicate high BP

Simple tests can be used to look at whether the blood pressure has caused changes to other organs:
  • Eye - looking at the back of the eyes with an ophthalmoscope can reveal changes to the blood vessels of the retina that can indicate high blood pressure.  Taking photographs enables changes to be monitored over time.
  • Kidneys - protein in your urine can be measured to find out if tiny amounts are 'leaking' from your kidneys as this could also suggest high blood pressure.
  • Heart - an echocardiograph (an ultrasound of the heart) can show how your heart is working.

  • Once you have been assessed, you may simply need regular check-ups like other people of your age, or you may need to begin treatment. 

    What sort of treatment am I likely to be prescribed?

    For raised cholesterol, this could be a statin such as atorvastatin or simvastatin. 

    If the blood pressure is thought to be too high, the doctor will usually follow a recommended pathway suggesting which tablets should be started and in which order.  If it is difficult to monitor the blood then a tablet such as amlodipine can be used that does not require any blood tests. 
    Your doctor may also discuss a new medication called the 'polypill' with you.  This is a single tablet, taken once a day, that contains a combination of medications that lower blood pressure and cholesterol.  The polypill is not yet widely available.  However, the idea behind the pill and how it can help is known and your doctor can discuss with you how it may help. 

    Additional Information

  • Medication - Some people affected by Thalidomide and other dysmelic conditions are concerned drugs affect them more than other people.  This is not normally the case.  If you are concerned how medicine for high blood pressure may affect you, talk to your doctor.  You could, for example, agree to start a lower dose of the drug.  This will be better than not taking it at all.

  • Difficulty having blood taken - If it is not easy to have a sample of blood taken, it may make it more difficult to assess your cardiovascular risk or the effect of drugs the doctor may choose to treat you with.  Certain medications do not need regular blood tests so talk to your doctor about this, for example the polypill medications.  We have published separate guidance - Giving Blood More Easily - about having blood taken.  You could print this off and show it to your doctor or other medical practitioner. 

  • Tags: Blood Pressure Hypertension Thalidomide Limb Difference Dysmelia EDRIC DysNet Thalidomide Trust Professor Bryan Williams Article


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