Traditionally, blood pressure tests have been conducted manually: a doctor or nurse would wrap a cuff around your upper arm, pump the cuff full of air, and release the air while listening through a stethoscope and reading the measurement on a gauge. But research over the past several decades has noted many problems with this form of testing:

“Talking with the patient, not allowing periods of rest before the readings, rapid deflation of the cuff and rounding off readings to the nearest zero have resulted in readings that are both inaccurate and inappropriately high,” says Dr. Martin Myers, a cardiologist at Sunnybrook Health Sciences Centre and a leading scientist in hypertension and blood pressure measurement.

Now, a new study published in JAMA Network and led by Myers, confirms manual measurement should be replaced with what’s known as fully automated office blood pressure (AOBP) measurement.

AOBP requires a patient to sit alone for several minutes as a computer records several blood pressure readings. These devices are similar to what you’d use for home monitoring, but are more advanced and have a built-in delay that allows a nurse or physician to initiate readings, and then leave the patient alone before any measurements are taken.

“The common cause of inaccuracy with any blood pressure measurement testing is human interaction or human error,” says Myers, “If we can remove or restrict human interaction with the test, we can improve its accuracy.”

The study also suggests AOBP measurement may effectively be taken in a community pharmacy or in physicians’ waiting rooms, as long as the patient is sitting alone and is not disturbed by medical staff.

When it comes to diagnosing hypertension, Myers says even using blood pressure monitoring devices at home can be better than testing exclusively in a medical office, provided the testing is done properly.

“If you’re at home, take your blood pressure readings twice in the morning and again in the evening for at least four days, and preferably a week,” says Myers. “These readings should be taken at about the same times each day, and not when you think your blood pressure may be particularly high or low.”

Myers adds that after a week of readings, you should take the device to your family doctor who could verify the measurements and give you a proper diagnosis.

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While these certainly may be great ideas, you might want to re-think how you word it, says Dr. Jeremy Rezmovitz, family doctor on Sunnybrook’s Academic Family Health Team.

“It’s not enough to say ‘exercise’,” he says. “We need to reframe this and ask ‘what are my health goals and how can I achieve them?’”

Dr. Rezmovitz says in his practice, he works with his patients to set ‘training goals’.

Training means approaching lifestyle changes in a structured, measurable and goal-oriented way. It makes Dr. Rezmovitz, as he puts it, “a health coach”.

For example, if a patient is found to have high blood pressure, Dr. Rezmovitz doesn’t simply pull out his prescription pad and call it a day.

“We talk about it,” he says. “What are the benefits to lowering your blood pressure? Do you want lower blood pressure? Do you want to do that with or without medication? Would you change your diet in order to achieve that goal?”

Sustained high blood pressure can put patients at risk of heart attack and stroke. Stress, genetics, diet and low physical activity levels can increase your chance of having high blood pressure.

“So, in the case of high blood pressure, I can’t change your genetics, but we can outline some goals that could help you lower it, if that is your goal,” he said. “If you want to make healthy eating choices, don’t buy potato chips the next time you do your grocery shopping. If you want to eat healthier lunches, plan ahead, pack your lunch and skip the drive-through. Align your actions with your goal. ”

Dr. Rezmovitz recommends talking to your primary care doctor or nurse about your goals, be they around your blood pressure, physical activity level or reducing your risk of illness.

“It’s a real shift in the relationship with your care team,” he says. “Rather than just taking about what ails you today, let’s talk about your overall health and your overall values. Is the way you are living your life matching those values?”

So maybe today you are a few pounds heavier than you’d like to be, he says. But instead of making your goal “lose weight” and then losing heart when you step on a scale, reflect on why you want to lose that weight.

“Maybe you want to lose weight so you can live longer, or you can avoid diabetes or you can reduce your risk of stroke,” Dr. Rezmovitz says. “So then instead of making the goal a negative action — like “lose weight” or “stop eating badly” — reframe it into a positive one: what will you do to make a change?”

And that’s where the training approach comes in, he says.

“Let’s reframe it together: I want to live a long life, free of illness. How can I do that?”

(A version of this post appears as a monthly health column in The Leaside Streeter)

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Myth 1: You can never get enough folic acid in pregnancy

“Only women who have added risk factors for neural tube defects will need to take 5mg per day of folic acid in the first trimester,” says Steinberg. Otherwise, most women only need 1mg per day of folic acid. Ideally, all women of childbearing age should be taking folic acid even before they are pregnant.

Myth 2: I should limit my salt intake to prevent high blood pressure

Restricting your salt intake any more than before you became pregnant doesn’t seem to have any impact on your blood pressure. Instead, “focus on getting enough calcium and vitamin D,” says Steinberg. Milk products include both of these, and you should aim to have 3-4 servings every day. Another good source of calcium is your prenatal multivitamin.

Myth 3: Honey is a good substitute for sugar

If you are looking to cut down the amount of sugar you eat, honey is not a good substitute, especially during pregnancy. “Honey has just as much sugar in it as sugar. Plus, honey is not always pasteurized, and pregnant women should avoid eating unpasteurized foods,” says Steinberg. Instead, use an artificial sweetener. Always be sure to check the label though, as not all sweeteners are safe for consumption during pregnancy. The Canadian Diabetes Association has a comprehensive list of sweeteners.

Myth 4: I’m eating for two

It turns out this old saying is, well, outdated. “You should be eating twice as healthy, not twice as much,” says Steinberg. Too much weight gain can lead to a big baby, and a vaginal delivery can cause trauma (like shoulder fractures and nerve damage) to a big baby.

Myth 5: I shouldn’t eat any fish

Not all fish is bad in pregnancy- in fact, it’s a great source of protein and omega-3’s. “The fish you want to avoid is raw or undercooked fish, like sushi, and fish that is high in mercury,” Steinberg says. Types of fish that are high in mercury (and therefore should be avoided) include:

• Fresh/frozen tuna
• Shark
• Swordfish
• Marlin
• Orange roughy
• Escolar
• King mackerel
• Tilefish

Additionally, you should limit your intake of albacore “white” tuna to no more than 300 grams (6 ounces) per week.

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