Blood Pressure Review

If you have been advised by the surgery to submit your blood pressure readings on a regular basis please use this form.

Patient Instructions: 1. In the morning, ensure that you are rested and have taken no exercise in the last 30 minutes. 2. Then sit in a chair comfortably upright with your arm supported on a table beside you, with both feet on the ground. 3. Put the cuff on your upper arm (5cm above your elbow) resting on the table, the cuff should be roughly at the level of your heart. 4. Press the on/start button on the BP monitor and take two readings at least 1 minute apart. 5. Record the readings below with your pulse rate and any comments. 6. Repeat that evening & for a total of 7 days using alternate arms. Then return this diary (& BP monitor if borrowed) to the surgery.

YOUR DETAILS

Name
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Smoking Status

YOUR BLOODS PRESSURE RESULTS

Please provide a minimum of one blood pressure reading, up to a maximum of seven.

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Morning Measurement

Evening Measurement

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Morning Measurement

Evening Measurement

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Morning Measurement

Evening Measurement

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Morning Measurement

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Morning Measurement

Evening Measurement

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Morning Measurement

Evening Measurement

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Morning Measurement

Evening Measurement

Average Blood Pressure

This is automatically calculated for internal use only.

Morning Measurement

Evening Measurement