Submit a 7 day blood pressure reading | Appletree Medical Practice

Full Name *

Address *

Date of birth *

Mobile

Landline

Instructions

Check the blood pressure 3 times in the morning and 3 times in the evening.

Only record the lowest reading of the 3 from each testing session.

Use the same arm each time.

Record for 7 days so you should have 14 recorded readings in all (2 per day, morning & evening)

Try to relax and avoid talking whilst using the monitor.

Try to avoid testing within 30 minutes of smoking, eating a large meal, caffeinated coffee, alcohol or vigorous exercise.

Reading 1 – Systolic Reading (Highest number)

Reading 1 – Diastolic Reading (Lowest number)

Reading 2 – Systolic Reading

Reading 2 – Diastolic Reading

Reading 3 – Systolic Reading

Reading 3 – Diastolic Reading

Reading 4 – Systolic Reading

Reading 4 – Diastolic Reading

Reading 5 – Systolic Reading

Reading 5 – Diastolic Reading

Reading 6 – Systolic Reading

Reading 6 – Diastolic Reading

Reading 7 – Systolic Reading

Reading 7- Diastolic Reading

Reading 8 – Systolic Reading

Reading 8 – Diastolic reading

Reading 9 – Systolic Reading

Reading 9 – Diastolic Reading

Reading 10 – Systolic Reading

Reading 10 – Diastolic Reading

Reading 11 – Systolic Reading

Reading 11 – Diastolic Reading

Reading 12 – Systolic Reading

Reading 12 – Diastolic Reading

Reading 13 – Systolic Reading

Reading 13 – Diastolic Reading

Reading 14 – Systolic Reading

Reading 14 – Diastolic Reading

Average Systolic – We always discount the first day’s reading, so to find the average, please add readings 2 to 14 together and divide by 13

Average Diastolic – We always discount the first day’s reading, so to find the average, please add readings 2 to 14 together and divide by 13

Have you previously been diagnosed with hypertension (high blood pressure)? *

YES

Why have you submitted these blood pressure readings? *

My blood pressure was raised in clinic and the doctor/nurse requested I submit.

My medication review is due and I was requested to submit them.

I submitted a blood pressure reading and it was raised, so I was requested to submit more readings.

Other – please write in the comments box below

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