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Blood pressure review

Blood Pressure Diary and Review
Have you been asked by the practice to complete this online review? *
Who has requested your blood pressure readings? *

eg. 1.75
eg. 60.6

Smoking

Smoking status *
How many cigarettes did you smoke in a day?
How many cigarettes do you smoke in a day?
Would you like to arrange an appointment for smoking cessation?

Alcohol Consumption

This is one unit of alcohol:

Amount of different types of drink representing one unit of alcohol

And each one of these, is more than one unit:

Amount of different types of drink representing more than one unit of alcoholAmount of different types of drink representing more than one unit of alcohol

Blood Pressure

Patient Instructions

  • In the morning, ensure that you are rested and have taken no exercise in the last 30 minutes.
  • Then sit in a chair comfortably upright with your arm supported on a table beside you, with both feet on the ground.
  • 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.
  • Press the on/start button on the BP monitor and take two readings at least 1 minute apart.
  • Record the readings below with your pulse rate and any comments.
  • Repeat that evening & for a total of 7 days using alternate arms.

For a list of validated home blood pressure monitors, visit www.bihsoc.org/bp-monitors or discuss with your pharmacy.

Day 1

Please use this date format: DD/MM/YYYY.
Morning Measurements
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Evening Measurements
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Day 2

Please use this date format: DD/MM/YYYY.
Morning Measurements
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Evening Measurements
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Day 3

Please use this date format: DD/MM/YYYY.
Morning Measurements
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Evening Measurements
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Day 4

Please use this date format: DD/MM/YYYY.
Morning Measurements
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Evening Measurements
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Day 5

Please use this date format: DD/MM/YYYY.
Morning Measurements
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Evening Measurements
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Day 6

Please use this date format: DD/MM/YYYY.
Morning Measurements
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Evening Measurements
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Day 7

Please use this date format: DD/MM/YYYY.
Morning Measurements
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Evening Measurements
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Average Blood Pressure

This is automatically calculated for internal use only. Average does not include day 1.

Morning Measurements

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Evening Measurements
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