If you have been advised by the surgery to submit your blood pressure readings on a regular basis, please use this diary form.
Please monitor and record your blood pressure at home for seven consecutive days (unless you have been advised otherwise).
Use the form to record all of your blood pressure readings. The numbers you input should be the same as those that appear on the blood pressure monitor screen – do not round the numbers up or down. Each time take a minimum of two readings, leaving at least a minute between each. If the first two readings are very different, take two or three further readings.
In the notes section, you should also write down anything that could have affected your readings, such as feeling unwell or changes to your medication. Please also record your pulse/heart rate.
Instructions for taking blood pressure:
- on each day monitor your blood pressure on two occasions:
morning between 6am and 12 noon
evening between 6pm and midnight
- before you start, ensure at least 30 minutes have passed without drinking caffeine or smoking
- sit with your arm supported on a table or at heart level. Keep your legs uncrossed; stay relaxed
- check cuff placement is correct
- rest for one minute, then check blood pressure
- repeat the process twice more and enter the lowest reading
- write down the results, then complete and submit your form after seven days. You can email the completed form to email@example.com or drop it into the surgery.