Tuesday, 26 July 2011

Around the Clock Doc

On the bus this week there was a poster advertising "around the clock" access to an NHS GP to the residents of Lambeth & Southwark. We are lucky in the UK that we can have access to health services at any time of day or night, which is great for when emergencies arise.

Free access to emergency healthcare information: NHS bus advert to patients in Lambeth & Southwark
However, are GPs making full use of the "time-of-day" information in their diagnosis of disorders?

Last Summer I went on a fascinating Chronobiology course in Germany where we studied how the time of day can affect biology.

One of the parts of the course involved wearing a portable blood pressure monitor that monitored my blood pressure every hour over the course of a day and night. It was a bit annoying having this contraption on my arm, but I did manage to stay focused in the lectures and get some sleep at night time whilst wearing it.

The results were really interesting. There was a clear daily rhythm in my blood pressure, dipping low at night and rising again during the day.

I was also classified as a "white-coat hypertensive", i.e. I had high blood pressure at the start and finish of the recording, when I knew someone was monitoring it. So I know in future to be careful not to be mis-diagnosed as hypertensive at the doctors.

It is normal for your blood pressure to dip at night, whether or not you are sleeping at the time. But some cardiovascular problems cause your blood pressure to remain high at night, in this case, it's better to take your blood pressure medication before going to bed. However, if your blood pressure does still drop at night normally, then it's better to take this medication in the morning, when the blood pressure will be rising.

Your circadian profile of blood pressure can help a doctor diagnose any problems, and indicate which treatment is best for you
There was one case our lecturers were relating to us about a person who was feeling really ill. When they monitored his circadian blood pressure profile they could see his blood pressure dipped dangerously low at night, and the medication he was taking just before bed was making it dip even lower.

Portable blood pressure monitors are expensive but the results can really help with diagnosis of cardiovascular problems. Blood pressure is a clear example of how our body changes over the course of 24 hours, and how by monitoring and understanding this condition we can improve our health services.

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