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When to measure resting heart rate and blood pressure for following day-to-day trend?


I'd like monitor my resting heart rate and blood pressure to see how they are affected by regular cardiovascular training and other events in life.

When should I take the measurements in order to reduce day-to-day variations? In the morning or evening? Before or after eating? Right after waking up?

Of course I'll make sure to follow good routines when measuring, but the ones I've found prescribed by hospitals don't state an appropriate time of the day.


I would be very surprised if the time of day made a difference. I've personally never heard mention of such a phenomenon in discussions with intensive care practitioners (where of course HR and BP are measured constantly). However this is only the case during rest, this paper (on horses) suggests that there is some difference in HR and BP after exercise depending on time of day.

You are right to attempt to control it however, I suppose. It doesn't matter when you take your measurements, as long as you take them at the same time each day.

I would say that one of your first suggestions of taking the measurements almost immediately after waking. Of course you would have to be relaxed as you assembled your equipment then rest for a few minutes in the posture you have chosen (this will matter) before taking the measurements but otherwise I can't see you having too great a problem.


It kind of depends. If you want to compare apples to apples, check it first thing in the morning. However, that's going to be at the lowest point. It's also important to know what your blood pressure is during the day, when you're living your normal daily life. I recommend checking fairly regularly in the morning so you'll know what your true baseline is and whether it's trending up or down, and to "spot-check" occasionally at different times of the day to see how your body is handling the normal daily stress


Actually in my research into circadian events, the hourly differences in blood pressure was the first thing that I found. Based on this, I'd state that there are hourly differences in blood pressure and cardiovascular efficiency.

Because these changes are circadian, measuring these values at the same time every day (ex: 1 hour after wake up time or 1 hour before bedtime) would reduce variation. Just be aware of your caffeine intake - it may skew the measurements.

I do not have access to the scholarly library that I used then, so the chances of finding the article are slim to none.


Five of the best health monitoring devices

Y ou can record your heart rate manually by holding your wrist and counting your pulse, but this hasn’t stopped technology companies producing devices to do the job with electronics. Most of these devices collect heart data all day long and record it on a smartphone app which builds up a richer set of data than you might get with a stopwatch and pencil. One of the most useful metrics they collect is your RHR (resting heart rate) a reading taken when you are relaxed, most typically first thing in the morning. In most cases a low RHR indicates a strong, healthy heart which has to beat fewer times to circulate blood around the body. However in older people a low RHR might indicate diseased heart muscle or overmedication. Some day-to-day variation in your RHR (or indeed in many of the metrics these devices measure) isn’t something to be worried about, explains Dr Satpal Arri of the British Heart Foundation Centre of Research Excellence, King’s College London, “A certain amount of variability is normal, healthy in fact – as you get older variability tends to decrease.” So by all means listen to your heart, but don’t become obsessed.


Introduction

Measuring an individual’s heart rate is a routine part of a clinical examination. Reference ranges for what is considered a “normal” heart rate have been established based on single determinations in artificial settings, such as the US National Health and Nutrition Examination Survey [1]. These population ranges are rarely a helpful measure of individual health, as heart rates that fall within the normal range have been associated with increased risks of mortality and morbidity [2–4]. While a high value of resting heart rate (RHR) is in general associated with increased cardiovascular risk in both general populations [5–7] and in those with cardiovascular comorbidities [8–11], one study has shown a low RHR (<65 bpm) to be associated with higher cardiovascular risk [12]. In this same study, a significant change in RHR at 3 years of follow-up was associated with a higher risk of cardiovascular disease. Thus, a single measurement of heart rate provides very little useful information about the current health of an individual, unless well out of the expected range of normal. Longitudinal, individual data may be of more value, as several studies of changes in discrete heart rate measurements over long periods of time have found an association with cardiovascular outcomes [13–16]. A long view of individual changes in cardiac performance may provide useful information to help refine existing phenotypes of health and illness and, when combined with other standard or enhanced clinical tests, might detect diseases at their earliest stages [17–19].

Today, through the integration of photoplethysmography (PPG) sensors into a range of commercial wearable sensors, heart rate can be measured continuously over the lifespan. Their accuracy at present is similar to that of standard electrocardiography (ECG) monitoring, especially at rest [20–22]. The ubiquity of these sensors enables a unique opportunity to better understand how RHR varies over time for and between individuals over the span of days, weeks, years, and eventually, lifetimes.

Only with such understanding can we begin to explore the myriad of environmental insults or physiologic changes that can impact heart rate. Unlike moment-to-moment changes in heart rate, an individual’s RHR, when measured daily in a consistent setting, might provide a measure of an individual’s overall cardiovascular physiologic status. Changes over weeks to months might indicate changes in cardiovascular fitness [23], but changes over days might reflect infection or other significant physiologic triggers.

In the present study, we retrospectively explore the largest dataset of longitudinal daily RHR available, including over 92,000 individuals who routinely used a wearable activity and heart-rate monitoring device over at least 35 weeks, for at least 2 days per week, and at least 20 hours per day. This dataset accounts for almost 33 million person-days of data for examining inter- and intraindividual variations in RHR. We analysed the association of the individual mean RHR, as well as RHR variability, with age, body-mass index (BMI), and average time asleep. We also explored the range in day-to-day RHR variability between individuals, and the long- and short-term changes in the trajectory of an individual’s daily RHR.


Increase in resting heart rate is a signal worth watching

When you sit quietly, your heart slips into the slower, steady pace known as your resting heart rate. An increase in your resting heart rate over time may be a signal of heart trouble ahead.

Your heart rate changes from minute to minute. It depends on whether you are standing up or lying down, moving around or sitting still, stressed or relaxed. Your resting heart rate, though, tends to be stable from day to day. The usual range for resting heart rate is anywhere between 60 and 90 beats per minute. Above 90 is considered high.

Many factors influence your resting heart rate. Genes play a role. Aging tends to speed it up. Regular exercise tends to slow your heart rate down. (In his prime, champion cyclist Miguel Indurain had a resting heart rate of just 28 beats per minute.) Stress, medications, and medical conditions also influence your resting heart rate.

Results of observational research studies support a link between health and heart rate. Researchers from Norway previously reported the results of a large study looking at changes in resting heart rate over 10 years. They recruited more than 29,000 people without any history or heart disease, high blood pressure, or any other type of cardiovascular disorder, and measured their resting heart rates when they started the study and again 10 years later. This study was published in the Journal of the American Medical Association.

Compared to people whose resting heart rates were under 70 beats per minute at the study&rsquos start and its end, those whose resting heart rate rose from under 70 to more than 85 were 90% more likely to have died during the course of the study. The increase in risk was slightly less for those with resting heart rates of 70 to 85 at the study&rsquos start and who had a greater than 85 at the study&rsquos end.

Although 90% sounds like a huge and scary increase, let me put it in perspective. Among the group whose heart rates stayed under 70 throughout the study, there were 8.2 deaths per 10,000 people per year. Among those whose heart rates rose above 85, there were 17.2 deaths per 10,000 people per year.

The results also suggested that lowering your resting heart rate over time may be beneficial, but the researchers could not say that for certain.

How to lower your resting heart rate

You don&rsquot need a doctor&rsquos visit to keep track of your resting heart rate. The best time to measure it is before you get out of bed in the morning. You can measure your heart rate at your wrist or neck by placing one or two fingers over a pulse point, counting the number of beats in 15 seconds, and multiplying by four.

By doing these 4 things you can start to lower your resting heart rate and also help maintain a healthy heart:


Resting Heart Rate During the Night

Nightly average RHR varies widely between individuals. A normal heart rate can range anywhere from 40 to 100 beats per minute (BPM) and still be considered average. It can also change from day to day, depending on your hydration level, elevation, physical activity, and body temperature. As with many of your body’s signals, it’s best to compare your RHR with your own baseline. Avoid comparisons to those around you.

When looking at your RHR curve, pay special attention to these three things:

  • Your trend: Does your RHR go up, down, or stay level during the night?
  • Your lowest point: When is your RHR lowest?
  • Your end: Right before you wake up, does your RHR change?

With these questions in mind, here are three patterns you may recognize in the night-time heart rate curves you can see with Oura:

The Hammock: Relaxed in Bed and Ready to Rise

The hammock curve shows an ideal heart rate journey. During your initial sleep stages, your body relaxes and your blood pressure and heart rate begin to drop.

In this scenario, your lowest RHR occurs near the midpoint of your sleep, when the amount of melatonin present reaches a peak. If you are perfectly in sync with the sun’s patterns, your body temperature drops to its lowest level around 4 a.m.

Your RHR may momentarily rise during REM sleep. This is normal and you can ignore these temporary spikes when looking for the hammock curve during your sleep.

As you wake in the morning, your heart rate begins to rise. The hammock curve is a sign that your body was relaxed during the night and is ready to rise after a quality night’s sleep.

The Downward Slope: Your Metabolism Working Overtime

The Downward Slope is a sign that your metabolism is working overtime. Did you have a late meal, a late workout, or a glass of wine before bed? If your RHR starts high and reaches its lowest point right before you wake up, you may start the day feeling groggy.

If you regularly see this downward slope, it may be wise to stop and reassess your evening routine. For example, if you normally work out late at night, exercising 1–2 hours earlier can result in positive changes.

The Hill: Too Exhausted for Bed

If your RHR increases right after you fall asleep, this could be a sign of exhaustion. Did you go to sleep on time? If it’s past your regular bedtime, you may start feeling the effects of increased melatonin–a hormone that aids sleep–and lower blood pressure. This communication from your body serves as a warning of sorts, reminding you to get to bed on time.

If you did go to sleep during your ideal bedtime window, it’s possible that your heart rate may be increasing at the start of the night for reasons you can’t control. For instance, your airways may have relaxed during sleep, causing you to snore, which raises your heart rate.


What It Means If You Have Low Blood Pressure But a High Heart Rate

You may be ecstatic that you finally got your blood pressure lowered, only to notice your heart seems to be racing — ALL THE TIME. So what gives when you successfully hit the magic number of <120/<80 mm, but your heart rate remains high?

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Heart rhythm specialist Tyler Taigen, MD, says sometimes this is normal and sometimes it’s not.

When is this combo not a big deal?

Sometimes blood pressure and high heart rate occurs momentarily. For example, Dr. Taigen explains, when we stand up:

  1. Blood pools in the veins of our legs and gut.
  2. Less blood travels to the heart muscle, so there isn’t much for the heart to pump out.
  3. The nervous system automatically increases the heart rate to get the blood pumping.
  4. Meanwhile, the blood pressure drops a bit because the force of blood moving through the veins is lower.

However, that phenomenon is short-lived. When the heart rate stays consistently high while blood pressure is low, there may be something problematic going on.

What else can cause an elevated heart rhythm along with low blood pressure?

When the heart’s electrical circuits aren’t properly functioning, the result can be a high heart rate coupled with low blood pressure, Dr. Taigen explains.

“When the heart has a fast, abnormal rhythm — anything over 100, but closer to 160 beats per minute — it can’t adequately fill with blood. The chaotic electrical signaling causes the heart muscles to be out of sync between the top and bottom chambers,” he says. “Less efficiency in the heart means less blood is pumping through the body — which means low blood pressure.”

You may have an abnormally fast heart rhythm when…

You may not know your heart rhythm is pacing more like a rabbit than a tortoise. But all that racing and ineffective blood pumping result in oxygen-deprived organs and tissues. It’s worth a trip to the doctor when you:

  • Are short of breath.
  • Feel lightheaded.
  • Experience a racing heart.
  • Have chest pain.
  • Faint.
  • Generally feel lousy.

Be still, my heart: How a heart rhythm specialist can help

When this happens, electrophysiologists first try and slow the heart rate using medicines, Dr. Taigen says. “But these medicines, known as beta-blockers or calcium channel blockers, can also drop the blood pressure,” he notes. “Quite often, there’s not much room for blood pressure to go lower.”

If your blood pressure is too low for medications, a procedure called direct current cardioversion can get the rhythm back to normal.

“With this procedure, we put pads on the front and back of the chest and sedate the patient for a minute or two,” Dr. Taigen explains. “When they are asleep, we deliver a shock that stops the heart from beating irregularly, so the natural heartbeat resumes.”

Once the heart rhythm is back to normal, an electrophysiologist determines if a more permanent treatment is needed. These could include:

  • Ablation: This procedure uses cold or heat energy to stop faulty electrical signals.
  • Pacemaker: Doctors place a small device under the skin to send electrical impulses that change the heart rhythm.
  • Implantable cardioverter defibrillator (ICD): Like a pacemaker, the ICD works by detecting and stopping faulty heart rhythms with electrical signals.
  • Surgery: Surgeons create scar tissue with incisions to permanently interrupt faulty electrical pathways in the heart.

Does this really matter if you’ve finally got low blood pressure?

Heart rhythm problems that affect the upper heart chamber (atrium) can put you at an increased risk for stroke, heart failure or death. Here’s why:

  1. The disorganized electric firing in the top chamber of your heart causes it to quiver.
  2. The blood swishes back and forth in a pouch off to the side of the atrium (called the left atrial appendage).
  3. People who are older, have heart disease or diabetes may be prone to the blood clotting in that left atrial appendage.
  4. If the clot breaks free, the heart can pump it to the brain and block blood flow to brain tissue — which is how a stroke happens.

If you’re diagnosed with an irregular heart rhythm, you may need to take blood-thinning medications, plus one of the treatments above, to decrease your risk of stroke. Your doctor can help you get the right care to keep everything steady and stable — so the only time your heart is racing is while you’re watching “Stranger Things.”

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy


6 Things Your Resting Heart Rate Can Tell You

You’re Not Active Enough
A normal resting heart rate for the average adult is 60 to 100 beats per minute (bpm) or 40 to 60 bpm for highly conditioned athletes. If you’re sedentary most of the day, your RHR likely approaches or exceeds the top end of this range. This may be because your heart is less efficient. The good news? By regularly engaging in moderate to vigorous aerobic activities (brisk walking, biking, swimming), you will help your heart become more efficient at pumping blood, plus you might shed a few pounds, all of which will lower your resting heart rate over time. Even modest reductions in resting heart rate can dramatically reduce your risk of cardiovascular disease and add years to your life !

You’re Overtraining
While pushing your body can lead to great gains, it can also be detrimental . If you notice an increase in your resting heart rate when you’re going heavy on the training and light on the rest, your body may be telling you that you need to scale back. By giving it the proper rest it needs, your body can repair and adapt and you may bounce back stronger than ever.

You’re Too Stressed
Prolonged mental and emotional stress can also cause your resting heart rate to creep up over time. If “fight-or-flight” mode becomes your norm, the associated increase in your resting heart rate can produce a higher risk of heart attacks , strokes, and much more. Try adding relaxation into your day—read, meditate, go for a walk with friends, or do a guided breathing session on your Fitbit Charge 2 or Fitbit Blaze . Regular relaxation activities may help you combat your stress and which could lead to a lower resting heart rate.

You’re Sleep Deprived
Always exhausted? Chronic sleep deprivation—which can lead to fatigue, a lower metabolism, and extra snacking—can also raise your resting heart rate . Aim for at least 7 hours of sleep each night.

You’re Dehydrated
During a hot summer day, if you notice a temporary increase in your resting heart rate, your body might simply be trying to cool down. However, it could also mean you’re dehydrated —especially if you’re thirstier than usual, your mouth is dry, and your pee is more yellow than normal. To help lower your resting heart rate, drink more water .

You’re Developing a Medical Condition
If you experience shortness of breath, unusual fatigue, dizziness, excessive thirst/urination and your resting heart rate has increased, you might be at risk for cardiovascular disease , hyperthyroidism , or type-2 diabetes . However, a low resting heart rate isn’t always ideal either. When combined with symptoms (like those above), it could indicate an issue with the electrical system of your heart. If you’re concerned, discuss these changes with your doctor.


Takeaway

These 8 common mistakes can be boiled down to 2 basic concepts: Accuracy and Context. In reverse order, here are one line summaries of what to do to avoid making these mistakes.

  1. Use accurate hardware.
  2. Determine if paced breathing is right for your situation.
  3. Track a few other subjective and/or objective metrics alongside HRV dependent on your goals.
  4. Measure 5+ days per week.
  5. Measure in the same position at the same time of day (or understand the effects of these differences).
  6. Measure more than once before making any conclusions (5+ is best).
  7. High HRV can be good or bad – context helps.
  8. Low HRV can be good or bad – context helps.

If you stick to these basic rules you will likely have very useful, reliable, and actionable Heart Rate Variability data for decision making.

Go deeper with the science and application of HRV. Get access to the “Foundations of Heart Rate Variability” course today!


The time that it takes for your heart and your breathing to slow back down to their resting rates is known as the recovery period. Its length can vary among individuals, and you may have a slower recovery time compared to someone else. People who are trained athletes or who exercise consistently have faster recovery times than those who live sedentary lifestyles and who occasionally work out.

Following your exercise routine, a cool-down period is important to slowly bring your heart rate and breathing patterns back to normal. After working out, allow yourself at least five minutes to cool down, which includes slowly decreasing the intensity of your workout until you are ready to stop. You can follow this with stretches and range of motion exercises.

Avoid stopping exercise completely until you have had sufficient time to cool down. The dramatic decrease in muscle activity can cause your blood pressure to drop, resulting in dizziness or lightheadedness. Dehydration following exercise may also cause lightheadedness.

Contact your doctor if you experience chest pain, shortness of breath or dizziness persists or occurs after a workout that does not normally cause any symptoms.


Go out for some vigorous exercise. A bike ride, jog or using an elliptical machine at the gym will suffice. Get your heart rate up to about 60 to 80 percent of your maximum heart rate, which you can estimate by subtracting your age from 220.

Once you've reached that level, stop and immediately take your pulse using your index and middle finger on the carotid artery in your neck or the radial artery on the inside of your wrist. Using a stopwatch, count the number of beats in 20 seconds, then multiply by three. Make note of that number.

Remain still, either seated or standing, and take your pulse again 60 seconds later. You don't need this number to determine heart rate recovery, but it is important to know for purposes of assessing markers of physical fitness.

At 2 minutes, take your pulse again. Subtract this number from your peak heart rate during exercise to find your recovery heart rate.


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