Sample blood pressure record for your doctor to download

Hypertension is a disease characterized by high blood pressure. And this disease is increasing rapidly in every country in the world. The number of adults suffering from hypertension has increased from 594 million in 1975 to 1.13 billion in 2015.

To prevent blood pressure peaks and to be able to adjust treatment, it is recommended that patients acquire a blood pressure device, take measurements at home and thus avoid the white coat syndrome.

White coat hypertension (WHT) is defined by a discrepancy between the blood pressure measured by the doctor in his office and an ambulatory measurement for the same patient. This white coat phenomenon is common enough to encourage patients to take their blood pressure regularly at home.

Blood pressure recording template in Word and Excel
Download and print a blood pressure record with Word or Excel

Below is a sample blood pressure reading for a 3-day follow-up:

  • Diastolic pressure is the low value displayed on the blood pressure monitor and corresponds to the measurement of blood pressure between two cardiac contractions (diastole),
  • The systolic pressure is the high value displayed on the monitor and corresponds to blood pressure measurement during cardiac contraction (systole).

Self-measurement of blood pressure  to free download

Your personal information:

  • First and last name: <To fill in>,
  • Date of birth: < To fill in>,
  • Current treatments: < To fill in>.

Rules for taking blood pressure measurements:

  • Three consecutive measurements (a few minutes apart in the morning before breakfast),
  • Three successive measurements (a few minutes apart in the morning between dinner and bedtime),
  • Three days in a row,
  • How to measure blood pressure: sitting, after 5 minutes of rest,
  • Write down all the numbers that appear on the screen.

Day 1: <To fill in>

Morning Evening
Systolic Diastolic Pulse Systolic Diastolic Pulse
Measure 1
Measure 2
Measure 3

Day 2: <To fill in>

Morning Evening
Systolic Diastolic Pulse Systolic Diastolic Pulse
Measure 1
Measure 2
Measure 3

Day 3: <To fill in>

Morning Evening
Systolic Diastolic Pulse Systolic Diastolic Pulse
Measure 1
Measure 2
Measure 3
Average Systolic (1) Average diastolic (1) Auto tensiometer
Brand: Model: Wrist / arm (2)

Required: show this document to the pharmacist when you come to the pharmacy and to the doctor at the next consultation.

  • (1): Add all the measurements and divide by 18,
  • (2): Cross out the unnecessary measurements.

To use and customize this sample blood pressure report, “Copy & Paste” the text from this article into your word processor (Microsoft Word or Open Office Writer). You can also download and print the free statement templates in PDF, Word, and Excel format (with the calculation of averages) here:

Pascal

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