BP monitoring in cats - your knowledge

FeebysOwner

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Feeby had her 3rd-ever BP test today - but her first with a Doppler. The previous two were done with what I believe was High Definition Oscillometric (HDO). They were done 1 - 1 1/2 years ago, with each testing done 3 times. They came out averaging on the normal high side around 150-160. Today, they only did one reading that came out very, very high - 230. The vet's office said it was as an accurate reading as they could possibly get - despite that they did not do additional reads. During this session, after shaving her for the Doppler, a vet tech held her down while two different vet techs had to try to get a reading.

I understand the reasoning for BP tests, and Feeby more than qualifies for them (hyperthyroidism and CKD). So, I am NOT asking why the test was done, but rather what you all know about the testing and the most reliable readings based on different testing protocols.

What do you know about BP checks on cats, what procedure was done, and how many 'checks' did they do to determine a reliable reading? Thanks!
 

silent meowlook

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Hi. A Doppler blood pressure reading on a cat is the most accurate bp you can get. But, it is subjective and the staff needs special training in order to preform it with accurate results. The size of the cuff should be 40% of the leg being measured. The leg being used, where the probe is needs to be level with the heart. You must use earphones or the cat will react, elevating the blood pressure, because of the sound. Once a reading is done, the first result is not logged. You get at least 5 readings, and average it out. You will only be able to get a systolic measurement. The cuff, when inflated, should only be inflated enough to occlude the vein, and then a reading is obtained by releasing the pressure very slowly until you hear the first beat of the pulse. This must be done very slowly.

I have checked my cats blood pressure at work and it was high. Borrowed the Doppler and it was normal at home.

You can buy the dopplers online, but you need to also get a cuff and the nanometer, thing that blows up the cuff. Also need the flat infant probe.

I have posted a link below to a write up for vets and techs from a well respected known feline medicine and care site.

I do note that they use different dopplers than I have and since this article is newer, I would assume those are good to use but I have no personal experience with https://icatcare.org/app/uploads/2020/05/ISFM-BP-recommendations.pdf
 
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FeebysOwner

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I pretty much read online what you offered as the basics of the overall procedure. There are several 'recommendations' made that were not followed during Feeby's procedure, hence the reason I was asking here what others have personally experienced.

I also did not find, when researching this topic, that one method (Doppler vs HDO) was considered more reliable given the improved HDO machines. And it almost seems that the HDO might be more reliable if the individual using the Doppler isn't proficient at it.
 

Antonio65

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My experiences with BP readings were when my Lola had to be checked frequently when she got blind due to a retina detachment. The ophthalmologist said it was caused by a BP spike, so we checked her a few times at different practices or clinics, and they used different methods and devices.
The one I think was the most accurate was the one that looks like the one in the link that S silent meowlook posted. I remember that they would do 3 readings at least, and then average them.

Other devices, like the one with a microphone on the vein and a loudspeaker or headset to hear the pulse, always proved to be rather unreliable, and difficult to use, even by a trained person.

I've always been interested in buying one machine for using it at home, where cats are more at ease, rather than at a clinic, where they arrive stressed out because of the trip, the waiting in a room with so many stranger people and noises, and the poking and handling by the vets. All these factors can't do anything else than raising the BP.
There are some devices that look great and reliable, that sell for a couple of hundreds.
 

silent meowlook

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I know when I worked at the cat hospital, if we were going to need to do a blood pressure, it would be on my schedule. I would get the cat with the owner immediately in the room upon arrival and get my reading then. I was always able to get a reading with the owner holding and just myself. I used the old parks doppler 811 with headphones and didn't have problems. I also didn't shave. I have taken courses and training to use it, which is definitely needed. So I can see where it would be hard for people who didn't know.
 
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FeebysOwner

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I know when I worked at the cat hospital, if we were going to need to do a blood pressure, it would be on my schedule. I would get the cat with the owner immediately in the room upon arrival and get my reading then. I was always able to get a reading with the owner holding and just myself. I used the old parks doppler 811 with headphones and didn't have problems. I also didn't shave. I have taken courses and training to use it, which is definitely needed. So I can see where it would be hard for people who didn't know.
I know that everyone does the BP readings differently, but the 'recommendations' include giving a cat time to acclimate to the room first.
I am sure the techs at my vet's office have been trained, but unless they are doing multiple readings per day, I think it would still be somewhat difficult for it to become 'second nature'. I haven't looked up what 'newer' doppler machines look like, but the one used at my vet's office sure looks like the one you mentioned above - maybe they all look like that, I don't know. Will be looking at more of them today just out of curiosity. Of course, they did not use headphones.

So, when you did readings, how many did you do, and how far apart did you space them out? The techs at my vet's office purportedly did 3 readings, although it seemed to me there was only one done 'successfully', with the second tech. If there were 3 readings, which I highly doubt, they would have had to be done back-to-back with no break in between readings.
 

silent meowlook

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Hi. So, I would personally vary what I did for each cat. If I am taking a reading, I start out with one reading. When done, say “ok” wait a couple of seconds and take another. If the second reading is lower than the first, I take another. If there is a downward trend, I am going to assume it is due to excitement. So I disregard the first 3 readings and take, then 4 or 5 readings and average it out.

I know it’s confusing. I am trying to get the most accurate reading. Some cats are afraid of the cuff compressing on their leg and need to adjust. Some cats only tolerate a couple of readings.

If you are wondering how many readings they took, if they took 3 you would have heard the pulse sound then quiet, then heard it again.

It is irresponsible to not use head phones. They are cheap and the sound frightens cats.

I will say that I didn’t ever see the BP go over 180 in a stressed cat. So a reading higher, should be considered high. Medication should be started and the Bo rechecked in a couple of weeks.

This is where I am torn as to the right thing to do. Veterinary visits stress cats no matter what. Stress is damaging to cats like it is to us. Fortunately, I am not a veterinarian so I don’t have any say in the matter.

Might be a good idea to pick up one of the newer models of blood pressure monitors for cats. I wouldn’t recommend the parks 811 model for home use, as it is a dinosaur piece of equipment that has been used since the 1950’s, and is difficult to master.
 
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FeebysOwner

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According to the notes taken by the techs, Feeby had 3 readings, 240 followed by 230 twice. I still doubt the multiple readings, but I can't verify that one way or the other as there seemed to be a lot of 'adjusting' the doppler probe on her leg, along with a lot of leaning down to hear the doppler machine. And only one time did either tech mentions a number - that being 230. When I stated that was high, they merely said 'yep'. The only thing I heard is the static coming from the doppler machine as they are trying to adjust it to hear the pulse sound. I swear I only once heard the pulse sound, and it went away very quickly - before the cuff was expanded.

So, all in all, I do think she has high blood pressure - even if only one reading was really done. But, the amount of med is determined by the level of the BP, so if she is checked again and is closer to 200 or less, I presume her dosage will be different than for a 230 reading - could be wrong, but the vet did agree that the reading will determine dosage. This is on top of having a 165 reading just 6 months ago. I am not saying that her increase is unprecedented because I don't know that, but her kidney/thyroid related numbers stayed pretty much within the same ballpark, so it shocked me that her BP would have elevated so much so quickly.

I asked the vet about me buying a BP package for home, and she thought it was fairly purposeless to do so. Of course, she said she is not telling me not to buy one if I want it. I did notice that there are digital doppler machines that appear to be easier to use than the one they had but could be wrong about that too.
 
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silent meowlook

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So, I think it is a good idea for you to try to monitor the blood pressure at home. I have always been of the belief that the more done at the comfort of home for cats the better. I think there are better options out there than the dinosaur that I like. The other ones may not be as accurate, but I think it would still allow you to see trends in blood pressure on that machine.

Here is a link to more information that you may not have seen already. I hope this helps.
 
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FeebysOwner

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So, I think it is a good idea for you to try to monitor the blood pressure at home. I have always been of the belief that the more done at the comfort of home for cats the better. I think there are better options out there than the dinosaur that I like. The other ones may not be as accurate, but I think it would still allow you to see trends in blood pressure on that machine. Here is a link to more information that you may not have seen already. I hope this helps.
Yeah, I have that link bookmarked already. I don't think I want to chance it at this point to get a monitor before she gets treated. So, I am leaning toward making her suffer again with this follow-up BP check, get her on meds, and then have another suffer session to recheck her BP with them the following week. Once that is done, maybe I will get a BP monitor on my own for her beyond that. I don't know yet what I will do - at this point, I think my BP is high (although, I do have a home monitor for humans, but I am not checking mine now)!
 
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FeebysOwner

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So....

Went in this morning for a BP re-check with what is supposed to be a very experienced vet tech. They tried her tail first and could not get a heartbeat with the doppler probe, so then they tried the same hind leg that was used last week. They finally got a good heartbeat on the doppler probe/machine, but when inflating the cuff, they went clear up to the maximum (300) and never got a stop in the heartbeat. They are telling me that her BP was so high it was off the charts. Is that even possible??? Or is it more likely they had the cuff too tight? I didn't even think to ask that until thinking it through hours later.

Feeby was pretty much a champ through the whole 1/2-hour ordeal, hardly squirmed at all and if she did, they stopped. I could tell her heart rate was a bit higher than normal, but otherwise she appeared to just consider the whole thing a nuisance.

The vet was consulted and wants Feeby on double the usual starting dose (1.25 mg vs. 0.625 mg). I won't be able to consult with her about the dose until Thursday. I have also reached out to my sister who is a nurse to ask her about variations on BP reading issues - have not heard back from her yet.

I have two questions - 1.) is it possible to have a BP so high it cannot be registered without the cat being in a worse state than Feeby, and 2.) despite all of this, wouldn't it still be better to start her on the lowest dose possible and re-check in 7 days (which the vet wants one way or the other)?
 

silent meowlook

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Is Feeby currently on any blood pressure medication?

When they did this was the leg at the level of the heart?

When they got the doppler to work, by adjusting the probe, was it a loud bounding kind of sound?

Check Feeby's gums. When you press them with your finger until they blanch white, then take your finger off of her gum and count how long it takes to go back to pink. Is it under a second or more like a second and a half? You don't have to use a watch, just count one, one thousand.

The highest blood pressure I have seen in a cat was when I worked in internal medicine. The cat was obese, very well cared for and loved. He was also blind because his retinas had detached. It was quite sad. He was so high it wouldn't read. There was absolutely no difficulty finding the pulse because his pulses were bounding and very loud. I never tried the tail. I don't do tails. I don't trust tail measurements, but they are acceptable as a location. Most cats don't want their tail messed with. I also usually do a front leg because I think it is also better accepted by cats.

Please, tell those people to get some bloody headphones already. It is ridiculous that they don't have them.

Then again, I have always had to buy them at any practice I have worked at.
 

Antonio65

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but when inflating the cuff, they went clear up to the maximum (300) and never got a stop in the heartbeat. They are telling me that her BP was so high it was off the charts. Is that even possible??? Or is it more likely they had the cuff too tight?
Quite the opposite, my guess is that the cuff was too loose and they had to inflate it up to 300 in order to have it "clamp" on the leg.
Had it been too tight, it would have stopped the heartbeat even earlier.
So, I wouldn't be too worried about that reading.

I have two questions - 1.) is it possible to have a BP so high it cannot be registered without the cat being in a worse state than Feeby, and 2.) despite all of this, wouldn't it still be better to start her on the lowest dose possible and re-check in 7 days (which the vet wants one way or the other)?
In the light of the above, and because you haven't noticed anything different in Feeby than before, if she were my cat I wouldn't change her therapy yet, until you have a clearer response from what they did on that day.
 
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silent meowlook

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If you were in the room with them when they did it, and since they don’t have headphones, do you remember the sound of the pulse getting quieter as they squeezed the nanometer?

They may have used the wrong size cuff, or taped it. I hope they tried several times.
 
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FeebysOwner

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Feeby is not on any BP meds as yet, but I am due to go pick them up today. This was all just surprising to me since her BP reading from June of last year was 165 - which could be considered mild hypertension, but the IM vet did not want to start her on meds, and I suspect it was because they were factoring in 'white coat syndrome'. I wasn't present, so I have no idea how many tries were made or if they gave her 'breaks' in between.

During Tuesday's BP reading, her position was appropriate; on her side, using the nondependent hind leg, her heart would have been 'level' with the leg. I don't believe the pulse ever got quieter when the cuff was inflated, but after multiple tries where they lost the pulse and repositioned the doppler probe, I'll be honest, I lost track. On the final tries, when they had gotten a steady, continual pulse sound from the doppler machine (which did not sound 'bounding'), I swear I never heard the pulse sound 'pause' when they inflated the cuff. I guess that is when they deemed her BP to be so high, it could not be recorded.

Feeby's only recent change in behavior as of late is what I call more lethargy - spending much of her time in a specific room day/night. This also happened a few months back before she first went on Solensia, but after two injections she began to move around more. Retreating to this specific room just started back up within the past week or so - she is up to date on her Solensia injections, so just guessing the increased lethargy is tied to something else. However, I do know that no studies have been done on CKD cats at Stage 3 & 4 who take Solensia, so perhaps that could be impacting her as well.

What is checking Feeby's gums supposed to tell me?

I would imagine her BP is high enough to be treated, based on last week's readings averaging 230. This follow up reading was supposed to be for the purpose of just ensuring the previous readings were 'reasonable'. Unfortunately, IMO, that didn't happen. While I don't think her BP was over 300, I do suspect had they gotten a good reading it wouldn't have been in the normal range.

From what I have read giving her the lowest dose of Amlodipine (0.625 mg) is not likely to cause her BP to drop below normal - especially if you assume it is at least in the ballpark of the 230 readings - but it is only half the dose the vet wants. I just feel like starting her on the lower dose will be better in terms of allowing her body to adjust, even if we have to raise the dose later.
 

silent meowlook

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I think that is a good plan. The gums of a cat with high blood pressure will usually go from the blanched out white where you press on the gum to pink immediately. Cats with a normal reading will take about one to one and a half seconds and cats with lower blood pressure 2 seconds. It is an old school way of checking and not all that accurate.

I would imagine the blood pressure is high as well, although I don’t think it is 300. Like I said before, the only cat with a 300 reading I ever saw had detached his retinas because of how high it was.

As I am sure you know high blood pressure and renal disease are often seen together in cats.
 

silent meowlook

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Yeah, sounds like Cheetah. Hyperthyroid, IBD, lymphoma, high blood pressure? Elevated heart enzymes. Asthma. And to top it off she was very feral and vet visits stress her out. Any meds used to reduce stress wipe her out for days. It is definitely juggling deciding what is worth the stress and what isn’t.
 
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