williamriveromd.com · BP Monitoring Log
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Patient Handout · williamriveromd.com
14-Day Blood Pressure Monitoring Log
Bring this completed form to your next consultation · Para sa inyong doktor
W Rivero, MD Nephrology · Internal Medicine FPCP, DPSN ·
How to Fill This Form
  • AM reading: Before medications, before eating, before activity — same time each morning.
  • PM reading: Evening, consistent time daily (e.g., before dinner).
  • Systolic / Diastolic: Top number first (e.g., 130 / 80).
  • Pulse: Beats per minute if your device shows it.
  • Meds Y/N: Y = took all medications that day; N = missed any.
  • Symptoms/Notes: Headache, dizziness, chest pain, blurred vision, or any notes (e.g., "stressed," "slept poorly").
How to Take a Correct Reading
  1. Rest 5 minutes — seated, no smoking, coffee, or exercise 30 min prior.
  2. Sit correctly — back supported, feet flat, arm at heart level on a flat surface.
  3. Position the cuff — bare upper arm, 2–3 cm above elbow crease, tubing over inner arm.
  4. Stay still and quiet — no talking or phone use during measurement.
  5. Take 2 readings — wait 1–2 minutes between them. Record both.
  6. Same arm every time — use the arm your doctor recommended.
🚨

Seek emergency care immediately if: SBP ≥ 180 mmHg or DBP ≥ 110 mmHg — especially with headache, blurred vision, chest pain, shortness of breath, or weakness. Do not drive yourself.

Day AM
PM		 Date Time Systolic
(mmHg)		 Diastolic
(mmHg)		 Pulse
(bpm)		 Meds
Y / N		 Symptoms & Notes
Week 1 — Days 1 through 7
Day 1 AM
PM
Day 2 AM
PM
Day 3 AM
PM
Day 4 AM
PM
Day 5 AM
PM
Day 6 AM
PM
Day 7 AM
PM
Week 2 — Days 8 through 14
Day 8 AM
PM
Day 9 AM
PM
Day 10 AM
PM
Day 11 AM
PM
Day 12 AM
PM
Day 13 AM
PM
Day 14 AM
PM
14-Day Average All
Abbreviations
SBP Systolic blood pressure (top number)
DBP Diastolic blood pressure (bottom number)
bpm Beats per minute (heart rate)
Meds Y = taken · N = missed
Home Normal home target: < 135/85 mmHg
BP Targets — Quick Reference
General adult (home reading) < 135/85
CKD without diabetes < 130/80
CKD with diabetes < 130/80
Pre-dialysis / ESKD < 140/90
Elderly (≥ 65 years) < 140/90
🚨 Hypertensive crisis SBP ≥ 180 or DBP ≥ 110 → ER

Notes for your doctor

williamriveromd.com · W Rivero, MD, FPCP, DPSN · For educational purposes only · Not a substitute for medical advice Book: seriousmd.com/doc/williamrivero