blood pressure log - duke university · 8/14/2019  · blood pressure log . page 2 of 14 reference...

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For this study, please record your blood pressure on the ___________________ arm each day and record the following. Date Time of Day Blood Pressure Check any special considerations related to this blood pressure Notes No special considerations I was anxious I was in pain It was an unusual time of day to check my BP I didn't take my meds this day I had poor sleep last night : _________ / _________ : _________ / _________ : _________ / _________ : _________ / _________ : _________ / _________ : _________ / _________ : _________ / _________ BLOOD PRESSURE LOG

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Page 1: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

For this study, please record your blood pressure on the ___________________ arm each day and record the following.

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

BLOOD PRESSURE LOG

Page 2: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 2 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 3: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 3 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 4: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 4 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 5: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 5 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 6: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 6 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 7: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 7 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 8: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 8 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 9: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 9 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 10: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 10 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 11: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 11 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 12: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 12 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 13: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 13 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 14: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 14 of 14 Reference Date: 14Aug2019

Date Time of Day Blood Pressure

Check any special considerations related to this blood pressure

Notes No

sp

ecia

l

con

sid

erat

ion

s

I was

an

xio

us

I was

in p

ain

It w

as a

n u

nu

sual

tim

e

of

day

to

ch

eck

my

BP

I did

n't

tak

e m

y m

eds

this

day

I had

po

or

slee

p la

st

nig

ht

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

: _________ / _________

Page 15: BLOOD PRESSURE LOG - Duke University · 8/14/2019  · BLOOD PRESSURE LOG . Page 2 of 14 Reference Date: 14Aug2019 Date Time of Day Blood Pressure Check any special considerations

Page 15 of 14 Reference Date: 14Aug2019