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

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 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 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 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 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 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 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 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 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 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 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 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 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 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 of 14 Reference Date: 14Aug2019