Weekly Blood Pressure Log
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1Name______________________________________
Weekly Blood Pressure Log
Date: _________________ to _________________
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Place a small dot at the
appropriate
Systolic — Top Number
intersection for the
180
high number (systolic)
and the time your
170
Stage 2
blood pressure was
Hypertension
160
taken. Then do the
same for the low
150
number (diastolic) in
Stage 1
Hypertension
the lower chart.
140
130
At the end of the week,
Pre-
hypertensive
connect the dots to see
120
your blood pressure
trend.
110
Normal
Diastolic — Bottom Number
100
Stage 2
120
Be sure to carefully
Hypertension
track the items below
110
to see how various
factors influence your
Stage 1
100
Hypertension
blood pressure.
Pre-
90
hypertensive
Bring this form to your
80
health care provider to
discuss trends in your
70
blood pressure.
Norma
60
50
AM PM
Eve
AM
PM
Eve
AM
PM
Eve
AM
PM
Eve
AM
PM
Eve
AM
PM
Eve
AM
PM
Eve
What did you eat for breakfast?
What did you eat for lunch?
What did you eat for dinner?
How often did you add salt to
your food?
How many alcoholic drinks did
you have today?
What medications did you take
today? How much?
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Parent category: Medical