Blood Pressure Chart

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FREE blank
Blood Pressure Chart
you can download

(Example of a blood pressure chart filled out)

Date:          April 10, 2002           Time:    1:00 pm                Blood Pressure:  _120 / 80    Pulse:   65
Location:         Home_____________________________________________________________

Activity:          Watching TV_______________________________________________________

Stress/worry:         Thinking about my doctors appointment______________________________

_______________Thinking about money_____________________________________________

                            Worried about Seth on my daytime soap opera______________________

Symptoms/Feelings:    I feel tired, lost, lonesome_______________________________________

Date:      April 10, 2002              Time:  2:30pm                  Blood Pressure:  125 / 75 Pulse: 70

Location:          Home____________________________________________________________

Activity:                  Doing laundry__________________________________________________

Stress/worry:         Worried about the stain in my shirt__________________________________

_____________  Worried about my health____________________________________________

Symptoms:          I have a headache_________________________________________________


Date:      April 10, 2002              Time:  9:30pm                  Blood Pressure: 130 / 90          Pulse: 64

Location:          Home________________________________________________________

Activity:          Going to bed___________________________________________________

Stress/worry:         Doctors appointment tomorrow , meeting with school board, have to get my
                      bills paid,   have to take the car to the garage, go shopping

Symptoms:          Iím really tired, feeling weak, exhausted. Time for sleep._________________

 Note:  This blood pressure chart is just an example of the kinds of information you may want
to record along with your blood pressure and pulse.  If there is something particularly important
or stressful about your present situation in life that you think is influencing your blood
pressure reading, feel free to just add it to this list.

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