FREE
Blood Pressure Chart
Click here for a
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: I’m
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.