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Hypertension Management Progress Chart

Personal Blood Pressure Monitoring and Lifestyle Tracking Tool

Cardiology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Chart Number: _________________ Start Date: _________________

Daily Blood Pressure Log

Instructions

  • Measure BP twice daily (morning and evening)
  • Take readings while seated quietly for 5 minutes
  • Record both systolic (top) and diastolic (bottom) numbers
Date Time Systolic Diastolic Pulse Notes

Lifestyle Modifications Tracker

Daily Medication Adherence

  • Check (✓) when medications taken as prescribed
  • Note any missed doses or side effects

Dietary Changes

  • Sodium intake goal: < 2,300 mg/day
  • Daily fruit/vegetable servings: ______
  • DASH diet adherence: Yes/No

Physical Activity Log

  • Type of activity: ________________
  • Duration: _______ minutes
  • Frequency: _______ times/week

Monthly Goals

  • Target BP: < 130/80 mmHg
  • Weight goal: _______ lbs
  • Exercise goal: _______ minutes/week

Healthcare Provider Follow-up

Next appointment: _________________ Provider notes: ___________________

Warning Signs

Contact your healthcare provider if:

  • BP > 180/120 mmHg
  • Severe headache
  • Chest pain
  • Difficulty breathing
  • Vision changes

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