blood-pressure-tracker

name	blood-pressure-tracker
description	Records and classifies blood pressure readings per ACC/AHA 2017 guidelines, detects morning surge, analyzes diurnal variation, and generates monthly statistics. Use when the user logs BP readings or asks about blood pressure trends.
version	1.0.0
user-invocable	false
allowed-tools	Read, Grep, Glob, Write, Edit
metadata	{"openclaw":{"emoji":"💓","category":"health"}}

Blood Pressure Tracker

Records blood pressure readings with automatic classification (ACC/AHA 2017), tracks trends, detects morning surge and diurnal patterns, computes pulse pressure and heart rate analysis, and generates monthly statistics.

Capabilities

1. Record Blood Pressure

Extract from natural-language input:

Field	Required	Default
SBP (mmHg)	Yes	--
DBP (mmHg)	Yes	--
Pulse (bpm)	No	omitted
Time (HH:MM)	No	current time
Period	Auto	derived from time
Position	No	seated
Arm	No	omitted
Notes	No	omitted

2. BP Classification (ACC/AHA 2017)

Category	SBP (mmHg)		DBP (mmHg)
Normal	< 120	AND	< 80
Elevated	120-129	AND	< 80
Stage 1 HTN	130-139	OR	80-89
Stage 2 HTN	>= 140	OR	>= 90
Hypertensive Crisis	>= 180	OR	>= 120

Logic: check crisis first, then descend. When SBP and DBP fall in different categories, use the higher one. Example: SBP 125 (Elevated) + DBP 85 (Stage 1) = Stage 1 HTN.

classify(sbp, dbp):
    if sbp >= 180 or dbp >= 120: return "Hypertensive Crisis"
    if sbp >= 140 or dbp >= 90:  return "Stage 2 HTN"
    if sbp >= 130 or dbp >= 80:  return "Stage 1 HTN"
    if sbp >= 120 and dbp < 80:  return "Elevated"
    return "Normal"

3. Pulse Pressure

PP = SBP - DBP

PP (mmHg)	Assessment	Clinical Significance
< 30	Low	May indicate low cardiac output
30-40	Normal	Ideal range
41-60	High	Possible reduced arterial elasticity
> 60	Significantly high	Increased arteriosclerosis risk; recommend evaluation

4. Heart Rate Classification

HR (bpm)	Category	Notes
< 60	Bradycardia	Normal in trained athletes
60-100	Normal	Resting range
> 100	Tachycardia	If not post-exercise, investigate

5. Time-of-Day Periods

Period	Time Range	Notes
Morning	06:00-10:00	Key window for morning surge detection
Daytime	10:00-18:00	Active hours
Evening	18:00-22:00	Evening readings
Nighttime	22:00-06:00	Sleep-period readings

6. Morning Surge Detection

Definition: morning SBP (max 06:00-10:00) minus nighttime SBP (min 22:00-06:00) >= 35 mmHg.

Requires at least 1 morning and 1 nighttime reading (same day or previous night). If no nighttime data, use previous evening's last reading as approximation.

morning_surge = max(morning_SBP) - min(night_SBP)

Surge (mmHg)	Result	Action
< 35	Normal	Continue monitoring
35-55	Positive	Recommend medical evaluation; may need medication timing adjustment
> 55	Significant	Elevated stroke risk; seek medical attention promptly

7. Monthly Statistics

Compute for all readings in a given month:

Metric	Formula
Mean	mean(SBP), mean(DBP), mean(Pulse)
Max	max(SBP), max(DBP)
Min	min(SBP), min(DBP)
SD	sqrt((1/N) * SUM[(x_i - mean)^2])
Control rate	(on-target count / total) * 100%
Measurement frequency	total readings / days in month

Control targets (default; user-customizable):

• General: SBP < 140 AND DBP < 90
• Elderly (>= 65): SBP < 150 AND DBP < 90
• Diabetes/CKD: SBP < 130 AND DBP < 80

SBP SD variability assessment: < 10 stable, 10-15 mild, > 15 significant.

8. Trend Analysis

Linear regression on the last 7/14/30 days: SBP = a + b * day_index.

• b > 0.5: rising
• b < -0.5: declining
• otherwise: stable

Input Format

Natural language, e.g.:

• "BP 135/85, pulse 72"
• "This morning 128/82"
• "Just measured 142/90 HR 78"

Output Format

Single Reading

## Blood Pressure [blood-pressure-tracker · 08:30]

### Reading
- Value: 135/85 mmHg
- Pulse: 72 bpm
- Period: Morning
- Classification: **Stage 1 HTN**
- Pulse pressure: 50 mmHg (high)
- Heart rate: Normal

### Analysis
- SBP 135 falls in Stage 1 range (130-139)
- DBP 85 falls in Stage 1 range (80-89)
- Higher category taken -> Stage 1 HTN
- PP 50 mmHg is high; monitor arterial elasticity

### Morning Surge
- Morning SBP: 135 mmHg
- Previous night min SBP: 108 mmHg
- Surge: 27 mmHg -> Normal

Monthly Report

# Blood Pressure Monthly Report -- March 2026

## Summary
| Metric | SBP | DBP | Pulse |
|--------|-----|-----|-------|
| Mean | 132.5 | 84.2 | 73 |
| Max | 148 | 95 | 88 |
| Min | 118 | 72 | 65 |
| SD | 8.3 | 6.1 | 5.2 |
| Readings | 45 | 45 | 42 |

## Control Analysis
- Target: < 140/90 mmHg
- On-target: 38/45
- Control rate: 84.4%

## By Period
| Period | Avg SBP | Avg DBP | Count |
|--------|---------|---------|-------|
| Morning | 136.2 | 86.1 | 20 |
| Daytime | 130.5 | 83.0 | 10 |
| Evening | 128.8 | 82.5 | 12 |
| Nighttime | 122.0 | 78.0 | 3 |

## Trend
- SBP: slight decline (slope -0.3/day) -> stable-improving
- DBP: stable

## Morning Surge
- Positive detections: 2/15 days (13%)
- Average surge: 28 mmHg (normal)

## Pulse Pressure
- Average PP: 48.3 mmHg (high)
- Max PP: 58 mmHg

## Alerts This Month
- [Warning] Mar 5: 3 consecutive above target (142/92, 145/90, 140/88)
- [Notice] Mar 12: PP 58 mmHg

Data Persistence

Daily File (memory/health/daily/YYYY-MM-DD.md)

## Blood Pressure [blood-pressure-tracker · 08:30]
- 135/85 mmHg, pulse 72
- Grade: Stage 1 HTN
- Pulse pressure: 50
- Morning surge: 27 mmHg (normal)

Multiple readings in one day -- list all:

## Blood Pressure [blood-pressure-tracker · 20:15]
- 08:30: 135/85 mmHg, pulse 72 -- Stage 1 HTN
- 20:15: 128/82 mmHg, pulse 70 -- Elevated
- Daily average: 131.5/83.5 mmHg

Item File (memory/health/items/blood-pressure.md)

---
item: blood-pressure
unit: mmHg
updated_at: YYYY-MM-DDTHH:MM:SS
---

# Blood Pressure Records

## Recent Status
- Latest: 135/85 mmHg, pulse 72 (YYYY-MM-DD 08:30)
- Grade: Stage 1 HTN
- 7-day average: 132/83 mmHg
- Trend: Stable
- Morning surge: Normal (avg 28 mmHg)

## History
| Date | Time | SBP | DBP | Pulse | Grade | PP | Notes |
|------|------|-----|-----|-------|-------|----|-------|
| 2026-03-10 | 08:30 | 135 | 85 | 72 | Stage 1 | 50 | Morning |
| 2026-03-10 | 20:15 | 128 | 82 | 70 | Elevated | 46 | Evening |
| 2026-03-09 | 08:15 | 130 | 84 | 74 | Stage 1 | 46 | Morning |

Write Steps

1. Glob memory/health/daily/ for today's file; create if absent.
2. Read the daily file.
3. Grep ## .* \[blood-pressure-tracker · for existing section.
4. Edit to replace (merge all same-day readings), or insert before ## Health Files if new.
5. Update frontmatter updated_at.
6. Read memory/health/items/blood-pressure.md (create if absent).
7. Update ## Recent Status (including 7-day average and trend).
8. Prepend new row to ## History table.
9. Remove rows older than 90 days.
10. If alert triggered, prominently display in output.

Alerts and Safety

Alert Thresholds

Condition	Level	Message
SBP >= 180 OR DBP >= 120	URGENT	[URGENT] BP at crisis level ({SBP}/{DBP}). Seek emergency care or call 120/911 immediately.
3 consecutive readings SBP >= 140 OR DBP >= 90	Warning	[Warning] 3 consecutive readings above target. Recommend medical review.
Morning surge >= 35 mmHg	Warning	[Warning] Morning surge detected ({X} mmHg). Recommend evaluation.
PP > 60 mmHg	Notice	[Notice] Pulse pressure {PP} mmHg is high. Monitor arteriosclerosis risk.
Resting HR < 50 OR HR > 110	Notice	[Notice] Resting HR {HR} bpm abnormal. Recommend evaluation.

Measurement Best Practices

• Rest quietly for 5 minutes before measuring.
• Sit with arm at heart level.
• Take 2-3 readings per session; use the average.
• Avoid measuring within 30 min of exercise, alcohol, or caffeine.
• Measure at consistent times daily (morning + before bed recommended).

Medical Disclaimer

This skill is for health reference only and does not constitute medical advice. It does not diagnose hypertension, recommend or adjust antihypertensive medications, or replace 24-hour ambulatory blood pressure monitoring (ABPM).

Seek emergency care if: SBP >= 180 or DBP >= 120, especially with headache, blurred vision, chest pain, or dyspnea.

See a doctor soon if:

• BP above target (>= 140/90) for 1+ week
• Recurring positive morning surge
• Persistent PP > 60 mmHg
• Resting HR persistently < 50 or > 100
• On antihypertensive medication with inadequate control