Measure Accurately

Nurse measuring blood pressure on female patient

Accurate measurement of BP is essential both to estimating CVD risk and to guiding management of high BP. Avoiding common errors can lead to correct diagnoses and speed time to treatment, improving BP control rates.

Statistically, this means more Americans will have high blood pressure. That doesn’t mean they face dramatic new risks or need to immediately start taking medication, but it is an opportunity to prevent problems by gaining awareness and taking action earlier.

New In-Office BP Thresholds Will Have an Impact on How You Diagnose

Assign patients with SBP and DBP in two categories to the higher BP category.
BP Category	SBP		DBP
Normal	<120 mm Hg	and	<80 mm Hg
Elevated	120-129 mm Hg	and	<80 mm Hg
Stage 1 Hypertension	130-139 mm Hg	or	80-89 mm Hg
Stage 2 Hypertension	≥140 mm Hg	or	≥90 mm Hg

“Over 50 percent of deaths from heart disease and stroke occurred among individuals with high blood pressure.

To Eliminate Inaccurate Readings, Position Your Patient Properly

Common positioning problems can lead to inaccurate BP measurement can have a serious impact on the numbers you use to diagnose and determine treatment. These evidence-based tips can help ensure correct positioning in the clinical setting:

Patient Has…	Reading May Be Off By…*	Adjustment to Make
Crossed legs	2-8 mm Hg	Ask patient to uncross legs
Cuff over clothing	5-50 mm Hg	Place cuff over bare arm
Cuff too small	2-10 mm Hg	Ensure cuff fits properly. If an upper arm cuff does not fit the patient due to arm size, use a wrist cuff
Full bladder	10 mm Hg	Suggest patient use restroom
Talking or active listening	10 mm Hg	Ask for silence and stillness before beginning the measurement and to the last duration of measurement
Unsupported arm	10 mm Hg	Position patient with arm supported, cuff at heart level
Unsupported back/feet	6 mm Hg	Make sure patient is not on the exam table, but seated in a chair with back supported, feet flat on the ground or on a footstool

*These values are not cumulative

Accurate BP Measurement Matters

Learn more about the Achieving Accuracy: BP Measurement e-module that provides re-training on proper BP measurement techniques for medical professionals.

Learn More

Practice Assessment: How Well Do You Measure?

Have a nurse or medical assistant take a patient’s BP? Use a validated, automated upper-arm device to measure BP? Measure BP in an environment that supports appropriate patient positioning (e.g., quiet, chairs with back support, hard surface to support arm at heart level, foot stool available)? Properly prepare patients before taking a BP measurement (e.g., advise to avoid tobacco and caffeine within 30 minutes, ensure patients have empty bladder, position patient properly)? Take a repeat or “confirmatory” measurement if initial BP is high?

Taking Accurate BP Measurements is a Critical First Step

To align with evidence-based protocols, always take care to:

Ask your patient to avoid caffeine, exercise, and smoking for at least 30 minutes
Ask your patient to empty bladder
Have your patient relax in a chair (feet on floor, back supported) for >5 min. Do not take BP readings while your patient is sitting or lying on an examining table
Instruct your patient not to talk during the rest period or the measurement
Ask your patient to bare the arm where you will place the cuff

Use a validated, calibrated measurement device
Be sure the patient’s arm is supported on a surface at the correct height
Place the middle of the cuff on the patient’s upper arm
Use the correct cuff size. The bladder should go around 80% of the arm. Make a note if an unusual cuff size is neededD13239
Use either the stethoscope diaphragm or bell for auscultatory readings

At the first visit, take readings from both arms. Take subsequent readings from the arm that gave the higher reading
Separate repeated measurements by 1–2 minutes
If you use the auscultation method, prefer a palpated estimate of radial pulse obliteration pressure to estimate SBP. Inflate the cuff 20–30 mm Hg above this level to determine BP
If you use the auscultation method, deflate the cuff pressure 2 mm Hg per/s and listen for Korotkoff sounds

Record both SBP and DBP. If using the auscultatory technique, record SBP and DBP as onset of the first Korotkoff sound and disappearance of all Korotkoff sounds, respectively, using the nearest even number.
Note how much time had passed between BP medication having been taken and time of measurement

Use an average based on ≥2 readings obtained on ≥2 occasions to estimate your patient’s BP

Give patients both their SBP and their DBP readings, verbally and in writing

Encourage patient to stop smoking cigarettes
Control diabetes mellitus if present
Control dyslipidemia or hypercholesterolemia
Counsel overweight or obese patients to reduce weight
Encourage patient who is inactive to begin regular exercise
Promote a healthy diet

Minimizing these risk factors may help patients reduce CVD risk.

It is reasonable to screen using automated office blood pressure (AOBP) and confirm using ambulatory blood pressure monitoring (ABPM) or SMBP before making your diagnosis. Depending on the measurements taken, categorize your patient as:

White coat hypertension
Sustained hypertension
Masked hypertension

—and take action.

Up Next: Act Rapidly

Featured Resources

Use these resources to follow current best practices and improve outcomes.

Measure Accurately

Measure Accurately

To Eliminate Inaccurate Readings, Position Your Patient Properly

Accurate BP Measurement Matters

Practice Assessment: How Well Do You Measure?

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Taking Accurate BP Measurements is a Critical First Step

Featured Resources

Measure Accurately Quick Start Guide

Accurate BP Measurement Matters

Identify Positioning Errors

Measuring BP

Technique Quick-Check