Measure Accurately

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.

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

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.

“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

 

Practice Assessment: How Well Do You Measure?

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 needed
  • 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

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