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
|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|
Practice Assessment: How Well Do You Measure?
You’re an expert.
Consider teaching others!
You’re becoming an expert!
Opportunity to improve!
Keep learning and making progress.
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.
Use these resources to follow current best practices and improve outcomes.
See the critical steps for measuring BP accurately—and the potential impact of mismeasurement.
Help ensure that everyone in your practice takes BP readings the right way—and the same way—every time.See All Tools & Downloads