Measuring What Matters: The Importance of Proper Blood Pressure Measurement
Blood pressure remains one of the most powerful—and modifiable—predictors of risk factors for development of cardiovascular diseases, such as stroke, kidney disease, heart attack, dementia and mortality. Yet despite its routine use in clinical practice, blood pressure measurement is not always standardized, which can lead to more variability between readings and can possibly lead to misclassification, under- or overtreatment, or missed diagnoses.
Even small deviations from standard changes in technique can result in clinically significant differences in blood pressure readings. Improper cuff size, patient positioning, inadequate rest time, or single measurements can falsely over- or under-estimate blood pressure. As hypertension guidelines increasingly emphasize individualized targets and risk-based treatment, the accuracy of the measurement becomes even more critical.
Key Elements: Consistency and Correct Technique
Evidence-based guidelines consistently recommend standardized measurement practices, including:
- Regularly validate and calibrate devices
- Ensure appropriate cuff size - read the Mayo Clinic's article on how blood pressure cuff size affects measurements for more information
- Standardize technique
- Ensure proper patient positioning - seated, back supported, feet flat, arm supported at heart level
- Allow for an adequate rest period of at least 5 minutes before measurement
- Don’t talk or eat during measurement
- Take multiple readings, averaged over time
- Use relaxation techniques, such as controlled breathing exercises before measurement.
Supporting Accurate Measurement Beyond the Office
Home blood pressure monitoring, combined with frequent interactions in medical settings using standardized measurement protocols, is important to improving hypertension diagnosis as well as monitoring blood pressure control. Out-of-office blood pressure measurement is increasingly recognized as an essential complement to in-office readings. Hypertension affects approximately 1 in 3 adults. Home and ambulatory blood pressure monitoring can help identify masked symptoms and engage patients in their care.
Physicians can support accurate home monitoring by encouraging patients to measure their BP at home using validated home blood pressure devices in a controlled, quiet, comfortable setting with minimal distractions. Patients are encouraged to take at least 2 readings a few minutes apart and log results consistently in a log or spreadsheet. Patients can share their home BP measurements during appointments.
Accessing Blood Pressure Screenings in the Community
- Pharmacies: Many pharmacies (like Hannaford, CVS, Walgreens, or Rite Aid) offer free blood pressure checks.
- Community Hubs: Clinics, libraries, YMCAs, and community centers often host free machines or kits.
- YMCA’s Blood Pressure Self-Monitoring Program at participating YMCAs - view the BPSM program brochure
- Health Insurance Provider: Check with your health insurance for in-network locations that offer blood pressure screenings.
Accurate blood pressure measurement may seem routine, but it has outsized implications for diagnosis, treatment, and long-term health. By prioritizing proper technique, consistency, and patient education, physicians and care teams can strengthen the foundation of hypertension management and improve outcomes for the patients we serve. An array of resources for physicians and patients to engage in self-monitored blood pressure screening is available on the site Validate Blood Pressure, a public health service of AMA.
Resources
- Validated devices (Validate Blood Pressure)
- Tools and Resources (Validate Blood Pressure)
- High blood pressure resources (American Heart Association)
- Home blood pressure measurement instructions (American Heart Association)
- Blood pressure log (CDC)
This material is provided as part of a public health grant between NHMS and the New Hampshire Department of Health and Human Services’ Division of Public Health.