4
Diagnosis
Table 4. Checklist for Accurate Measurement of BP
Key Steps for Proper
BP Measurements Specific Instructions
Step 1: Properly
prepare the patient
• Have the patient relax, sitting in a chair (feet on floor, back
supported) for >5 min.
• The patient should avoid caffeine, exercise, and smoking
for at least 30 min before measurement.
• Ensure patient has emptied his/her bladder.
• Neither the patient nor the observer should talk during the
rest period or during the measurement.
• Remove all clothing covering the location of cuff
placement.
• Measurements made while the patient is sitting or lying on
an examining table do not fulfill these criteria.
Step 2: Use proper
technique for BP
measurements
• Use a BP measurement device that has been validated, and
ensure that the device is calibrated periodically.
• Support the patient's arm (e.g., resting on a desk).
• Position the middle of the cuff on the patient's upper
arm at the level of the right atrium (the midpoint of the
sternum).
• Use the correct cuff size, such that the bladder encircles
80% of the arm, and note if a larger- or smaller-than-
normal cuff size is used (Table 5).
• Either the stethoscope diaphragm or bell may be used for
auscultatory readings.
Step 3: Take the
proper measurements
needed for diagnosis
and treatment
of elevated BP/
hypertension
• At the first visit, record BP in both arms. Use the arm that
gives the higher reading for subsequent readings.
• Separate repeated measurements by 1–2 min.
• For auscultatory determinations, use a palpated estimate of
radial pulse obliteration pressure to estimate SBP. Inflate
the cuff 20–30 mm Hg above this level for an auscultatory
determination of the BP level.
• For auscultatory readings, deflate the cuff pressure 2 mm
Hg per second, and listen for Korotkoff sounds.
Accurate Measurement of BP in the Office
COR LOE
Recommendation
I C-EO For diagnosis and management of high BP, proper methods are
recommended for accurate measurement and documentation of
BP.
