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Blood pressure measurement is one of the most fundamental tests any health professional performs. No physical exam would be complete without it.
Despite its importance, blood pressure measurement is frequently done incorrectly. That’s the consensus of experts at a scientific meeting of the American Society of Hypertension (JAMA, June 25, 2008).
The procedure may seem simple, but in reality it is more complex than most people (including physicians and nurses) realize. In one of the studies presented at the meeting, it was revealed that only about a quarter of specialized doctors and nurses took blood pressure readings properly.
The American Heart Association has published guidelines on how to measure blood pressure accurately, but only 8 percent of the health care providers participating in another study had read them. Here’s a checklist for proper blood pressure measurement:
- Are you seated in a chair with back support so that your feet can rest on the floor?
- Are you allowed to sit quietly for five minutes before your blood pressure is measured?
- Is your arm resting on a table so that the cuff is the same height as your heart?
- Is the cuff the right size for your arm? Big arms need larger cuffs.
- Is the health care provider silent while taking your blood pressure? Engaging in conversation may be a friendly gesture, but talking can raise a person’s blood pressure significantly.
If any of these guidelines are not followed, there is a good chance that the resulting blood pressure measurement will not be accurate. Clearly, this approach takes more time and care than the usual routine. Health care providers are not compensated for the extra time involved, despite the likelihood of error when they are rushed.
Since everyone assumes that blood pressure measurement is easy and does not require special training, the accuracy of results is rarely verified. The consequences of errors can be serious.
When the blood pressure reading is falsely low, patients and physicians may be lulled into an unwarranted sense of security. Needed treatment may not be given.
If the reading produced is higher than the patient’s actual blood pressure, he may be subjected to unnecessary medication that can have side effects as well as financial costs. In fact, according to hypertension expert Clarence E. Grim, MD, an extra 5 mm of mercury in diastolic reading between 85 and 90 would expose about 27 million Americans to a false diagnosis of hypertension and to the risks of medication.
We address proper blood pressure measurement, white coat hypertension and non-drug approaches to lower blood pressure in our new Guide to Blood Pressure Treatment.
Home measurement of blood pressure is one way to monitor progress. Only about one third of people with hypertension control their blood pressure adequately, even though this is a critical step to help prevent heart attacks and strokes.
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Your arm being used should be at heart level plus your bladder should be empty for optimum reading! Left arm is preferable....and of course if the cuff not the correct size you will get a higher and incorrect reading!
I monitor my blood pressure here at home and the Pharmacy. My Dr. takes it and it's always higher than either of the other times. In his examing room I sit on the table, one leg touching a stool , no back support and the arm rests on his. I know he isn't taking it properly----the problem is how to tell him???
The nurse in my doctor's office used to always rest my arm against her side at her hip level. I pleasantly asked her if I might rest my arm on the table instead, as I was making an effort to help hold my arm up. Am sure that affected the blood pressure reading. She readily agreed and that fixed that.
Are any of the wrist monitors for use at home accurate? If so, how do I find one? Thanks.
I am sure that the nurse at my doctor's office is taking my blood pressure incorrectly, as she takes my blood pressure first thing (no 5 minute rest beforehand), has me sit on the exam table with my arm resting parallel to my body ON the table, and she asks me questions during the procedure! My doctor wants to increase my bp meds because the readings are "high", but the readings can't be accurate! How do I tell the nurse and the doctor that they are not doing it correctly?
PEOPLE'S PHARMACY RESPONSE: THIS WILL REQUIRE SOME DIPLOMACY, BUT IT SOUNDS AS IF YOU ARE RIGHT. YOU MAY WANT TO GET OUR GUIDE TO BLOOD PRESSURE TREATMENT (WHICH DESCRIBES THE CORRECT TECHNIQUE) AND ASK THE DOCTOR ABOUT THE DISCREPANCIES BETWEEN THE WAY BLOOD PRESSURE MEASUREMENTS SHOULD BE TAKEN AND THE WAY THE NURSE IS ACTUALLY DOING IT.
The difference posture and arm position makes in BP readings is significant. Seated with arm on my lap, it was 144/84. Raised to chest level immediately afterwards, 111/66. I'd never heard this before.