a close up of someone getting their blood pressure checked, blood pressure pill

One of the most fundamental measurements that is taken at almost every doctor’s visit is blood pressure. After you get weighed, a nurse frequently will check to see whether your blood pressure is within the “normal” limits. Not infrequently, blood pressure measurements are taken incorrectly as this reader reports:

Q. I recently had a doctor’s appointment and the nurse measured my blood pressure while I was sitting on the exam table with my arm dangling at my side. It was 153 over 95 and that was entered into my chart. At home it was 135 over 82.

The doctor is talking about starting me on a diuretic to lower my high blood pressure. I’m not convinced I really need it.

A. Proper blood pressure measurement requires the patient to be seated in a chair with back support and both feet on the floor. The arm should be supported at heart level, the cuff should be the right size and there should be no talking. Otherwise, the reading could be inaccurate.

What’s the Big Deal?

When a blood pressure reading is falsely elevated either because the cuff is the wrong size or your arm is in the wrong position, you could be falsely diagnosed as hypertensive. That can set in motion a domino effect.

First, you are labeled with a chronic condition: high blood pressure or hypertension. That can affect life insurance, health insurance and employment. It also affects sense of self. You are now no longer “normal.” A diagnosis of high blood pressure can also lead to medication, with potential side effects.

Cuff Size:

Let’s just take cuff size, for example. If you have a large arm, a cuff that is too small can falsely elevate blood pressure. When was the last time someone actually measured your arm to see if it required a larger cuff? Did the nurse have a larger cuff available. And by the way, a very thin arm should not be measured with a standard sized cuff either. That could lead to an inaccurate reading.

Do NOT Talk!

Talking while your blood pressure is being taken can increase the reading by 10 to 20 points. If the nurse ask you something personal or emotional, the reading could go even higher (Angiology, July, 1982). This is not something most health professionals are aware of.

Reader Stories about High Blood Pressure & Faulty Measurements:

This report came from D.B.

“Just after I entered menopause, my doctor felt I had high blood pressure – even though readings were taken incorrectly. (I was having lots of trouble sleeping at the time.) She put me on a diuretic called HCTZ. After a couple of days, I was feeling really awful. Dizzy, nauseated, shaky, no energy. After four days, my heart was racing – 120 beats/minute – and I was just relaxing in a recliner reading the newspaper.

“I called to report the side effects and was told by the nurse that these side effects were not listed under this medication. I let her know that they were listed in the info I got from the pharmacy.

“After talking with the doctor, the nurse said they’d switch me to a Beta Blocker, until I reminded her that I have asthma – so a Beta Blocker would not be a good idea for me! I think my electrolytes were completely out of balance. No one ever suggested a smaller dose or anything else.

“I recently worked with a functional medicine (FM) practitioner to figure out why I couldn’t lose weight and was still very fatigued. Since then I have lost about 25 pounds of fat and have healed my esophagus of Barrett’s and healed SIBO and have lots less inflammation, and guess what! My blood pressure is much better. Funny, though, the FM practitioner never takes my blood pressure the same way twice and often does it incorrectly, too! I still take my own blood pressure at home a couple times a week, just to keep my eye on it.”

Louis in Florida makes a good point:

“In addition to no talking, I have found that no body movement-head, arms, legs or shifting around will result in a most accurate reading, whether at home or in the doctor’s office.
Differences of 10 to 40 points higher occur with movement.”

Nurse Carol reports her own experience:

“I always take my BP at home for the week prior to my doctor visit and give her the readings. As a registered nurse, I am appalled by what I see when the assistants take BP’s. You are sitting on the end of the exam table with your legs dangling and your arm is hanging down.

“They also never seem to put the cuff on tight enough to pick up an accurate reading. My brachial pulse is difficult to palpate so the cuff needs to be snug to pick up the pulse. I have had readings of 180/110 with the cuff is not even touching my skin but when the cuff is on snug the reading comes down to 120/80. The assistants also don’t allow for a 10 minute rest period after escorting you to the exam room. I bet over half of people on drugs for hypertension have normal blood pressure.”

Anyone who would like to learn more about proper blood pressure measurement techniques and ways to control hypertension with and without drugs may find our Guide to Blood Pressure Treatment of interest.

Get The Graedons' Favorite Home Remedies Health Guide for FREE

Join our daily email newsletter with breaking health news, prescription drug information, home remedies AND you'll get a copy of our brand new full-length health guide — for FREE!

  1. Flo

    I am constantly asking the Dr’s assistant to go over my rx list first so I can stop huffing and puffing from the long fast walk from reception room to the exam room before she takes my blood pressure. Some will and others state “the Dr. will take it if they are concerned.” Some do, and some do not.

  2. Janet

    Patients need to be their own advocates, everyone should read the AHA guidelines, especially about the patients’ position. I am a certified medical assistant and am fanatic about how patients, and my, blood pressure is taken. Do not ever sit on an exam table, do not let someone hold your arm, do not talk, and ask that your vital signs be done after you’ve been sitting a few minutes. Patients need to advocate for themselves, always refuse to sit on the table, for example. One additional suggestion I have, when seated in the chair, make sure feet are flat on the floor with no pressure on the back of the legs. If there is any doubt in the reading, ask that it be taken again before leaving.

    A correct blood pressure is so important; blood pressure medication dosages are based on the blood pressure reading.

  3. Judy

    One of my specialist doctors took my BP after placing the cuff on my forearm. I got numbers 30 points higher, which scared me. I was consistently getting high BP numbers at home than from my primary care doctor, who suggested I needed a new machine with a large cuff. I am now getting lower readings in the normal range at home using the larger cuff and following proper methodology. Incidentally, it is now very hard to get a BP reading at any doctor’s office due to time constraints. They march you in, weigh you and then almost immediately take your BP while you sit on the table. There isn’t time to do things properly. At least my primary care doctor seems aware of this issue.

  4. matenai
    Jacksonville Beach, FL

    Speaking of technique it is good to understand how the technology of automatic blood pressures work as well as related methods done manually. If this is to technical then just read the last sentence.

    In a manual blood pressure test what is important is a cuff that is comfortable and on with full contact but not tight. The reason for this is that the when the air is vented from the cuff to make the measurement it needs to come out slowly and constantly…this occurs best when there is plenty of air to release. A fast release…a quick test…will have errors from to much of a change during the time one hears the change in the sound used to determine high and low transition points. If someone takes your blood pressure insist they do a slow release.

    This problem is similar with digital devices only the issue here is the quality of the components and the speed of processing. You can test this yourself by putting on a cuff real tight and then loose. The former will result in a fast test. Do this a few times and you will see large differences. This is because a cheaper design has a slower processing and the pressure changes so much between samples. So if you make sure the cuff is loose but in contact it will take longer to fill and empty resulting in more accurate readings for simple consumer devices.

  5. Sandy
    San Jose

    Since we don’t sit perfectly still all day, I am wondering why such emphasis is placed on resting blood pressure. What is a normal blood pressure when active? If a person has untreated sleep apnea, does that result in high blood pressure throughout the day or a higher reading when first waking up?

    I was sent to have an echocardiogram due to a new murmur. The technician took my reading on the exam table with my arm dangling down. When I commented on this he said it didn’t matter what position my arm was in. My reading was excessively high.

  6. Jan Maluf
    North Carolina

    The American Heart Association published clear guidelines in 2005 for proper measurement of blood pressure “In-Clinic”. https://www.aafp.org/afp/2005/1001/p1391.html
    These include parameters for proper equipment, proper positioning of patient, and proper behavior before and during measurement. I do not allow my blood pressure to be taken, much less recorded, by any practitioner who is not following these guidelines to the letter. Makes a big difference!

What Do You Think?

We invite you to share your thoughts with others, but remember that our comment section is a public forum. Please do not use your full first and last name if you want to keep details of your medical history anonymous. A first name and last initial or a pseudonym is acceptable. Advice from other commenters on this website is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. Stopping medication suddenly could result in serious harm. We expect comments to be civil in tone and language. By commenting, you agree to abide by our commenting policy and website terms & conditions. Comments that do not follow these policies will not be posted.

Your cart

Shipping and discount codes are added at checkout.