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.

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  1. Patti
    Reply

    I had a new nurse take my blood pressure last week & she just held my hand between her arm and body. The reading was good. Very impressed (there’s no table to rest your arm on) and I made sure to thank her. She knew the arm should be at heart level.

  2. Ann
    Reply

    Those automatic cuffs in the hospital can be too tight. If one has fibromalygia the pain may raise the blood pressure but not always.

  3. Carolyn P.
    Reply

    I think if the BP reading is elevated when the nurse takes it soon after coming into the exam room, it should be taken again by the doctor before the patient leaves. Nothing is ever mentioned about not talking during the reading. When taking a reading at home, my BP is usually normal, but almost always is elevated over the normal when taken by the nurse.

  4. Bill
    Asheboro,NC
    Reply

    Sometimes the cuff is placed over my shirt or sweater and I am told it is not necessary to remove them or roll up my sleeve. Will this make a difference?

  5. Anne
    Florida
    Reply

    I was almost a victim of this misdiagnosis. My blood pressure reading dropped from 145/92 to my normal (and consistent) 102/59 just by following these steps at my doctors office. Thank you for a great article. Everyone should read this, including those rotating assistants most doctors have now.

  6. Kenneth
    Reply

    I have large arms & time after time they put cuffs on my arm that must be for little old ladies. It hurts, my fingers go numb, and then to add injury to insult they repeat it at least once. The walk into my doctors office is strenuous at a V.A. hospital. By the time I get there my heart is pumping. Yet they’ve made these electronic BP machines add to a laziness factor. It’s quick, they can do other things while a thermometer is in your mouth, a pulse ox is on your finger, and the cuff is crushing my arm. Technology is great & multitasking gives them more time to get more things done. But accuracy isn’t as important as it used to be. And who pays for that in the end.

  7. SML
    North Carolina
    Reply

    As a previous medical assistant, we were never taught about how the patient’s should be situated prior to taking blood pressure, (although typically if a patient didn’t have high bp the readings were still typically normal), not to mention that the blood pressure devices are usually mounted to the wall next to the exam table. It is true that ideally one should wait 10 minutes before testing blood pressure, but unfortunately that is time that cannot be spared when an appointment is usually only 15 minutes long to begin with and a doctor is waiting to see the patient. I did try to get the medical history and chart information before taking a reading to give the patient a few moments to get situated. My advice, especially if you tend to have high readings in the office, is to check your bp at home or elsewhere when circumstances are less rushed and bring those readings with you to your appointment to get a more accurate picture of your health.

  8. Wayne
    Reply

    There are a lot of variables. Recient exercize from which my heart rate shows recovery or near recovery can substantially reduce it as compared to measurting before exercize. Making 2 measuremenents 1 minute apart sometimes shows a higher first reading. I don’t know just what that means but I understand that it is the second one that should be relied upon.

  9. JAS
    Reply

    My readings are always much higher with the automatic reading machines! I also need a larger sized cuff. Those automatic blood pressure reading machines are so extremely painful that my blood pressure reading drops 30 points when the nurse or PA takes it manually (not with the automatic machine). And I also get a much lower reading after talking to the doctor or PA… probably the “White Coat” high blood pressure syndrome….

  10. Kat
    Reply

    I had a series of doctor’s visits three weeks in a row. After complaining to the assistant after the second very high BP reading (which was totally out of range from my regular BP), and also suggesting he use a larger cuff, the third week he used a different machine and a larger cuff and my BP was normal. I check my BP at home periodically and before going to the doctor to verify that it is in the normal range. A friend who had a hemmoragic stroke has her BP taken twice a day—morning and late afternoon—when her aide arrives and leaves. She sits very still with her arm at heart level and will NOT talk to you if you happen to be there. Someone taught her the correct way to do it for optimal accuracy.

  11. Leise
    Los Angeles
    Reply

    It’s important to say “not right now” when you’ve just gotten into the exam room. The points about sitting position and cuff size are also critical to an accurate assessment. If you are on BP medicine and monitor it at home, bring a copy of your recent readings and dates. Nurses often say they can’t accept a verbal report. As one of your comments pointed out, inaccurate readings can actually be harmful.

  12. Louise
    Illinois
    Reply

    I have aver thin arm. I read above that a regular
    blood pressure cuff would not be accurate for me. But I don’t know where to get a smaller one.

  13. Patti
    Texas
    Reply

    For the last twelve years, my husband and I have had to deal with nurse’s taking the blood pressure wrong, talking, asking us questions while taking it and NOT having a place to rest the arm at heart level. At some specialists they have a bp machine with a attachment that keeps your arm at heart level while taking bp, guess we need to buy one. Just a joke……..

  14. Peter
    Texas
    Reply

    I have always had white coat hypertension in doctors’ offices, and more than once I have informed my doctors of that tendency, usually to no avail. At one point, after having an unrelated procedure in my doctor’s office, where my BP was on the high side, and where the doctor suggested that I monitor my BP readings more carefully, I decided to prove to him once and for all that my BP readings were normal, and that I had been put on BP medicine improperly.

    So, I spent a full year where I took a total of 3873 readings (my monitor takes three spaced-apart readings and averages the three readings, so there were 1291 sets of readings). Unlike the readings taken in my doctor’s office, the readings were taken as advised by the manufacturer of my monitor, and were taken at different times of days and under all kinds of conditions. I averaged the BP readings on a monthly basis, and calculated the final number for the entire year. That reading was 117.46/67.68. I prepared a final report for the doctor that laid out everything in excruciating detail. The report was three typed pages long.

    I should add that one factor that helped me control my BP was my daily walks. I have taken such walks for years and it was not because of high blood pressure concerns although it helped lower my BP by about 5.29 points on the systolic on average and by about 3.73 points on the diastolic on average. I have a pedometer so I used it to keep track of how far I walked over the year. Not counting walking around my home, I estimate that I walked around 1300-1400 miles that year. And, for me, about 4-5 miles was the sweet spot in terms of controlling my BP. Less than that, the reduction of BP was not effective; greater than that, the BP would stabilize and not go much lower, quite possibly because of homeostasis protecting me from going overboard.

    At the time of my study, I was around 75. And, once I saw that the medication had no effect that I could tell, I stopped taking it. And, since the study, for the few weeks that precede my annual physical, I take readings and give my doctor another report covering that period. I actually think I intimidated my doctor by my reports. I also now think that I am an expert on how my body works with respect to BP.

  15. Donna
    Oklahoma
    Reply

    I have to remind medical personnel that they cannot take my blood pressure with the automatic BP machine. For some reason, it doesn’t detect my heart beat and every so often my heart skips a beat. One visit, they were using it to read my blood pressure and the cuff did not stop squeezing my arm. Blood vessels broke in my hand it was so tight.

  16. Fred
    Lodi ca
    Reply

    What about the automatic cuff readers that harbor freight sells are those worth using ? That’s the type my dentist used on me. They said I have high blood pressure . I know it’s high but I also have a basic fear when any medical person gets close to me I call it white coat syndrome.

  17. Jean
    California
    Reply

    Cuff size for blood pressure readings is vital. I was put on a blood pressure med after a month of slightly elevated readings. Then I learned that a small cuff had been used consistently. That has changed and I will only allow a large cuff to be used for my blood pressure readings. I now take Amlodipine for blood pressure and Coumadin for DVT and PE. My blood pressure is recorded every week when I see my hematologist. Do I have high blood pressure or did the small cuff used on my ‘good size’ arm give an elevated but false reading. This is a major health issue – do not let this question go by the wayside – why should a nursing assistant’s poor choice in using the wrong cuff size determine a patient outcome.

  18. joanie
    Reply

    One of my hot buttons is the way assistants take blood pressure readings in md offices. It always shows way too low as they do not ever pump up the pressure enough, telling me that patients complain about the pressure. So I now tell them to pump it up to 200 and then I will get an accurate reading. No more aggravation.

  19. Pamela
    BC
    Reply

    I have seen patients being instructed to hold their arm at heart level without support from a desk or by the provider. I always noted higher blood pressure readings, so I did my own experiments. Flexing the arm muscles during the procedure results in readings at least 20 mm higher, so make sure that your provider is supporting your arm at heart level.

  20. Shauna
    WA
    Reply

    The blood pressure machine invariably reads my blood pressure higher than the manual one. I now refuse to have it taken by machine, and I follow being seated on a chair, feet flat on the floor, and no talking.

  21. Robin
    CT
    Reply

    My dr. office takes my blood pressure after I am weighed in downstairs, then led up a flight of stairs and down a hallway, to sit & immediately have blood pressure taken. If it’s extremely high, they will take it again later on & it’s always way down, but I am still on a blood pressure drug, Lisinopril! Now I wonder if I should be!

  22. Judy A
    michigan
    Reply

    Only two people have ever taken my blood pressure properly. Both were my primary care doctors of past and present.
    I’ve been tested sitting with dangling arms, tested after getting my aging body up onto the exam table, once with my arm held against my chest after the cuff was put on, once standing and I could go on and on. What are they teaching in med and nursing schools??
    I monitor my readings at home, used to take them in for the doctor. Now, if my reading is high I request a retake before I leave the exam room when I am relaxed and been sitting for a bit.

  23. Lida
    Reply

    I am particularly interested in knowing how to reduce inflammation and in knowing how the Barette’s esophagus was treated.

  24. Martha
    Bartow, FL
    Reply

    My blood pressure is always taken the minute I walk into the exam room, no rest, no instructions about arm position. I am on medication too which my cardiologist reduced by half as my blood pressure was low.

  25. Sally
    Dallas
    Reply

    I agree with readers’ stories regarding blood pressure readings. I have experienced most of them. One medical assistant insisted that incorrect readings depend on whether the pressure cuff was on the left or right arm. I’ll continue to monitor mine at home, about the same time every day, and follow a diet to keep my blood pressure at a healthy level.

  26. Michael
    Washington
    Reply

    I also don’t trust the machines commonly used to measure BP. At one office, I complained to a sympathetic nurse about the seemingly high readings from the machine, so she brought over a real mercury-based sphygmomanometer (say THAT 3 times fast) and took the reading manually. My numbers went down by about 30 points.

  27. Lida
    Dayton OH
    Reply

    How can we find out what methods D.B.’s functional medicine practitioner used to improve his/her symptoms that resulted in weight loss and other improvements to health? It is both enlightening and frustrating when a reader shares experiences but fails to include relevant and helpful information.

  28. sheri
    surfside beach sc
    Reply

    Get yourself a BP monitor from the drugstore and take your pressure at home, following the directions. Every time I go to my cardiologist, my BP is through the roof, but when they take it, they don’t follow the procedure I do at at home i.e., quiet, cuff at the same level as your heart, etc. At home, it’s 105/70, or somewhere in that range. When my md talks to me about hypertension, I hand him the cuff and tell him ” it’s not me, it’s you”. The numbers don’t lie, it IS him.

  29. Lee S.
    Atlanta
    Reply

    A full bladder will falsely elevate blood oressure readings

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