Blood pressure measurement

We imagine that many blood pressure readings are taken incorrectly. That’s in the doctor’s office, clinic and hospital. We suspect that few health professionals are familiar with the guidelines set up by the American Heart Association (AHA). We have observed technicians in a highly rated hospital make mistake after mistake. Can you detect the serious mistakes in the picture to your left? Measuring blood pressure is important enough to get it right. This reader points out a couple of common errors.

Three Bad Mistakes to Avoid When Measuring Blood Pressure:

Q. The instructions for my home blood pressure machine make it clear that you should be sitting for five minutes at least, with your arm at just below heart height.

In the doctor’s office, you hop off the scale, climb on a stool and seat yourself with your legs dangling. Then the nurse takes your BP with your arm hanging down, nowhere near the level of your heart. How can that be accurate?

A. We too have been shocked to observe how often blood pressure measurements in the clinic are performed incorrectly. We do not understand why the people who are charged with measuring blood pressure are not instructed in the AHA recommendations:

Checklist Prior to Measuring Blood Pressure:

  1. Did you get time to relax? Whether you take your BP yourself at home or have it measured in a clinic setting, always take 5 to 10 minutes to sit and relax prior to any reading.
  2. Did you sit in a comfortable chair with back support and an arm rest? Were your feet flat on the floor? Never allow any health professional to take your blood pressure while you sit on an exam table with your feet dangling and no back rest or arm support!
  3. Did someone measure your arm circumference to make sure the BP cuff is the right size? We have NEVER seen a technician do this. If your arm is smaller or larger than average the wrong sized cuff will lead to misleading BP readings.
  4. Was your arm supported at heart level while someone was measuring blood pressure? This is critical to an accurate reading. We are constantly dismayed to see people having their blood pressure read with their arm dangling at their side.
  5. Did the technician, nurse or doctor talk to you or ask you a question while measuring blood pressure? If you responded, the chances are very good that your blood pressure was falsely elevated. NEVER speak during the minute or two it takes to pump up the cuff and let the air all the way out!
  6. Did you get to go to the bathroom prior to a BP measurement? A full bladder can impact your readings.
  7. Did the doctor, nurse or technician take your BP at least twice during your visit? One single reading is not adequate. It is recommended that two measurements be made some time apart. The two readings can then be averaged to get a better sense of your true blood pressure.

Measuring Blood Pressure At Home:

We have been advocating home blood pressure measurements for more than 40 years. Because of all the mistakes that can be made in the clinic we think regular home readings may be more reliable. They also lead to better blood pressure control (Lancet, March 10, 2018).

For more information on the proper technique for measurement as well as nondrug strategies for controlling BP, we offer this link:

Why Lower Your Blood Pressure If It Was Measured Incorrectly?

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  1. Jeanne

    I had a doctor appointment today and I was so frustrated. Since a light heart attack I monitor my blood pressure at home almost daily and when I follow the rules for taking BP it is fine. Today when I got to the clinic, I got whisked down to a station where I stood for oxygen test and answered a couple questions, then I was whisked into a room where I was told to sit on the examining table. I am very short, so I had to use a stool to get on the table.

    There I am–legs dangling, arms down, light blouse on and she takes my blood pressure and says it’s high. No kidding? I have tried to say something in two of the three doctors offices about blood pressure [my heart Drs. office does it fine] and I get this look of you-are-the-patient-I-am-the-one-who-knows-what-I-am-doing look and they go on. I almost get a comment, “Your blood pressure is high or on the high side.” Don’t nurses get any training anymore? Don’t doctors check on this?

    I feel like it is rigged to the point if you have a high BP reading, then you will have to either go on medicine or increase what is already being taken, not to mention that these high numbers stay on your medical record. When I tell them my BP is often below or around 120/80 I get a “yeah right” look. I know my blood pressure machine is good and it has been checked for accuracy. I just don’t get why clinics are not monitoring standards for blood pressure readings. It has to be about time/money.

  2. laura b.

    the nurses always have to take my bp at least twice. the automatic cuff squeezes my arm so tightly, it is painful; I think it makes my bp read higher. When they do it manually, it’s OK.

  3. Nurse R

    Two other considerations not mentioned – inflating the cuff over 200 “just because”- that hurts! One should only inflate 20-30 mm/Hg beyond where the radial pulse, detected before the cuff was inflated, can no longer be palpated) AND releasing the inflation too rapidly (should not be deflated faster than 2-4 mm/Hg per second) to allow detection of the nuances of the Korotkoff sounds, including any auscultatory gap.

    Any health care professional who is unaware of these practices needs an update in manual blood pressure measurement. Which leads me to another issue… the electronic devices, not reliable! And all of the equipment needs annual calibration! This VITAL sign is rarely taken/recorded correctly!

  4. puddles

    About 15 years ago, my doctor suggested I get a wrist BP cuff and take my own readings throughout the day for a week before my appointment. I also brought the cuff in to verify mine was reading approximately what his was reading. And yes, the doctor himself took my pressure!!!

    Even though the readings are a bit high in the office, my weeklong readings were usually within range. Therefore he prescribed a very tiny dose of atenolol and it was never increased. All these years later, and several doctors later, I am still taking my BP at home before an office visit.

  5. Eugene Joseph M

    Buddy, Katahleen, Dan: How much higher?
    Linda: What is your usual “doctors office” blood pressure readings and what are the BP meds they prescribed?

  6. Susan

    Not only do I not get 5 minutes to relax prior to a reading, my doctor’s office does it over the sleeve, even if I’m wearing a sweater. I always get lower numbers when I take my own at home.

  7. Buddy

    I take my blood pressure on both arms and get two different readings!
    The Left arm is always higher than the Right arm.
    Why is this?

  8. Sami
    South Carolina

    I had a funny (but sad) experience once while getting my BP taken. The nurse would put the cuff around my arm very lose and try to pump it real fast to catch it from sliding down my arm. NO KIDDING! I looked around the room and asked if there were hidden camera’s. She got upset and wanted to know why.

    After the 3rd time trying to ‘catch’ my BP she managed to stop the cuff at my elbow. It was something like 280/220….so now she is concerned. I am almost on the floor laughing insisting this is a joke. She was extremely upset with me as the laughing might give a false reading.

    Again I am NOT KIDDING!

  9. Kathleen
    Greenville NC

    Home monitoring of blood pressure: Be sure to read the directions for your device. Some need to be periodically calibrated. My father couldn’t understand why his blood pressure was consistently much higher at home than at the doctor’s office. While visiting, I read the directions, calibrated the BP monitor. Now Dad gets a reading within the same range as the doctor’s office.

  10. Dan

    I measure my blood pressure at home about once per week and take reading three times. I follow the AHA instructions. The first reading is always (every time!) much higher than the last two.

  11. Hans
    Salem, Virginia

    I may already have made this comment, but I will repeat:
    If you hook up your BP monitor yourself at home, wait at least one minute before pushing the start button. (The exertion involved strapping on the cuff may temporarily increase your BP)

  12. P J T

    “Automatic” blood pressure cuff, not manual, caused me so much pain squeezing my arm, my BP was 186 !! and me very angry !! moved to other arm, same…pain/high BP/anger. later using a manual cuff…. 140/70 ! upsetting

  13. Linda

    I so totally agree with this article. I get very agitated when going to a doctors office and need to calm down before my BP is taken. Some doctors don’t agree or believe in this and I was prescribed BP meds only to have my BP drop to 94/54. All doctors that I see take the BP upon entering the room when you are rushing around. Luckily, my regulars know to take it again before I leave and it is normal

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