The People's Perspective on Medicine

Do You Know How to Take Your Blood Pressure Right?

If you want to lower your risk of heart disease or stroke, you should learn to take your blood pressure accurately. Hypertension is a risk factor.
Female healthcare worker checking the blood pressure of a senior woman during a home visit

Public health experts at the American Heart Association estimate that about half of American adults have high blood pressure, also termed hypertension. As a result, they are at increased risk for strokes and heart attacks. Consequently, doctors like to treat hypertension conscientiously, but first they must diagnose it accurately. When you last saw your primary care provider, did someone take your blood pressure with the proper technique? Or did they make some mistakes?

White Coat Hypertension Requires Careful Measurement:

Q. I have white coat hypertension, as evidenced by my much lower blood pressure readings at home. I am retired from the medical field and follow proper guidelines when taking my BP at home.

You described the procedures well. Only once in over 20 years in a doctor’s office have I had my BP measured correctly.

How to Take Your Blood Pressure Right:

A. We have also observed sloppy blood pressure measurement practices in some clinics. For an accurate measurement, the person should be seated for at least five minutes in a chair that supports the back and allows feet to rest on the floor. The arm should be supported at heart height, and there should be no conversation during the measurement. The cuff used for the monitor must be the right size; a cuff that is too small will overestimate the reading, while a large one may give too low a value.

No Eating or Drinking!

If you are eating or drinking anything during or right before you make the measurement, you can throw it off (Journal of Hypertension, March 2017). Caffeine and alcohol are particular offenders. Likewise, smoking, crossing your legs or having a full bladder can change the reading you get and make it inaccurate. If the person doing the measurement uses the old-fashioned technique of a stethoscope and a mercury sphygmomanometer (considered the gold standard), their hearing can also lead to inaccuracies.

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Luckily, home blood pressure monitors and many monitors in clinical settings are now automated and give digital readouts. While poor technique can still lead to a bad reading, at least hearing is not a factor. Japanese researchers recently reported an automated system for measuring blood pressure, heart rate, body weight and some brain activity (Advances in Experimental Medicine and Biology, 2020). Their pilot study demonstrated that ordinary people can manage these measurements accurately outside the clinical setting. In this case, the equipment was provided in a fitness gym. 

Learn More:

It is important to know your blood pressure under a variety of conditions. Blood pressure may vary at home, at work and in the doctor’s office. Some people whose blood pressure appears normal in the clinic may have elevated readings at home. Doctors call this “masked hypertension” (Current Hypertension Reports, Oct. 25, 2017).Your situation of “white coat hypertension,” with lower blood pressure readings at home, is better known, though. In both situations, you should use a home monitor on a regular basis to get a more accurate picture of your risk.

We have included additional details and a recommendation for a home blood pressure monitor in our recently updated eGuide to Blood Pressure Treatment. You will find information on medications and nondrug options to controlling hypertension in this online resource. You might also wish to listen to the interviews we did with several experts in Show 1134: Can You Control Your Blood Pressure Without Drugs?

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Citations
  • Kalloinen N et al, "Sources of inaccuracy in the measurement of adult patients' resting blood pressure in clinical settings: A systematic review." Journal of Hypertension, March 2017. DOI: 10.1097/HJH.0000000000001197
  • Ishida M et al, "Development of an IoT-based monitoring system for healthcare: A preliminary study." Advances in Experimental Medicine and Biology, 2020. DOI: 10.1007/978-3-030-34461-0_37
  • Anstey DE et al, "An update on masked hypertension." Current Hypertension Reports, Oct. 25, 2017. DOI: 10.1007/s11906-017-0792-4
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Unbelievable: they put the cuff over bulky clothing; they make you sit on an examination table with your feet dangling in the air; they use your right arm; and they pull your arm straight out; and they talk to you while they are doing it; and they pooh-pooh what you say when you tell them what you understand is the proper way to take blood pressure. And I am talking about what goes on in CARDIOLOGISTS’ offices. We see several different ones, and they all fit this description.

I was told by a medical professional that after taking a reading sitting down, it should be followed up with a second reading while standing.

Re. positioning for BP reading: I’ve found that the easiest way to get my arm to the right level with my heart and to relax, etc., is to lie on my back with my head somewhat elevated with pillows. That seems to meet all the requirements. Any problems with this approach?

After years of high readings taken at the doctor’s office, I bought a “top of the line” BP monitor about 6 years ago.
Readings are as accurate as doctor’s office and allow me to report whether medication is working as desired.
Doctor tweaked the meds a couple of times, and the BP is now under control to everyone’s satisfaction.

I rated this “1” because you never mentioned proper placement of the Doppler. When I was a PACU nurse, patients would come in on vasopressors, and we would take them off of them when I correctly put the Doppler over the radial artery instead of on the back of their arm. And I’ve seen this mistake over and over again as an ED nurse, including myself as a doctor’s office patient.

I have one question to ask: When my husband goes to get his blood pressure checked, they always put the cuff on over his bulky sweatshirt, and I always question the nurse who says it is “fine.” I don’t think this is “fine.” Do you?

NOT fine. The cuff should be on bare skin.

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