Process | Recommendation |
---|---|
Proper preparation | Resting for 5 min in a quiet room. |
No smoking, alcohol, or caffeine for 30 min before measurement. | |
No talking by individual or observer during measurement or between measurements. | |
Emptying bladder before measurement. | |
Proper posture | Sitting in a chair with back support. |
Legs uncrossed and feet kept flat on the floor. | |
Bare upper arm or upper arm with light clothes resting on the table. | |
Proper technique | |
 Use of validated device | Auscultatory device or automated device. |
 Use the correct cuff size | |
  Auscultatory device | Inflatable bladder length which is 75–100% of an individual’s middle upper-arm circumference and width 37–50% of the arm circumference. |
  Automated device | Select cuff size according to the device’s instructions. |
 Placement of cuff at the heart level | The middle portion of the cuff on the individual’s upper arm at the mid-sternal level (lower end of the cuff 2–3 cm above the antecubital fossa) |
 Measurement with auscultatory device | Estimate radial pulse obliteration pressure and inflate the cuff 20–30 mmHg above this level for auscultatory determination of the BP level. |
Place the stethoscope (bell side) on the brachial artery at the point of maximal pulsation. | |
For auscultatory readings, deflate the cuff pressure 2 mmHg per beat or second and listen to Korotkoff sounds. | |
Document accurate BP readings properly: Record SBP as the onset of first Korotkoff sound (K1) and diastolic DBP as disappearance of all Korotkoff sound (K5). Record as DBP at the fourth Korotkoff sound (K4) in pregnancy, arteriovenous shunt, and chronic aortic insufficiency. | |
Repeated measurements | Separate repeated measurements in intervals of 1–2 min. |
BP measurement in both arms | Measure BP in both arms at the first visit and then the arm with the higher BP should be used at subsequent visits. |
Positional BP measurement | Measure BP 1 and 3 minutes after standing from a seated position in older people, people with diabetes, and people with suspected orthostatic hypotension. |
BP measurement in arrhythmia | Take triplicate BP measurements and use their average. |
Pulse measurement | Record heart rate and use pulse palpation at rest to exclude arrhythmia. |
BP measurement in the leg | Measure leg BP in suspected peripheral arterial disease if the lower extremity pulse is weak. |
Measure ankle BP, in the supine position using a validated automated device with the cuff placed around the ankle/lower calf. |