Checklist for accurate measurement of blood pressure

Key steps for proper BP measurements	Specific instructions
Step 1: Properly prepare the patient	Have the patient relax, sitting in a chair (feet on floor, back supported) for >5 minutes. The patient should avoid caffeine, exercise, and smoking for at least 30 minutes before measurement. Ensure patient has emptied his/her bladder. Neither the patient nor the observer should talk during the rest period or during the measurement. Remove all clothing covering the location of cuff placement. Measurements made while the patient is sitting or lying on an examining table do not fulfill these criteria.
Step 2: Use proper technique for BP measurements	Use a BP measurement device that has been validated, and ensure that the device is calibrated periodically.* Support the patient's arm (eg, resting on a desk). Position the middle of the cuff on the patient's upper arm at the level of the right atrium (the midpoint of the sternum). Use the correct cuff size, such that the bladder encircles 80% of the arm, and note if a larger- or smaller-than-normal cuff size is used. Either the stethoscope diaphragm or bell may be used for auscultatory readings.
Step 3: Take the proper measurements needed for diagnosis and treatment of elevated BP/hypertension	At the first visit, record BP in both arms. Use the arm that gives the higher reading for subsequent readings. Separate repeated measurements by one to two minutes. For auscultatory determinations, use a palpated estimate of radial pulse obliteration pressure to estimate SBP. Inflate the cuff 20 to 30 mmHg above this level for an auscultatory determination of the BP level. For auscultatory readings, deflate the cuff pressure 2 mmHg per second, and listen for Korotkoff sounds.
Step 4: Properly document accurate BP readings	Record SBP and DBP. If using the auscultatory technique, record SBP and DBP as onset of the first Korotkoff sound and disappearance of all Korotkoff sounds, respectively, using the nearest even number. Note the time of most recent BP medication taken before measurements.
Step 5: Average the readings	Use an average of ≥2 readings obtained on ≥2 occasions to estimate the individual's level of BP.
Step 6: Provide BP readings to patient	Provide patients the SBP/DBP readings both verbally and in writing
BP: blood pressure; DBP: diastolic blood pressure; SBP: systolic blood pressure.

uptodate