Hypertension

Proper technique for blood pressure measurement

Type	Recommendations
Patient positioning	Patient should relax and sit in chair Feet on floor with back supported Avoid caffeine, exercise, or smoking 30 minutes before measurement Ideally empty bladder before measurement
Blood pressure cuff	Cuff should be placed on skin under clothing and not on clothing Cuff should be appropriate size to patient’s arm Place cuff and support arm to level of heart Place stethoscope (bell or diaphragm) slightly under cuff at brachial artery Inflate cuff 20-30 mm Hg above usual BP reading Slowly deflate 2-4 mm Hg/second and listen for Korotkoff sounds First Korotkoff sound is SBP and disappearance of sounds is DBP
Cuff sizes	*Small adult* 22-26 cm *Adult* 27-34 cm *Large adult* 35-44 cm *Adult high* 45-52 cm
Special measurements	*Suspected orthostatic (postural) hypotension* Measure BP in supine, sitting, and/or upright positions SBP decrease > 20 mm Hg confirms diagnosis *Suspected peripheral arterial disease* Measure readings in left and right arms SBP difference > 15 mm Hg suggests subclavian stenosis
Ambulatory blood pressure monitoring (ABPM)	Record BP at preset intervals (eg, every 15-20 minutes during daytime and/or 30 minutes during sleep) *Indications for ABPM* Suspected white coat hypertension Suspected episodic hypertension Resistant hypertension Autonomic dysfunction Hypotension while taking antihypertensives
Home blood pressure monitoring (HBPM)	Use validated blood pressure cuff and measure over brachial artery Measure both morning and evening readings (12-14 preferred) over a week

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