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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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