Blood Pressure measurement at home and in the clinic is often fraught with casual error, such as having feet dangling, an unsupported back and arm, and arm below heart level.
Why this matters
The most recent hypertension guidelines stress accurate measurement. The American Heart Association offers a handy visual for patient or clinic use or display, covering steps to take before, during, and after BP measurement.
How many of these common mistakes do you make?
• Cuff over clothing: this can add 50 mmHg to a reading, depending on the clothing thickness.
• No resting before measurement: the patient should sit quietly for 5 minutes.
• Using a cuff that is the wrong size: too small can mean adding 2-10 mmHg to a measurement.
• Talking: the act of listening can raise BP by as much as 10 mmHg.
• Any measurement that yields an inaccurately high BP can mean a patient who suddenly has a hypertension diagnosis, especially with cutoffs now at 130/80 mmHg.
Care should always be taken before giving someone a chronic disease label. In 1 BP challenge of 160 medical students during an American Medical Association meeting, students had to perform 11 elements of the process correctly. Only 1 student did so. Average was only 4 of the 11. No effect of first- vs fourth-year or specialty.