People with suspected elevated blood pressure should have all of their blood pressure measurements taken using:
Whelton PK, Carey RM, Aronow WS, Casey Jr DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith Jr SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams Sr KA, Williamson JD, Wright Jr JT. Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, Journal of the American College of Cardiology (2017), doi: 10.1016/j.jacc.2017.11.006
For diagnosis and management of high BP, proper methods are recommended for accurate measurement and documentation of BP.
National Heart Foundation of Australia. Guideline for the diagnosis and management of hypertension in adults – 2016. Melbourne: National Heart Foundation of Australia, 2016.
Finger and/or wrist blood pressure measuring devices are not recommended.
Leung AA, Nerenberg K, Daskalopoulou SS, et al. Hypertension Canada’s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can J Cardiol. 2016; 32(5): 569-588. doi: 10.1016/j.cjca.2016.02.066.
Measurement using electronic (oscillometric) upper arm devices is preferred over auscultation.
Use of standardized measurement techniques and validated equipment for all methods (office BP measurement taken with a non-automated device [non-AOBP], AOBP, home BP monitoring, and ambulatory BP monitoring) is recommended.
AOBP is the preferred method of performing in-office BP measurement (Grade D; new recommendation). When using AOBP (see the section on Recommended Technique for Automated Office Blood Pressure in Supplemental Table S2), a displayed mean SBP of >= 135 mm Hg or DBP >= 85 mm Hg DBP is high.
Patients should be advised to purchase and use only home BP monitoring devices that are appropriate for the individual and have met standards of the Association for the Advancement of Medical Instrumentation, the most recent requirements of the British Hypertension Society protocol, or the International Protocol for validation of automated BP measuring devices. Patients should be encouraged to use devices with data recording capabilities or automatic data transmission to increase the reliability of reported home BP monitoring (Grade D).
Ambulatory BP monitoring upper arm devices that have been validated independently using established protocols must be used (see www.dableducational.org) .
National Institute for Health and Care Excellence (NICE). Hypertension in adults: Diagnosis and management 2011. Available from: nice.org.uk/guidance/cg127. Accessed: August 2017.
Because automated devices may not measure blood pressure accurately if there is pulse irregularity (for example, due to atrial fibrillation), palpate the radial or brachial pulse before measuring blood pressure. If pulse irregularity is present, measure blood pressure manually using direct auscultation over the brachial artery.
Healthcare providers must ensure that devices for measuring blood pressure are properly validated, maintained and regularly recalibrated according to manufacturers' instructions.
If using an automated blood pressure monitoring device, ensure that the device is validated and an appropriate cuff size for the person's arm is used.