Table

Guidelines for Clinic (or Office) BP Measurement

Posture
 BP obtained in the seated position is recommended. The subject should sit quietly for 5 min, with the back supported in a chair, with feet on the floor and the arm supported at the level of the heart, before BP is recorded.
Circumstances
 No caffeine should be ingested during the hour preceding the reading, and no smoking during the 30 min preceding the reading.
 A quiet, warm setting should be available for BP measurements.
Equipment
 Cuff size
  The bladder should encircle and cover at least 80% of the length of the arm; if it does not, use a larger cuff. If bladder is too short, misleadingly high readings may result.
Manometer
 Use a validated electronic (digital) device, a recently calibrated aneroid or mercury column sphygmomanometer.
Technique
 Number of readings
  On each occasion, take at least 2 readings, separated by as much time as is practical. If readings vary by >10 mm Hg, take additional readings until 2 consecutive readings are within 10 mm Hg.
  If the arm pressure is elevated, take the measurement in 1 leg to rule out aortic coarctation (particularly in patients <30 y of age).
  Initially, take pressures in both arms; if the blood pressures differ, use the arm with the higher pressure.
  If the initial values are elevated, obtain 2 other sets of readings at least 1 wk apart.
Performance
 Inflate the bladder quickly to a pressure 20 mm Hg above the systolic BP, as recognized by the disappearance of the radial pulse; deflate the bladder at 2 mm Hg/s.
 Record the Korotkoff phase I (appearance) and phase V (disappearance) sounds. If the Korotkoff sounds are weak, have the patient raise the arm, then open and close the hand 5–10 times, and then reinflate the bladder quickly.

BP indicates blood pressure.