How do you instruct a patient to take their blood pressure?

Instructions for Blood Pressure Measurement

Patients should be instructed to follow a standardized protocol for blood pressure measurement that includes proper preparation, positioning, and technique to ensure accurate readings.

Patient Preparation

• Have the patient relax in a seated position with back supported and feet flat on floor for at least 5 minutes before measurement 1
• Instruct the patient to avoid caffeine, exercise, and smoking for at least 30 minutes before measurement 1, 2
• Ensure the patient has emptied their bladder before measurement 1, 3
• Neither the patient nor anyone else should talk during the rest period or during the measurement 1, 4
• Remove all clothing covering the location of cuff placement 1, 3

Proper Positioning

• The patient should be seated in a chair with back supported and feet flat on the floor 1
• Support the patient's arm (e.g., resting on a desk) at heart level (midpoint of the sternum) 1
• Position the middle of the cuff on the upper arm at the level of the right atrium 1, 3
• Ensure the arm is relaxed and not tensed during measurement 1, 4

Cuff Selection and Application

• Use the correct cuff size, such that the bladder encircles 80% of the arm 1, 3
• Apply the cuff snugly around the bare upper arm 1, 4
• For electronic devices, squeeze all residual air out of the cuff before applying it 4
• Note if a larger or smaller-than-normal cuff size is used 1, 3

Measurement Technique

• Use a validated blood pressure measurement device that has been calibrated periodically 1
• At the first measurement, record BP in both arms and use the arm with the higher reading for subsequent measurements 1
• For auscultatory readings, inflate the cuff 20-30 mm Hg above the estimated systolic pressure 1
• Deflate the cuff pressure at 2 mm Hg per second for auscultatory readings 1
• Record systolic BP at the onset of the first Korotkoff sound and diastolic BP at the disappearance of all Korotkoff sounds 1

Multiple Readings and Documentation

• Take at least two readings separated by 1-2 minutes 1, 2
• For home monitoring, instruct patients to take two readings in the morning and two in the evening for at least one week 2
• Calculate the average of multiple readings to estimate the individual's level of BP 1
• Document the BP readings both verbally and in writing for the patient 1
• Note the time of most recent BP medication taken before measurements 1

Common Pitfalls to Avoid

• Avoid measuring BP with the patient sitting on an examination table without back or arm support 1, 3
• Do not measure BP over clothing, which can lead to falsely elevated readings 3, 4
• Avoid relying on a single measurement; multiple readings on different occasions are necessary 1, 3
• For wrist devices, maintain the wrist at heart level and in the neutral position (not flexed or extended) 5, 6
• Avoid using finger-based BP monitors as they are less reliable than upper arm devices 5, 6

Special Considerations for Home Blood Pressure Monitoring

• Recommend using validated upper-arm cuff devices rather than wrist or finger devices 2, 6
• Instruct patients to follow the same protocol for each measurement 2
• Advise patients to bring their device to appointments for accuracy verification 2
• Explain that home readings are typically lower than office readings 2
• Instruct patients to keep a log of their readings to share with healthcare providers 2