Measuring Blood Pressure at Home

Preparation and Environment

Patients should relax in a chair with feet flat on the floor and back supported for more than 5 minutes before measurement, avoiding caffeine, exercise, and smoking for at least 30 minutes, in a silent environment, with an empty bladder, as recommended by the American College of Cardiology, American Heart Association, and European Society of Cardiology, with a moderate level of evidence 1, 2, 3
A quiet environment with no talking during the rest period or measurement should be maintained, as recommended by the American Heart Association 3

A validated upper arm cuff device should be used, not wrist or finger devices, with the patient's arm supported at heart level, an appropriate cuff size (bladder encircling 80% of the arm), and the middle of the cuff positioned on the patient's upper arm, as recommended by the American College of Cardiology, European Heart Journal, and journal Hypertension, with a high level of evidence 1, 2, 3, 4, 5
All clothing covering the location of cuff placement should be removed, as suggested by the American Heart Association 3

At the first visit, blood pressure should be measured in both arms, and the arm with the higher reading should be used for subsequent measurements, as recommended by the American College of Cardiology and the American Heart Association, with a moderate level of evidence 1, 2, 3
At least two readings, separated by 1-2 minutes, should be taken, and the readings should be averaged to determine blood pressure level, according to the American College of Cardiology and the American Heart Association 2, 3
The radial pulse should be palpated, the cuff inflated until the pulse disappears (pulse obliteration pressure), and this value noted as an estimate of systolic blood pressure, with a high level of evidence, as recommended by the American College of Cardiology 1, 2, 6
The cuff should be inflated 20-30 mmHg above the pulse obliteration pressure, a stethoscope placed over the brachial artery, the cuff deflated at a rate of 2 mmHg per second, and Korotkoff sounds listened for, with a high level of evidence, as suggested by the American Heart Association 1, 2, 6
Systolic blood pressure should be recorded as the onset of the first Korotkoff sound (phase 1) and diastolic blood pressure as the disappearance of all Korotkoff sounds (phase 5), using the nearest even number when recording values, with a moderate level of evidence, as recommended by the American College of Cardiology 1, 2

Out-of-office measurements should be considered if a white coat effect is suspected, with a moderate level of evidence, as recommended by the European Society of Cardiology 2, 3
Oscillometric monitors may not be accurate in patients with atrial fibrillation, and multiple auscultatory measurements are recommended, with a high level of evidence, as suggested by the American Heart Association 5
Orthostatic hypotension (≥20/10 mmHg drop at 1 and/or 3 min after standing) should be assessed at initial diagnosis, with a moderate level of evidence, as recommended by the European Society of Cardiology 5

Using an inappropriately sized cuff, taking only a single reading, measuring immediately after physical activity, eating, or drinking caffeine, measuring through clothing, and inadequate rest time can lead to falsely elevated readings, as noted by the American Heart Association, European Society of Cardiology, and European Heart Journal 1, 3, 6, 5
Healthcare professionals should undergo regular retraining in blood pressure measurement technique every 6 months, with a moderate level of evidence, as recommended by the American Heart Association 7