How to measure home blood pressure: Recommendations for healthcare professionals and patients (2022)

Home blood pressure (BP) monitoring, the self-measurement of BP in the home, away from a medical environment, provides a greater number of BP readings that are more reliable for assessment of true underlying BP than clinic BP measurement. While 24-hour ambulatory BP monitoring is the gold standard method to assess BP control, it is not always practical to use this in general practice. Home BP monitoring is already in widespread use,1 but many factors can affect the reliability of BP readings. A standardised approach to measuring home BP is recommended to help minimise error.

The purpose of this article is to provide a practical summary guide for Australian healthcare professionals and their patients on how to measure home BP using a standardised, evidence-based protocol. Pragmatic resources for ease of clinical implementation are also provided. It is beyond the scope of this paper to provide a detailed rationale for using home BP monitoring in general practice. This topic is extensively addressed in several international guidelines,2–4 including an Australian consensus statement5 in which evidence is provided to show that home BP monitoring offers advantages beyond clinic BP measurement in terms of:

  • better evaluation of BP control
  • better prognostic indication
  • greater engagement of patients
  • improved compliance with drug therapy.

Standardised measurement of home BP

What type of BP device touse?

The BP device should be validated, automated, preferably with memory storage, and used with a correctly sized upper arm cuff. Device validity should be tested in the patient population intended for its use.4 A list of validated devices can be found at www.bhsoc.org/bp-monitors/bp-monitors (Figure 1).

How to measure home blood pressure: Recommendations for healthcare professionals and patients (1)
Figure 1. Standardised method on how to measure home blood pressure
Downloadable version

Inaccurate recording of home BP using patient diaries6–8 is a problem that can be circumvented by using BP devices with memory storage or telemonitoring, if feasible. An appropriately sized cuff that fits the arm within the appropriate range indicated on the cuff must be used. A cuff that is too small will overestimate BP and a cuff that is too large will underestimate BP.9 Wrist and finger cuff monitors are less likely to have passed validation testing and should be avoided.4 A validated wrist device may be a reasonable option in patients with a large arm circumference that is beyond the maximum cuff range. Intermittent servicing (eg every three years) to check device condition and accuracy is generally recommended, and devices should be serviced or replaced if the accuracy is questionable. This process can be carried out through contact with the local distributor of the device.

(Video) How to Use Your Home Blood Pressure Monitor

When should home BP be taken?

Ask the patient (and provide written material) to measure their BP at around the same time in the morning and the evening over a seven-day period. Monitoring may be for initial assessment of BP, but also to assess the effectiveness of treatment, and typically would include the following options:

  • the seven-day period before a clinic visit
  • approximately four weeks after initiating a change in medication10
  • at regular, long-term intervals (eg six months) in keeping with appropriate clinical follow-up according to cardiovascular risk.11,12

The repeat measurement of home BP over seven days helps to narrow the variability of BP around the true mean BP value,13 and generally provides the highest prognostic and diagnostic capacity in comparison with shorter monitoring periods.14,15 However, a minimum of five days may also provide a good indication of BP control.16

Home BP should be recorded in the morning and evening before medication (if treated).17-–20 Home BP may also be recorded at other times, such as in the late morning when BP may be at the lowest for the day (particularly if medications are taken in the morning, or if symptoms suggest), and their measurement may help protect against over-medication. Late morning readings may also provide guidance on optimising the timing of medications (eg morning versus night-time), assisted by 24-hour ambulatory BP monitoring where necessary. Home BP should be taken after voiding and before food or vigorous exercise, as all these factors can affect BP. Caffeine and cigarettes can each acutely raise BP21,22 and BP measurement should be undertaken before, or at least 30minutes after, these stimulants.

How should home BP be taken?

Two measurements should be taken in a quiet room after five minutes of seated rest, with readings taken one minute apart. BP should be recorded immediately in a diary (Figure 2) if the device has no memory function or is not telemonitored. The overall home BP value is derived by averaging the BP values over the seven-day monitoring period after discarding the first day of readings (ie average of 24 home BP readings). Electronic recording of BP values directly into a Microsoft Excel spreadsheet with automatic averaging of BP values is available online.

How to measure home blood pressure: Recommendations for healthcare professionals and patients (2)

Figure 2. Example home blood pressure diary
Download paper version
Download electronic version

(Video) Blood Pressure Measurement: How to Check Blood Pressure Manually

An average home BP measurement of ≥135/85 mmHg is an appropriate threshold for the diagnosis of hypertension.5

The patient should be in the seated position with feet flat on the floor, legs uncrossed, upper arm bare, back supported and arm supported in a relaxed position with the cuff at heart level (Figure1). If the cuff is significantly above or below heart level, the BP measurements may be decreased or increased respectively.23 If the cuff is applied so that its midpoint is about the midpoint of the upper arm, this will approximate the level of the heart. Patients should not be distracted (eg talking, watching television). Similarly, if the patient is affected by extremes of temperature, or is uncomfortable, stressed or in pain, BP should not be taken.

After five minutes of rest, the patient should take two consecutive measurements one minute apart and, after each measurement, record the systolic and diastolic BP. If patients are not compliant with a rest period before recording BP, this could lead to higher home BP values.24 They should be asked to note in the diary anything unusual that may affect readings. Standing BP measurements may be requested when orthostatic hypotension is suspected; BP measurements at one and three minutes after standing are recommended.5

Key points

  • Home BP monitoring provides a more reliable assessment of true underlying BP than clinic BP measurement.
  • Many factors can affect reliability of home BP monitoring and a standardised approach is advised in order to minimise error.
  • Standardised measurement includes:
    • using a validated BP device with correct cuff size
    • duplicate measurements in the morning and evening over seven days (five days minimum)
    • measurements being taken in a quiet room after five minutes of seated rest (record in a diary).
  • Average home BP ≥135/85 mmHg is the threshold for diagnosis of hypertension.
  • Practical materials (Figures 1, 2 and the electronic home BP diary) are accessible on the AFP website. Links to these materials are provided in the figure legends and the ‘Resources’ section.

Authors

James Sharman BHMS (Hons), PhD, Associate Professor and Senior Research Fellow, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS. james.sharman@utas.edu.au

(Video) 12 Tips to Get an Accurate Blood Pressure Measurement

Faline Howes MBBS, General Practitioner, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS

Geoffrey Head BSc, PhD, NHMRC Principal Research Fellow, Baker IDI Heart and Diabetes Institute, Melbourne, VIC

Barry McGrath MBBS, PhD, Professor of Vascular Medicine & Medicine, Monash University, Clayton, VIC

Michael Stowasser MBBS, PhD, Professor of Medicine, Director of the Hypertension Units, Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, QLD

Markus Schlaich MBBS, PhD, Renal Physician and Hypertension Specialist, Baker IDI Heart and Diabetes Institute, Melbourne, VIC; School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, WA

(Video) Bad Blood Pressure Measurement Is Killing Our Patients | AMA 29

Paul Glasziou MBBS, PhD, General Practitioner and Professor of Evidence-Based Medicine, Centre for Research in Evidence Based Practice, Bond University, QLD

Mark R Nelson MBBS, PhD, Chair, Discipline of General Practice, and Senior Professorial Fellow, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS

Competing interests: None.
Provenance and peer review: Not commissioned, externally peer reviewed.

Acknowledgements

This paper has been endorsed by the High Blood Pressure Research Council of Australia and the National Heart Foundation of Australia. The writing group is very grateful to Jinty Wilson from the National Heart Foundation of Australia for her significant input to the content of this paper.

Resources

  • How to measure home BP
  • Home BP diary (paper)
  • Home BP diary (electronic)

FAQs

What are the recommended guidelines for monitoring blood pressure at home? ›

Monitoring Schedule

A common recommendation is that self-measured BP monitoring be based on 2 measurements taken at least 1 minute apart in the morning and evening (ie, 4 readings per day) optimally for 7 days (ie, 28 readings total) with a minimum of 3 days (ie, 12 readings total).

How do health care professionals measure my blood pressure? ›

How do health care professionals measure my blood pressure? First, a health care professional wraps an inflatable cuff around your arm. The health care professional then inflates the cuff, which gently tightens on your arm. The cuff has a gauge on it that will measure your blood pressure.

When teaching patients how do you assess their own blood pressure at home what should you remind them to do? ›

Home BP should be measured using a validated, automatic BP device (preferably with memory storage), using an appropriately sized upper arm cuff. Measurements should be taken after five minutes of seated rest and before medication, food or vigorous exercise.

Which method of blood pressure measurement is commonly used in the home setting? ›

Measurement of home blood pressure

Patients should use automated brachial blood pressure monitors that have been validated30,35,49 and calibrated annually against standardized clinic measurements. Use of the arm cuff is preferred compared to wrist and finger monitors.

What is the gold standard for measuring blood pressure? ›

Although the mercury sphygmomanometer is widely regarded as the “gold standard” for office blood pressure measurement, the ban on use of mercury devices continues to diminish their role in office and hospital settings.

How accurate are home blood pressure monitors? ›

But home blood pressure monitors aren't always as accurate as they should be. "Home blood pressure monitors may be inaccurate in 5% to 15% of patients, depending on the threshold for accuracy used," according to Dr.

Which of the following is the proper way to take a blood pressure measurement quizlet? ›

To determine blood​ pressure, the EMT should position the cuff over the upper arm and place the stethoscope over the brachial artery. ​ Next, she should inflate the​ cuff, then slowly deflate the​ cuff, listening for clicks or tapping sounds while remembering the number at the first sound.

How do you get a accurate blood pressure reading? ›

Simple Tips to Get an Accurate Blood Pressure Reading at Home
  1. Check your device's accuracy. ...
  2. Measure your blood pressure twice daily. ...
  3. Don't measure your blood pressure right after you wake up. ...
  4. Avoid food, caffeine, tobacco and alcohol for 30 minutes before taking a measurement. ...
  5. Sit quietly before and during monitoring.
21 Aug 2019

What are the three most important steps in measuring blood pressure? ›

Step-by-Step Blood Pressure Check
  • Locate your pulse. Locate your pulse by lightly pressing your index and middle fingers slightly to the inside center of the bend of your elbow (where the brachial artery is). ...
  • Secure the cuff. ...
  • Inflate and deflate the cuff. ...
  • Record your blood pressure.
6 May 2021

What are the nursing responsibilities while taking blood pressure of a patient? ›

- The blood pressure should be recorded to the nearest 2mmHg - to maintain accuracy. - Nurses should wash their hands thoroughly between patients to eliminate the risk of cross infection. - The correct size cuff should be used - the wrong size cuff will lead to an inaccurate measurements.

How is home blood pressure heart Foundation measured? ›

Sit with your feet flat on the ground. Keep the top half of your arm bare and your back and arm supported and in a relaxed position. Measure your blood pressure for 7 days (minimum 5 days) at around the same time in the morning and in the evening. Each time you measure, take 2 readings, 1 minute apart.

What is the difference between clinic blood pressure and home blood pressure? ›

Some people consistently get different blood pressure readings outside the doctor's office — even when blood pressure is measured correctly and repeatedly. If your home blood pressure readings are accurate and consistently higher than those at your doctor's office, you might be at risk for a heart attack or stroke.

Which instrument is used to measure blood pressure and what is its normal range in general? ›

A sphygmomanometer has three parts: a cuff that can be inflated with air, a pressure meter (manometer) for measuring air pressure in the cuff, and. a stethoscope for listening to the sound the blood makes as it flows through the brachial artery (the major artery found in your upper arm).

Why is accurate measurement of blood pressure important? ›

Accurate blood pressure measurement is therefore vital in the prevention and treatment of blood-pressure–related diseases. Additionally, in very ill patients, accurate measurement of blood pressure is essential for monitoring cardiovascular homeostasis.

Which instrument is used for measuring blood pressure? ›

Overview. To measure blood pressure, your doctor uses an instrument call a sphygmomanometer, which is more often referred to as a blood pressure cuff. The cuff is wrapped around your upper arm and inflated to stop the flow of blood in your artery.

When should you measure blood pressure? ›

At the beginning, measure your blood pressure at least twice daily. Take it first in the morning before eating or taking any medications. Take it again in the evening. Each time you measure, take two or three readings to make sure your results are the same.

How do you take blood pressure at home with a cuff? ›

How To Take Blood Pressure Correctly - YouTube

What is the best way to measure a client's blood pressure? ›

Press firmly to feel the brachial pulse. Wrap the blood pressure cuff securely and evenly around the client's upper, bare arm (not over clothing) with the cuff's artery marker aligned with the brachial artery and about 3cm above the antecubital fossa.

What is a normal blood pressure by age? ›

Normal Blood Pressure By Age
AgeSBP
Male51-55125.5
56-60129.5
61-65143.5
Female21-25115.5
14 more rows

What are the principles of blood pressure maintenance? ›

Here is what the numbers mean: Systolic pressure less than 120 and diastolic less than 80 means normal blood pressure. Systolic between 120 and 139 and diastolic between 80 and 89 means prehypertension.
...
Here's how:
  • Exercise. ...
  • Lose excess weight. ...
  • Eat healthily. ...
  • Shake the salt habit. ...
  • Put the brakes on smoking and drinking.
8 Jul 2010

What is the most accurate blood pressure monitor for home use 2022? ›

1. Omron Platinum: Most accurate blood pressure monitor.

Are home blood pressure monitors accurate compared to validated devices? ›

Researchers say part of the problem is discrepancies between medical device approval and medical device validation. If you have an at-home blood pressure monitor, the reading may not be as accurate as you think.

What time of day is blood pressure the highest? ›

Blood pressure has a daily pattern. Usually, blood pressure starts to rise a few hours before a person wakes up. It continues to rise during the day, peaking in midday. Blood pressure typically drops in the late afternoon and evening.

What is blood pressure and how is it measured quizlet? ›

Blood pressure is measured in millimeters of mercury (mmHg). A blood pressure cuff is inflated to temporarily halt the flow of blood through an artery. The air is then slowly let out of the cuff to allow blood flow to resume, which allows the pressure exerted by the flow to be measured through the pressure gauge.

When taking someone's systolic blood pressure you are measuring the pressure created by the quizlet? ›

Systolic blood pressure is measured when the ventricles contract. Diastolic pressure is measured when the ventricles relax.

When measuring blood pressure the position of the cuff should be quizlet? ›

Center the inner bladder over the brachial pulse site. Place cuff approximately 1-2 inches above the bend of their elbow. Wrap cuff smoothly and snugly around the patient's arm, and secure the end of it.

What is the most accurate blood pressure reading? ›

Omron Platinum Wireless Upper Arm Blood Pressure Monitor

It averages three readings taken within a span of two minutes to provide the most precise reading of your blood pressure, and it can provide a side-by-side comparison of your current and previous readings to help you track health information over time.

Which BP reading is more accurate first or second? ›

Solely relying on your first blood pressure reading may lead to an inaccurate diagnosis because it's usually higher than the second reading. Your doctor or nurse should take more than one reading and compare the results for better accuracy.

What are the new blood pressure guidelines for seniors 2022? ›

The new guidelines change nothing if you're younger than 60. But if you're 60 or older, the target has moved up: Your goal is to keep your blood pressure at 150/90 or lower. If you have kidney disease or diabetes, your target used to be 130/80 or lower; now it's 140/90 or lower.

What are the common causes of errors in blood pressure readings? ›

Acute meal ingestion, caffeine or nicotine use can all negatively affect BP readings, leading to errors in measurement accuracy. If the patient has a full bladder, that can lead to an error in systolic BP of between 4 mm Hg and 33 mm Hg, compared with the white-coat effect can have an error of up to 26 mm Hg.

Do your feet have to be on the floor when taking blood pressure? ›

When blood pressure is measured, subjects should be instructed to have feet flat on the floor to eliminate a potential source of error.

How do I know if my blood pressure monitor is accurate? ›

Check for accuracy

If the systolic blood pressure (the top number) on your cuff is within 10 points of the monitor, then it's generally accurate,” he says. Most home blood pressure machines last for about two or three years. After that, check it at your doctor's office annually to make sure it's still accurate.

What should the nurse do if the patient's blood pressure is not within normal limits? ›

What should the nurse do if the patient's blood pressure is not within normal limits? Review the blood pressure readings in the patient's record. Assess for proper cuff size and arm positioning. Promptly report the assessment data to the nurse in charge or to the health care provider.

How do nurses take blood pressure manually? ›

How to Take a Blood Pressure Measurement Manually - YouTube

When should a blood pressure be reported to the nurse immediately? ›

Always contact your nurse or doctor if your systolic—top—pressure is above 180 or your diastolic—bottom—pressure is above 110.

What are the recommended guidelines for monitoring blood pressure at home? ›

Monitoring Schedule

A common recommendation is that self-measured BP monitoring be based on 2 measurements taken at least 1 minute apart in the morning and evening (ie, 4 readings per day) optimally for 7 days (ie, 28 readings total) with a minimum of 3 days (ie, 12 readings total).

When teaching patients how do you assess their own blood pressure at home what should you remind them to do? ›

Home BP should be measured using a validated, automatic BP device (preferably with memory storage), using an appropriately sized upper arm cuff. Measurements should be taken after five minutes of seated rest and before medication, food or vigorous exercise.

What is the gold standard for measuring blood pressure? ›

Although the mercury sphygmomanometer is widely regarded as the “gold standard” for office blood pressure measurement, the ban on use of mercury devices continues to diminish their role in office and hospital settings.

How accurate are home blood pressure machines? ›

But home blood pressure monitors aren't always as accurate as they should be. "Home blood pressure monitors may be inaccurate in 5% to 15% of patients, depending on the threshold for accuracy used," according to Dr.

Is blood pressure at home accurate? ›

SEATTLE — Blood pressure measurements routinely taken at home are more likely to provide the basis for accurate diagnoses of hypertension than those taken in a clinic setting, according to a new study led by Kaiser Permanente investigators.

Which is more accurate digital or manual blood pressure readings? ›

A digital blood pressure monitor will not be as accurate if your body is moving when you are using it. Also, an irregular heart rate will make the reading less accurate. However, digital monitors are the best choice for most people.

What are the two methods of assessing blood pressure? ›

If manually, he or she will place a stethoscope over the major artery in your upper arm to listen to the blood flow and pulse as the cuff inflates and deflates. If using an automated device, the blood pressure cuff automatically inflates, deflates, and measures pressure.

What are the steps to measure blood pressure? ›

Step-by-Step Blood Pressure Check
  1. Locate your pulse. Locate your pulse by lightly pressing your index and middle fingers slightly to the inside center of the bend of your elbow (where the brachial artery is). ...
  2. Secure the cuff. ...
  3. Inflate and deflate the cuff. ...
  4. Record your blood pressure.
6 May 2021

What is the average blood pressure for a 70 year old? ›

Normal blood pressure for most adults is defined as a systolic pressure of less than 120 and a diastolic pressure of less than 80.

Why is blood pressure higher in the morning? ›

Circadian rhythm is a 24-hour cycle that affects our sleep/wake patterns. In the morning, the body releases hormones such as adrenaline and noradrenaline. These hormones give you boosts of energy but can also raise your blood pressure.

How often should you check your blood pressure with hypertension? ›

“I advise people diagnosed with hypertension to check their blood pressure twice per day until they have it under control,” she says. “After that, it's fine to check it one to two times per week.” If your blood pressure is abnormally high or low when you're checking it at home, don't panic.

How accurate are home blood pressure monitors? ›

But home blood pressure monitors aren't always as accurate as they should be. "Home blood pressure monitors may be inaccurate in 5% to 15% of patients, depending on the threshold for accuracy used," according to Dr.

What's the best time to take blood pressure medicine morning or night? ›

23, 2019 (HealthDay News) -- Taking blood pressure medications at bedtime rather than in the morning nearly halves the risk of dying from a heart attack, stroke or heart failure, a large, new study finds.

What time of day is blood pressure the highest? ›

Blood pressure has a daily pattern. Usually, blood pressure starts to rise a few hours before a person wakes up. It continues to rise during the day, peaking in midday. Blood pressure typically drops in the late afternoon and evening.

What is the best time to measure blood pressure? ›

At the beginning, measure your blood pressure at least twice daily. Take it first in the morning before eating or taking any medications. Take it again in the evening. Each time you measure, take two or three readings to make sure your results are the same.

What is the most accurate blood pressure monitor for home use 2022? ›

1. Omron Platinum: Most accurate blood pressure monitor.

How do you get a accurate blood pressure reading? ›

How do I get the most accurate measurement? Do not smoke, drink caffeinated beverages or exercise within 30 minutes before measuring your blood pressure. It's important to use a cuff that fits your arm. Cuffs that are too small can artificially raise your blood pressure reading.

Are home blood pressure monitors accurate compared to validated devices? ›

Researchers say part of the problem is discrepancies between medical device approval and medical device validation. If you have an at-home blood pressure monitor, the reading may not be as accurate as you think.

What is the average blood pressure for a 70 year old? ›

Normal blood pressure for most adults is defined as a systolic pressure of less than 120 and a diastolic pressure of less than 80.

Why is the first blood pressure reading always the highest? ›

Your first blood pressure reading will almost always be higher than the second due to a wide range of factors, both environmental and psychological. These factors include white coat syndrome, stress, and having a full bladder.

How long after you wake up should you take your blood pressure? ›

Your blood pressure should be checked in the morning, about an hour after you wake up, and in the evening, about an hour before you go to sleep, using the same arm each time. Taking 3 consecutive measurements (about 1 minute apart) will provide a more accurate understanding of your "true" blood pressure.

Can drinking water lower blood pressure? ›

Something as simple as keeping yourself hydrated by drinking six to eight glasses of water every day improves blood pressure. Water makes up 73% of the human heart,¹ so no other liquid is better at controlling blood pressure.

Can you take blood pressure and cholesterol medicine at the same time? ›

Taking daily doses of two blood pressure drugs (fixed dose candesartan and hydrochlorothiazide) along with a cholesterol-lowering drug (low-dose rosuvastatin), proved to be the most effective, cutting first-time strokes by 44 percent among patients at intermediate risk for heart disease.

Can a tight blood pressure cuff cause a high reading? ›

If the cuff is too small, it can add 2 to 10 points to your bp measurement. Be sure to roll up your sleeve for a blood pressure test and also let your doctor know if the cuff feels too tight around your arm.

How soon after eating salt does it affect blood pressure? ›

Consuming highly salty foods may begin to impair the functioning of blood vessels within 30 minutes, according to new research published in the American Journal of Clinical Nutrition.

Does drinking a lot of water increase blood pressure? ›

Water drinking also acutely raises blood pressure in older normal subjects. The pressor effect of oral water is an important yet unrecognized confounding factor in clinical studies of pressor agents and antihypertensive medications.

Videos

1. Self-Measurement: How patients and care teams are bringing blood pressure to control
(NACHC)
2. Measuring Blood Pressure at Home
(Gerald L. Ignace Indian Health Center)
3. Home Blood Pressure Monitoring – Its advantages and future perspectives
(OMRON Healthcare EU)
4. High Blood Pressure? A UK Doctor's View - Home Monitoring Is Better! - FREE Home BP Sheet
(Everything Home)
5. How To Measure Blood Pressure At Home With Digital Machine
(Dr Joe TV)
6. Release the Pressure Self-Measured Blood Pressure (SMBP) Training Video
(American Medical Association (AMA))

Top Articles

You might also like

Latest Posts

Article information

Author: Ray Christiansen

Last Updated: 12/01/2022

Views: 5974

Rating: 4.9 / 5 (69 voted)

Reviews: 92% of readers found this page helpful

Author information

Name: Ray Christiansen

Birthday: 1998-05-04

Address: Apt. 814 34339 Sauer Islands, Hirtheville, GA 02446-8771

Phone: +337636892828

Job: Lead Hospitality Designer

Hobby: Urban exploration, Tai chi, Lockpicking, Fashion, Gunsmithing, Pottery, Geocaching

Introduction: My name is Ray Christiansen, I am a fair, good, cute, gentle, vast, glamorous, excited person who loves writing and wants to share my knowledge and understanding with you.