Office blood pressure is easily raised by technique and setting. Measure after five minutes seated, back supported, feet flat, arm at heart level, with a cuff sized to the arm and nothing said during the reading. Take at least two readings a minute or two apart and use the average.
Before labelling a patient, confirm a raised office value out of the clinic with home readings over several days or ambulatory monitoring. This catches white-coat hypertension and its opposite, masked hypertension, which a single clinic reading misses.
- Seat the patient for five minutes, back supported, arm at heart level, before measuring.
- Use a cuff that fits the arm; a small cuff on a large arm reads falsely high.
- Average at least two readings, and measure both arms at the first visit.
- Confirm raised office readings with home or ambulatory monitoring before diagnosing or reclassifying.
- Teach patients to take home readings twice daily for several days before review.
Why it matters
Stricter categories make measurement error more costly, because more patients sit near a cut-off.
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