Measuring Blood Pressure Checklist

Prepare the Patient

  • Ask patients to empty their bladder prior to checking blood pressure, to avoid elevated readings.1
  • Ensure clothing is not tight around the upper arm or covering the area where the cuff will be placed.1,4
  • Have patients sit in a chair, with both feet on the floor, back supported, and legs uncrossed.1-3
  • Allow patients to rest quietly for at least five minutes before checking blood pressure.1-3
  • Ideally, patients should not have engaged in activities that can raise blood pressure, such as:1,2
    • Exercised within the last 30 minutes
    • Consumed caffeine within the last 30 minutes (at least one hour per Canadian guidelines)
    • Used nicotine within the last 30 minutes (at least one hour per Canadian guidelines)
  • Avoid talking to or having patients talk while they are resting AND when taking blood pressure.1,4

Proper Equipment

  • Ensure automated equipment has been validated.1
    • Ensure equipment has been calibrated according to policy timelines.1,2
  • Use the correct cuff size for each patient (e.g., small adult, adult, large adult, adult thigh).
    • When positioning the cuff, the bladder of the cuff should be at least 80%, but not more than 100% of the way around a patient’s arm (use markings on the cuff to help with this).1,2,4
    • The width of the bladder should be about 40% of the patient’s arm circumference.4

Proper Technique

  • Ensure the patient’s arm is supported at the level of the heart.1,2
  • Place the cuff in the middle of the upper arm, 1 inch (about 2 to 3 cm) above the bend of the elbow.1,2,4
    • The center of the cuff bladder should be placed directly over the brachial artery.1,2,4
    • Cuff should be snug, allowing for only two fingers to slide between the arm and the cuff.5
  • When taking a manual measurement (e.g., using a stethoscope and sphygmomanometer)
    • Determine pulse-obliteration pressure to avoid underestimation of blood pressure:1,5
      • Place the bell or diaphragm of the stethoscope over the brachial artery.6
      • Inflate cuff to a pressure above which you can no longer hear the pulse.
      • Slowly and fully deflate cuff at a rate of about 2 mmHg per second.
      • Note pressure at which radial pulse reappears. This is the pulse-obliteration pressure.
    • Inflate cuff about 20 mmHg above the pulse-obliteration pressure.1,4
    • Deflate the cuff by about 2 mmHg per second and note systolic and diastolic pressure.1,4
      • Pressure when the first Korotkoff sound appears is the systolic blood pressure (SBP).
      • Pressure when all Korotkoff sounds disappear is the diastolic blood pressure (DBP).
  • For a patient’s first blood pressure measurement, check pressure in both arms.1
    • If blood pressures differ between arms (e.g., >10 mmHg), use the arm with a higher pressure.1,2
  • Take two or three readings, separated by at least one minute, and average the readings.1,3

Documenting Measurements

  • Record average SBP and DBP and note where pressure was measured (e.g., right arm, left arm).1,2,4
  • Transfer blood pressures documented in progress notes to the vital signs section of the medical record.
    • This ensures all blood pressures are able to be reviewed when making treatment decisions.
  • Note specifics that should be considered with the measurement (e.g., when blood pressure meds were last taken; recent exercise, tobacco, or caffeine; date; time of day).1

Project Leader in preparation of this clinical resource (340102): Beth Bryant, Pharm.D., BCPS, Assistant Editor

References

  1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol 2017. doi: 10.1016/j.jacc.2017.11.006.
  2. Leung AA, Daskalopoulou SS, Dasgupta K, et al. Hypertension Canada’s 2017 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Can J Cardiol 2017;33:557-76.
  3. American Heart Association. Monitoring your blood pressure at home. November 2017. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Monitoring-Your-Blood-Pressure-at-Home_UCM_301874_Article.jsp#.Whw33VWnFEY. (Accessed November 27, 2017).
  4. American Medical Group Foundation. Provider toolkit to improve hypertension control. http://www.measureuppressuredown.com/hcprof/toolkit.pdf. (Accessed November 27, 2017).
  5. Williams JS, Brown SM, Conlin PR. Videos in clinical medicine. Blood pressure measurement. N Engl J Med 2009;360:e6.
  6. Kantola I, Vesalainen R, Kangassalo K, Kariluoto A. Bell or diaphragm in the measurement of blood pressure? J Hypertens 2005;23:499-503.

Cite this document as follows: Clinical Resource, Measuring Blood Pressure Checklist. Pharmacist’s Letter/Prescriber’s Letter. January 2018.

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