How to take an accurate blood pressure reading

By Bill Peckham

I've heard two presentations in the last couple weeks where the proper way to take a blood pressure was explained:

• Before the test, sit for five minutes with your back supported and your feet flat on the ground.
• Rest your arm on a table at the level of your heart.
• Wear short sleeves so your arm is exposed.  ...
• Get two readings, taken at least two minutes apart, and average the results.

I actually hadn't been doing any of this, and I don't think I've ever had someone take my blood pressure correctly.

Most of the time at the doctors office I'm sitting on the edge of an exam table with feet dangling, back not supported and it's taken with my arm by my side - never supported at heart level. Not to mention that at the doctors you're often being asked questions or conversing during the process. At home I would have to purposely sit quietly for five minutes (not talking isn't an issue) and then stack some pillows to get my arm level with my heart. And then take a second reading two quiet minutes later. I haven't seen any data on how much BP readings are impacted by each element or several taken together, but a wrong reading is a wrong reading.

This article from the American Medical Association offers a solution:

measuring a patient's blood pressure with a device set to automatically take a reading every 2.5 minutes. The patient was left alone, to minimize the white-coat effect, and the final six readings out of 10 were averaged. Researchers found that this achieved results comparable with ambulatory monitoring.

This might be hard to implement in the doctors office (though I can imagine that instead of reading old magazines while waiting at the doctor's, there could be purpose built blood pressure cubicles that would take a series of BP readings while soothing wellness messages were looped on a computer monitor) but this could be done at home. Blood pressure control is a key to health no matter what stage of CKD but it is critical for those using dialysis to manage CKD5. Getting an accurate reading would be the place to start good BP control. How to take an accurate reading should be common knowledge but so long as bad habits are modeled, people will continue to get and base their care on, incorrect readings.

Comments

[Miriam Lippel Blum]

I have peripheral vascular disease that impacts the blood vessels in my arms, as well as everywhere else. When I take a blood pressure I must wait at least 10 minutes before doing another because if I do it too soon I get an artificially low reading. If I kept doing blood pressures every two minutes they would just read lower and lower.

I also have very thin arms and if the cuff is too loose my BP will also read low when it really isn't. I used to have a heck of a time when I was on in-center hemo with the blood pressure cuffs reading low and having techs and nurses want to adjust my fluid goals based on faulty data.

Getting an accurate reading may be difficult for others like me with similar conditions.

[Zach]

Since my fistula is on my left arm, blood pressures are performed on my right arm. They should be taken on the left arm.

"How to take an accurate blood pressure" will just never happen for me.

[Bill Peckham]

@Zach I've read that you should take BPs in both arms and then average the two (not possible for those of us with fistulas) but I can't find anything indicating that one arm is more accurate then the other.

[Zach]

And then there are people on hemodialysis who have had fistulas placed in both arms over time and the blood pressure needs to be taken from the ankle.