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Hypertension Notebook

Consumer's Guide to BP Measurement

The Foundation for IgA Nephropathy
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Hypertension Notebook

Consumer's Guide to BP Measurement
Reproduced by permission:


Clarence E. Grim, BS, MS, MD.
Hypertension Research, Medical College of Wisconsin

Carlene M. Grim, BS, MSN, SpDN.
Shared Care Research and Education, Inc.

Although blood pressure is one of the most important measures of your health,
current research has revealed that blood pressure is almost never taken
correctly in the practice of medicine today.  By being an informed consumer can
you can help improve blood pressure measurements taken on you and your loved
ones.  Thanks for the help!

To assure that the person taking your blood pressure is doing this properly you
should ask them the following questions and request the correct steps.

1.  Do you have a certificate that states you have been trained and certified
to be an accurate blood pressure observer according to the new (1993) American
Heart Association's Guidelines?  Can I see your certificate?  Many health care
workers have not been updated on these new guidelines and are likely to make
errors that may result in an incorrect blood pressure (BP) reading.  

2.  When was the last time your hearing was checked to be certain that you can
hear my blood pressure sounds accurately?  Your life and the life of your loved
ones depends on the hearing of those who take their blood pressure.  

3.  When was the last time the equipment that you are using on me was checked
for accuracy?  Can I see the evidence that it was checked?  Many devices have
never been checked to assure accuracy!  Some may be off 30 mm Hg  (1 mm Hg is
one blood pressure unit).  A recent survey of devices in use in Green Bay
Wisconsin demonstrated that 1/3 should not have been in use.  A similar result
was found in Newfoundland. Errors as large as 50 mm have been found.

4.  Does my arm require a small, regular or large cuff? Please measure my arm
to be certain you are using the correct cuff for me.  If you need a large cuff
and a smaller one is used you may be falsely labeled as having high blood
pressure.  Errors of over 30 mm Hg can occur with the wrong cuff.

5.  Will you let me rest seated in a chair and leaning against the back for at
least five minutes before my blood pressure is checked?  Never let your health
care provider measure the BP on the exam table. This will lead to a falsely
high blood pressure.  On the average the error is 5 mm Hg too high.

6.  Will you first check about how high my blood pressure is by
feeling my pulse as you inflate the cuff until the pulse stops.... then let all
of the air out before listening to my blood pressure?  Failure to do this can
lead to errors of up to 100 mm Hg.

7.  Watch to be sure the observer deflates the cuff at 2 mm per second.  They
can be no more accurate that the rate at which the cuff is deflated.   10 mm Hg
errors are common.    

8.  Will you check my BP at least 2 times (3 is better)?  Failure to do this
may give a high value.  

9.  Will you check my blood pressure in both arms on my first visit?  Tell me
which arm is higher.  Always request that your blood pressure be checked in
your highest arm.  This will usually be on the right.  Some people have a 100
mm Hg difference in their arms.  

10.  What were my readings?  I want to keep a record of them.  

11.  What should I do about my blood pressure readings?  When should I have it
rechecked again?

The cuff I need is:  small, regular, large. Circle the one you doctor recommends.
The best arm to measure my blood pressure on is the:  right  or  left.
My blood pressure today was:  1 ____/____   2  ____/ ____   3 ____/____
My average was ____/____.        Recheck again on ____/____/____.    

Other tips:  

It is good to be sure your pressure at each visit is measured by the same
person on the same arm using the same cuff and the same instrument. This makes
it more likely that if your measured BP today differs by much from the last
visit that it is truly a change in the blood pressure and not because a
different person used a different instrument.

The most accurate and reliable instrument is a mercury manometer.  Look to see
if the top of the mercury column is at the zero line and that the tube is

If an aneroid gauge is used see if the needle returns to zero or the little box
at the bottom of the dial.  If it does not then inform the observer that this
device is likely not accurate and you would like to have another device used.  

If the office uses an electronic device be sure they always take at least 3
readings.  These devices have much more variation than a trained human and a
single reading is likely to be off.  

If the office uses an electronic device insist that your pressure be checked by
the hearing method and the electric.  The hearing method is what we have based
all of our previous methods and we don't know if the electronic devices are as
good in the long run.  

Learn to take your own blood pressure.  If you can hear use one that you listen
to.  If you use an electronic be sure your Dr. checks it by listening to the BP
as it takes it to be sure the machine is reading accurately.   

For information on how to purchase teaching videotapes on how to take a BP or
how to take your own BP contact

(c) 1996 Shared Care

© 2002-2006 Foundation for IgA Nephropathy

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