General recommendations for arterial pressure measurement

The level of arterial pressure is not a constant value — it continuously varies depending on the impact of various factors. Variation in arterial pressure in patients with hypertension is much greater than in those who do not have this disease.
One of the main factors affecting the level of arterial pressure is the human condition.
Measurement of arterial pressure can be carried out both at rest and during physical or psychoemotional strain, as well as in the intervals between different types of activity.
Measurements at rest allow estimating an approximate level of arterial pressure in certain periods of time, which can be associated, for example, with taking medicines or with other daily living activities.
Arterial pressure is most often measured when the patient is seated. However, in some cases it is necessary to measure arterial pressure when the patient is lying or standing.

In order to perform measurement at rest, it is necessary to provide comfortable conditions for the patient and fulfil the following requirements:

• • 30 minutes before measurement, avoid eating, smoking, physical strain and exposure to cold;
  • before measuring blood pressure, it is necessary to sit or lie down (depending on the selected position of the body, at which blood pressure measured) and relax;
  • measurement starts 5 minutes after resting in the above position;
  • when measuring blood pressure in the sitting position, the back should lean on some support because any form of isometric exercises causes an immediate increase in arterial pressure. The middle point of the shoulder should be at the level of the heart (4th intercostal space);
  • in the lying position, the arm should be placed alongside the body and slightly raised to the level corresponding to the middle of the chest (under the shoulder and elbow, one can put a small pad);
  • during measurement, no talking or making any sudden movements are allowed;
  • if a series of measurements is done, it is recommended to change the original position. The interval between measurements should be at least 15 seconds (recommended interval — 1 minute).
  • In the pauses between measurements, it is desirable to loosen the cuff.

Features of arterial pressure measurement with electronic blood pressure monitors with a cuff tonometer placed on the wrist: 

• • remove any watch or bracelets from the wrist on which measurement will be made, unbutton and slightly roll up sleeves
  • place the monitor on the wrist with the display upwards at a distance of 1 cm from the wrist (Fig. 1);
  • place the hand, on which blood pressure measurement will be made, on the opposite shoulder with your palm down (Fig. 2);
  • press the START button with your other hand and move this hand under the elbow to support the arm with the tonometer (Fig. 3). Keep this position until the end of measurement – automatic release of the remaining air from the cuff.

Blood pressure meters on the wrist are not necessarily recommended for people with severe vascular wall changes and peripheral vascular diseases (atherosclerosis, diabetes, etc.). In these cases, before using of the 

! Before using the wrist blood pressure monitor, it is necessary to make a control measurement with an upper arm cuff blood pressure monitor and make sure that there is no big difference in the readings. 

When is it allowed to repeat arterial pressure measurement?

Time interval between arterial pressure measurements depends on objectives, patient’s age, presence of arrhythmia, and on other factors.
If it is necessary to perform a series of 2-3 repeated measurements, time interval between measurements should be at least 15 seconds. In this case, the average value of these measurements should be recorded.

On which hand is it better to measure blood pressure? 

Pressure difference between arms can be quite significant, that is why it is recommended to take measurement on an arm with higher arterial pressure values. 

Why may the results of medical measurements differ from the results of self-measurements?

It is quite often that when the doctor measures arterial pressure in patients, higher values of arterial pressure (by 30-40 mm Hg) are recorded than when the patient takes measurement on his own at home. This is explained by the “effect of a white-coat”, a stressful situation connected with medical examination. In some patients, something similar occurs even with self-measurement (hypertensive reaction to measurement procedure). Therefore, when self-monitoring of arterial pressure at home, it is recommended to repeat measurements 2-3 times in a row and take the average value of these measurements for the true level of blood pressure.