Improving Hypertension Management

August 19, 2020

Key Steps for Accurate Blood Pressure Measurements

Blue Cross and Blue Shield of Oklahoma’s Quality Improvement (QI) team is here to help improve member education on hypertension and related medication compliance. Based on claims data in 2018, the QI team identified hypertension as the number one ranked diagnosis by in-network health care professionals.

Accurate blood pressure (BP) measurements are important to improve the health of our members and your patients.

How can you help?

  • Review the checklist below of key steps to take for accurate measurements.
  • Provide our member/your patient their BP numbers and educate them on BP ranges and goals for their pressure.
  • Educate our member/your patient on how to help manage high BP with diet, exercise, and overall healthy lifestyle.
  • Provide education on self-monitoring and appropriate ways to measure at home.
  • Discuss questions, concerns, problems at every visit.

For more information please review our clinical practice guidelines.

*Checklist for Accurate Measurement of BP

Key Steps for Proper BP Measurements

Specific Instructions

Step 1: Properly prepare the patient

  1. Have the patient relax, sitting in a chair (feet on floor, back supported) for >5 min.
  2. The patient should avoid caffeine, exercise, and smoking for at least 30 min before measurement.
  3. Ensure patient has emptied his/her bladder.
  4. Neither the patient nor the observer should talk during the rest period or during the measurement.
  5. Remove all clothing covering the location of cuff placement.
  6. Measurements made while the patient is sitting or lying on an examining table do not fulfill these criteria.

Step 2: Use proper technique for BP measurements

  1. Use a BP measurement device that has been validated, and ensure that the device is calibrated periodically.
  2. Support the patient’s arm (eg, resting on a desk).
  3. Position the middle of the cuff on the patient’s upper arm at the level of the right atrium (the midpoint of the sternum).
  4. Use the correct cuff size, such that the bladder encircles 80% of the arm, and note if a larger- or smaller-than-normal cuff size is used (Table 9).
  5. Either the stethoscope diaphragm or bell may be used for auscultatory readings.

Step 3: Take the proper measurements needed for diagnosis and treatment of elevated BP/hypertension

  1. At the first visit, record BP in both arms. Use the arm that gives the higher reading for subsequent readings.
  2. Separate repeated measurements by 1-2 min.
  3. For auscultatory determinations, use a palpated estimate of radial pulse obliteration pressure to estimate SBP. Inflate the cuff 20– 30 mm Hg above this level for an auscultatory determination of the BP level.
  4. For auscultatory readings, deflate the cuff pressure 2 mm Hg per second, and listen for Korotkoff sounds.

Step 4: Properly document accurate BP readings

  1. Record SBP and DBP. If using the auscultatory technique, record SBP and DBP as onset of the first Korotkoff sound and disappearance of all Korotkoff sounds, respectively, using the nearest even number.
  2. Note the time of most recent BP medication taken before measurements.

Step 5: Average the readings

  1. Use an average of 2 readings obtained on 2 occasions to estimate the individual’s level of BP.

Step 6: Provide BP readings to the patient

  1. Provide patients the SBP/DBP readings both verbally and in writing.

* American Heart Association 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults


BP Cuff size for Measurement of BP in Adults (Table 9).

Arm Circumference

Usual Cuff Size

22–26 cm

Small adult

27–34 cm


35–44 cm

Large adult

45–52 cm

Adult thigh


A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.