How to measure blood pressure properly with a sphygmomanometer?

How an accurate blood pressure measurement is important?

High blood pressure, or hypertension, is one of the key causes of death worldwide (World Health Organization). It is a reversible disorder that has the possibility to avoid many premature deaths if diagnosed and treated well. High blood pressure can be due to many reasons, i.e., cardiac disorders, kidney failure, stroke, smoking, drinking, stress, etc.

In order to save lives, we need to measure blood pressure accurately. Correct blood pressure measurement is the key to the right treatment if needed. Incorrect measurements, on the other hand, can be disastrous. A false positive (an incorrect low or high blood pressure reading when it is normal) exposes the measured person to unnecessary treatment, which may even be fatal in some cases. Likewise, a false negative (showing normal blood pressure when it is not) can damage the health condition due to non-treatment.

A process tree showing the various pathways a blood pressure measurement can initiate.
A process tree showing the various pathways a blood pressure measurement can initiate.

Get-Set-Go Strategy to Measure Blood Pressure Properly

We have made it easier for you to learn how to measure blood pressure accurately. As simple as the three words are, the Get-Set-Go method for measuring blood pressure is quite easy. You just need to remember 3 words. You can visualize the sequential workflow in the diagram below.

A Diagram showing Sequential Workflow Explaining the Three Steps (Get-Set-Go) in Measuring Blood Pressure
A Sequential Workflow Explaining the Three Steps (Get-Set-Go) in Measuring Blood Pressure

Step 1: Get the right device

You need to get a suitable device for measuring blood pressure. Get one that is cross-validated by experts to meet different standards. A very good resource to learn about blood pressure devices is available by Menzies Institute for Medical Research. It would also be great to have a stethoscope handy for sensing systolic and diastolic blood pressure.

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Mainly, it is the right cuff size that you need to fit the organ being measured, i.e., an arm (or leg when it is not possible to use an arm). Besides that, as long as the sphygmomanometer is validated and calibrated, you can use it. There is a validated device listing available at ValidateBP that lists all the devices that meet the criteria established for clinical accuracy by the American Medical Association (AMA).

Remember, all the fancy features (digital readings, record keeping, etc.) just add more to the cost and complexity of using the equipment.

You can usually find a mark (and diameter range) on the cuff that helps you determine if you are using a proper cuff size. If you have two cuff sizes available, use one that is larger.

Get a table to place the measured arm on it. You might need cushions or pillows for support to set the patient up properly.

Step 2: Set the patient and environment

The person being measured for blood pressure and the environment should be ready (as per the criteria below), at least five minutes before the procedure. The best position to take blood pressure is sitting in a chair with the arm placed on a table.

  • Comfortably seated with back support
  • Good ambiance (temperature, humidity, light, etc.)
  • No communication (speaking, listening, writing, or reading)

The person should not have had the following at least half an hour before the measurement.

  • No smoking or chewing of tobacco
  • No caffeine use (coffee, chocolates, etc.)
  • No sleep or dizziness
  • No salt or cheese or anything raising blood pressure normally

If the person has had one of these, wait for about half an hour so that they reach a steady state.

The arm should be placed at heart level (crease of the elbow matching the position of the apex of the heart).

Only very thin clothing is allowed so that the cuff is snuggly and closely fit on the arm.

Legs should not be crossed, and feet should be kept flat and gently firm on the floor.

The cuff should be placed with an artery marking placed exactly over the brachial artery. Wrap the cuff gently and comfortably; neither too tight nor too loose. A quick test is to see if you can insert a couple of fingers in when the cuff is wrapped but not inflated yet.

When using an analog sphygmomanometer, place the dial or scale exactly in front of your eyes to avoid parallax errors (i.e., keep your eye level in the middle of the meniscus or wire)

Step 3: Go with the measurement now

Push the button or pump the bulb to inflate the cuffs quickly. Remember, you only need to inflate just enough where you stop feeling the pulse (on the inner wrist). Inflating the cuff more than the pressure of the brachial artery would restrict the blood flow to a level uncomfortable to the patient.

Just a reminder that any communication or activity (whether by the measured person, or one measuring it) can affect the measurement.

Now, deflate the bulb slowly and pay attention to listen for a sharp tapping sound with a stethoscope. When you hear that sound, note the reading. The reading is systolic blood pressure or upper reading. The sound will fade and then vanish – note the reading just before or at the time of its vanishing – that’s diastolic blood pressure or lower reading. These sounds are called Korotkoff sounds and their role is very important in helping you take readings properly.

For those getting measurements for the first time, or after a long time, measure the blood pressure in both arms. An arm with a relatively high blood pressure reading is one that should subsequently be used to take blood pressure measurements.

After taking the measurement, wait for 60 seconds, and repeat it. You should take 3 measurements with 60 seconds of the time gap between consecutive measurements, and average them. For certain people (i.e. those with atrial fibrillation or irregular heartbeat), you should not take that many measurements consecutively. You might even need an oscillometric device for them.

If there is a significant difference between readings, take another measurement. The first reading can usually be abnormal and may be discarded when averaging if the remaining set of readings is pretty much constant.

A complete reading will include systolic and diastolic reading, the arm used (left or right?), cuff size, heart rate (if you can measure it), date, time, gender, and any history of anti-hypertensive drugs used. As this method is quite easy to follow and is based on the learning of someone who is a jack of all trades, we call it Jack’s way.

What do the readings mean?

Please go through this page by the American Heart Association (AHA) to understand your readings and consult a healthcare professional, when needed.

There are very good videos that follow this strategy (though they don’t call it Get-Set-Go). One such video is appended below for your reference. They are good to show you how to measure blood pressure with sphygmomanometer. There are methods out there showing you how to measure blood pressure without equipment, but we don’t rely on it for routine measurements.

Do you like this blog post and want to read similar ones? Please go through our blog to find out more.

Last Updated on 10 months by Shahbaz Ahmed

This Post Has 6 Comments

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