Sources of errors in measuring blood pressure in a doctor’s office

In order to diagnose arterial hypertension and monitor the results of treatment, there are only three research options:

  1. Measurement of blood pressure by a doctor or nurse (the so-called office measurement of blood pressure, because it is carried out in the doctor’s office)
  2. Daily monitoring of blood pressure (BPM). A special device is used, which is mounted on the patient and fixes blood pressure with a predetermined frequency.
  3. Measuring blood pressure at home, both completely independently and with the help of loved ones

Currently, self-monitoring of blood pressure is the best, in our opinion, method of both diagnosis (.) And treatment of hypertension treatment.

It should be noted that SMA blood pressure is also good in achieving the stated goals, but has some disadvantages:

  • Cost (the price of daily monitoring of blood pressure currently ranges from 1000 to 3000 rubles)
  • Inconvenience. The device measures pressure with a certain frequency, usually twice an hour, including working hours and night hours.
  • Availability Issues. Not always and not everywhere this examination method is available to the patient both economically and physically; there may not be a free device on a day convenient for you; in the region of your residence, in general, daily monitoring of blood pressure is not available.

Speaking about the shortcomings of the ABPM, it is impossible not to say about its advantages. Most likely, your doctor will recommend a -hour blood pressure monitoring if one of the following situations suggests:

  • Hypertension of the white coat (we will talk about this phenomenon in more detail below)
  • The so-called masked hypertension is a situation in which at the doctor’s appointment normal numbers of blood pressure are recorded, and during self-monitoring the patient fixes an elevated level of blood pressure. In this case, SMA blood pressure allows not only to exclude the patient’s error in measuring pressure, but also to document the presence of arterial hypertension.
  • Occasional and short-term rise in blood pressure.
  • Nocturnal arterial hypertension.

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Sleep Apnea and Hypertension

The Journal of Clinical Sleep Medicine published .

Despite the fact that we called home measurement of blood pressure the best method, you should be aware that SMA is currently the gold standard in the diagnosis of hypertension. And here there are no disagreements, SMA blood pressure has an indisputable advantage – it is an independent documentation of the research results.

The superiority of home measurement Blood pressure over other methods of pressure control is possible only if the rules that this article is devoted to are observed.

Instead, auscultatory or oscillometric semi-automatic sphygmomanometers are used.

They should be validated according to standard protocols, and their accuracy should be periodically checked by calibration in a technical laboratory. Blood pressure is best measured on the shoulder, while the dimensions of the cuff and its cavity for pumping air should be adapted to the circumference of the arm.

Differences in the measurement results Blood pressure on the two hands is important if they are detected while measuring on both hands. If the differences between the arms are obtained by sequential measurement of blood pressure, they may be due to the variability of blood pressure.

In the elderly, in patients with diabetes, and in other conditions when orthostatic hypotension is often present or suspected, it is recommended to measure blood pressure after 1 minute and 3 minutes of being in an upright position.

Orthostatic hypotension is defined as a decrease in blood pressure by more than 20 mmHg. or DA blood pressure greater than 10 mmHg. after 3 minutes of standing. It is shown that it is accompanied by higher mortality and a higher frequency of cardiac vascular events.

If it is possible to carry out automatic repeated measurements of Blood pressure in the office, in a patient’s sitting position, in a separate room, this procedure can be considered one of the ways to improve reproducibility and approximation of office indicators. Blood pressure to daily values ​​SMA or DMAD, although it is less informative .

Methodological aspects of home monitoring of blood pressure.

The Working Group of the European Society of Hypertension (ESH) on blood pressure monitoring has developed a number of recommendations for home monitoring of Blood Pressure (DMAD). Typically, DMA blood pressure involves self-monitoring of blood pressure for patients, although some patients may require the help of a trained health professional.

Currently, the use of devices that are worn on the patient’s wrist is not recommended. However, their use can be justified in obese individuals with a very large circumference of the shoulder.

As part of the diagnostic examination, Blood pressure should be measured daily for a minimum of 3-4 days, and preferably for 7 consecutive days, in the mornings and evenings. Measurement Blood pressure is carried out in a quiet room, in the patient’s sitting position, resting on the back and resting on the arm, after 5 minutes of rest.

Each time, two measurements should be performed with an interval between them of 1-2 minutes; immediately after each measurement, the results are entered in a standard diary. However, the blood pressure values ​​recorded by the patient cannot always be trusted; in this regard, it is advisable to store them in the memory of the device for measuring blood pressure.

Home Monitoring Diary AD.pdf [389,6 Kb] (Downloads: 7803)

Home BP is the average of these results, with the exception of the first day of monitoring. Telemonitoring and applications for DMA blood pressure to smartphones can become even more useful.

The interpretation of the results should always be carried out under the close supervision of a physician. Compared with office blood pressure, DMA blood pressure gives many values ​​for several days or even for a longer time, and these values ​​were obtained in the usual setting for the patient.

Compared with SMA, blood pressure (daily monitoring of blood pressure), DM blood pressure provides data for a long time, allows you to assess the variability of blood pressure on different days, cheaper, more affordable and easier to repeat.

However, unlike the ABPM, it does not provide information about blood pressure during normal daily activities and during sleep, and also does not allow quantifying the variability of blood pressure over short periods of time.

According to commonly used definitions in the recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, JNC-7

  • Normal blood pressure is below 120/80 mmHg.
  • prehypertension – Blood pressure from 120 to 139 and from 80 to 89 mm RT. Art.
  • arterial hypertension is a blood pressure equal to or greater than 140/90 mm Hg. Art. [4]

The mean values ​​of systolic and diastolic blood pressure in two positions were calculated for the measurement results for each patient, and the patient was classified as having normal blood pressure, prehypertension, or arterial hypertension. The classification was repeated using another manual published by the American College of Cardiology (ACC) / AHA in 2017, in which normal Blood Pressure is defined as Blood Pressure below 120/80 mmHg.

, high blood pressure is from 120 to 129 and below 80 mm Hg, and arterial hypertension – as Blood pressure 130/80 mm Hg. Art. or higher. [12] Patients whose arterial pressure showed a significant decrease between the average table and stool measurements, which led to a change in classification from prehypertension (elevated blood pressure) to normal blood pressure or from hypertension to prehypertension or normal blood pressure, were considered erroneously classified .

Statistical analysis. The difference between the mean values ​​of the arterial pressure in the position on the table and in the position on the stool was calculated for the results of measuring systolic and diastolic blood pressure in each patient, and an unpaired t-test was performed to analyze the data. The standard error of the mean value for these differences was determined, and the upper limit of the bilateral 95% confidence interval for the standard difference error (SD) was based on the upper limit of the normal distribution of 1,96 × SD.

Using the assumption of a normal distribution, this gives the upper bounds of 8,36 mmHg. for systolic blood pressure and 7,74 mmHg for diastolic blood pressure. The differences observed in patients were compared with the upper limit of the confidence interval to detect significant changes in systolic and diastolic blood pressure due to the different positions of the patient.

For example, consider a patient with two results of automatic measurement of systolic blood pressure in a position on the table, an average of 129 mmHg and two results of automatic measurement of systolic blood pressure in a position on a chair, on average 119 mmHg. Assuming CO is 4,26 mmHg.

Last digit error

Observational study. Blood pressure values ​​recorded by three nurses using manual and automatic devices were analyzed for the last digit error. Blood pressure measurements using manual and automatic devices were taken from patient records and classified according to the observer and the type of device used.

The manual device in this study was the Welch AllynCE0297 aneroid sphygmomanometer. The automatic device was the Omron Digital BP Monitor, model HEM-907 XL, which was certified and used in several large studies of arterial hypertension. [12] Altogether, 3000 observations of the last BP figure were estimated.

Statistical analysis. Manual measurement results Blood pressure with the last digits 0, 2, 4, 6, and 8 were analyzed using the χ2 criterion for independence with 4 degrees of freedom. Results of automatic measurements Blood pressure with final numbers from 0 to 9 were analyzed using the χ2 criterion for independence with 9 degrees of freedom. Χ2 criteria were calculated in Microsoft Excel for each nurse with a P value lt; 0,01, considered statistically significant.

Detonic  Preinfarction symptoms and first signs in men and women

About measuring blood pressure at a doctor’s appointment

God decided to fix things in Russian

medicine and got a doctor in the clinic.

Comes to the reception, to him first

paralyzed patient in a wheelchair.

God lays his hands on his head and says: get up and go.

He got up and went. It goes out into the corridor

– Yes, like all of them – I didn’t even measure the pressure.

Oddly enough, the measurement of blood pressure by a doctor at the reception is far from the best and most accurate method of research, despite the fact that the measurement is carried out by a specialist, most often armed with a professional apparatus.

The first, and perhaps the most important difficulty is the so-called hypertension of a white coat, a situation when a person (who is not yet a patient) has an elevated level of Blood pressure only at a doctor’s appointment. In other situations, high blood pressure is not recorded. A similar phenomenon can be observed in 15% of doctor’s visitors (according to the results of various studies, white coat hypertension occurs in 10-20% of patients who are measured by pressure at the reception), which can lead to overdiagnosis and unnecessary treatment.

Data from Mancia G, Parati G, Pomidossi G, et al. Alerting reaction and rise in blood pressure during measurement by physician and nurse. Hypertension 1987; 9: 209.

The graph shows how blood pressure changes (difference in mmHg from the original) during the first and subsequent measurements of blood pressure by a doctor and a nurse. The difference between the first and third dimension exceeds 10 mm Hg.

The second, no less entertaining phenomenon, is the difference between blood pressure measurements, depending on who measures it – a doctor or a nurse. The error is shown in the graphs. It decreases over time.

Redrawn from: Millar JA, Isles CG, Lever AF. J Hypertens 1995; 13: 175.

Effect of patient position on blood pressure measurement results

Pressure should be measured as part of self-monitoring in a familiar environment, in a warm and quiet room.

  • Measurement in a cold room leads to an error in the direction of overstatement. For example, in one study, it was shown that in a cold room the error in measuring pressure reached an average of 8-15 mm Hg.
  • Smoking. A recently smoked cigarette can increase blood pressure by 10-20 mmHg. If you smoke, then the time from the last cigarette to measuring blood pressure should be at least 30 minutes. Dependence Blood pressure on cigarettes is shown in the graph.

Data from Gropelli, A, Giorgi, DM, Omboni, S, et al, J Hypertens 1992; 10: 495.

  • Bladder. Full bladder, urination may increase blood pressure up to 20 mmHg
  • Extraneous noises and conversations. The room in which the study is carried out should not be noisy, noise, the conversation of both the researcher and the subject can lead to an increase in pressure by 10 mmHg.
  • If you have consumed caffeinated drinks (tea also applies), you should measure the pressure no earlier than after one hour.
  • Also, the hourly interval should be maintained after eating.
  • Do not measure pressure in a state of stress or other forms of emotional stress.
  • Before measuring pressure, refrain from physical exertion.

Coffee and hypertension

In a study involving patients with untreated arterial .

In most studies, pressure is measured while sitting on a chair with a back. The absence of a backrest in the stool (or if the patient does not lean on it) can increase blood pressure by 10 mmHg. The position of the foot-to-foot gives an error of another 5-10 mm Hg. If the forearm of the hand on which the Blood pressure is measured is not placed on the stop (for example, on the table), then the Blood Pressure indicator can be overestimated by 5-15 mm Hg. Especially if the arm is tense.

Sit comfortably, taking into account the recommendations given, and sit for 5 minutes before proceeding with the measurement.

When putting on the cuff, pay attention to its positioning on the shoulder. An incorrectly worn cuff is a measurement error of up to 20 mm Hg. The location of the cuff on the shoulder is usually applied by the manufacturer to the cuff itself. If there is no such scheme, carefully read the tonometer instructions.

If you are measuring pressure for the first time in your life, then you should measure on both hands. With a discrepancy of indicators within 10 mmHg hereinafter, blood pressure is measured on the arm on which the pressure was higher.

If the discrepancy is greater, inform your doctor.

IMPORTANT: The hand on which the pressure is measured should be free of clothing. Do not roll up your sleeve, as this can lead to clamping of the brachial artery and a significant measurement error. If you have a shirt made of very thin fabric, then it is permissible to measure blood pressure by placing a cuff on top of it. But we strongly recommend that you free your hand from clothing.

Arterial hypertension. Just about complicated.

Arterial hypertension (hypertension), diagnosis, factors .

IMPORTANT # 2: When starting to measure pressure after a long break, measure the pressure three times in a row at intervals of one minute. Record ALL THREE recorded indicators in your blood pressure diary.

IMPORTANT No. 3: if you use semi-automatic or manual blood pressure monitors, pump air into the cuff gently, if you pump air very quickly or abruptly, then the error in measuring pressure can reach 20-40 mm Hg

IMPORTANT No. 4: if you place the head of the phonendoscope UNDER the cuff, then this will lead to an error of 3-12 mm Hg.

A hand with a cuff over it is at heart level. Air is rapidly pumped into the cuff until the systolic blood pressure is exceeded. The achievement of this goal can be judged by the disappearance of the pulse on the arm. Then air is released from the cuff at a speed of 3-4 mm Hg per second and the moments of the appearance and disappearance of Korotkov noise are recorded. Too high a rate of pressure reduction in the cuff can lead to a distortion of the result by 5-10 mm Hg.

  • The measurement should be carried out in a comfortable, calm environment, the room should have room temperature.
  • At the same time, about 30-60 minutes before the determination of Blood pressure, smoking, the use of tonic drinks, alcohol, caffeine, as well as physical activity should be excluded.
  • Blood pressure can only be measured after at least five minutes of patient rest. If there was significant emotional or physical stress before the procedure, in order to achieve the correct blood pressure, you need to increase the rest period to 15-30 minutes.
  • Blood pressure should be measured in the morning and evening. With regular measurement of blood pressure, measurements should be taken at the same time 2 times a day, recorded and shown to the doctor at the next appointment. To increase accuracy, make a series of 3 measurements (this is especially important for patients with arrhythmia), the interval between measurements should be at least 2 minutes.
  • The measurement should be carried out while sitting (leaning on the back of the chair, with relaxed and not crossed legs, the hand rests on the table, at heart level), in a relaxed atmosphere, after 5 minutes of rest. The legs should be straight and on the floor, and the arms should be straightened and freely positioned at the level of the heart. It should be remembered that the shoulder should not be squeezed by clothing, especially since it is incorrect to measure blood pressure through clothing. Do not move or talk during measurement.
  • In the initial measurement, you should determine the blood pressure on both hands and then measure the blood pressure on the arm where the pressure was higher. (The difference in blood pressure on the hands up to 10-15 mmHg is normal.)
  • Bladder before measuring Blood pressure must be emptied.

Blood pressure measurement with a manual blood pressure monitor (Korotkov method)

  • The tonometer cuff should be at the level of the heart (middle of the chest) 2 cm above the elbow. A finger should pass between the non-inflated cuff and the arm. The cuff should cover at least 80% of the circumference of the shoulder and at least 40% of the length of the shoulder. It is possible (but not recommended) to apply a cuff to a sleeve of thin fabric, if this does not interfere with the measurement.
  • Place the phonendoscope membrane on the pulsation point of the brachial artery (approximately in the region of the ulnar fossa).
  • Quickly pump air into the cuff with a pear (do not forget to close the pear valve (s) first so that the air does not come back) to a pressure level of 20 mmHg. Art. exceeding systolic (determined by the disappearance of the pulse).
  • Slowly release air from the cuff (using the valve) at a speed of 2 mmHg. Art. per second. The first shock heard (sound, tone) corresponds to the value of systolic (upper) pressure. The level of termination of tones corresponds to diastolic (lower) pressure. If the tones are very weak, you should raise your hand, bend it several times and unbend it and repeat the measurement.
  • Normal blood pressure: 110-139 / 60-89 mm Hg. Art. for adults

Rules for self-measurement of pressure with an electronic tonometer.

  1. Sit comfortably: free your hand from the clothes, and lay it so that the cuff is flush with the heart.
  2. Make sure that the rolled up sleeve does not squeeze the hand.
  3. Position the edge of the cuff 2-3 cm above the elbow joint so that the tube from the cuff is in the m >

Rules for measuring Blood pressure with a wrist device:

  1. Take off your watch, bracelet. Pay attention to the correct position of the body of the carpal tonometer relative to the palm. The correct position of the body of the carpal tonometer is recommended by photographs or drawings on the tonometer box or in the description of the tonometer.
  2. Place the cuff on your left wrist with your hand so that your thumb is pointing up.
  3. Apply the cuff directly to the skin, 1 – 1,5 cm above the carpal fold, wrap the cuff around the arm until it fits snugly.
  4. Bend your hand so that the device is located on the same level with the heart.
  5. During the measurement, relax and refrain from talking.

Mistake # 1. Unsuitable pressure gauges are used. For the sake of convenience, many people buy carpal tonometers – tonometers that are worn on the patient’s wrist.

A high-quality, branded wrist blood pressure monitor is a very good and convenient thing, only most wrist blood pressure monitors are intended exclusively for young patients, for people under 45 years old.

Wrist sphygmomanometers are not suitable for people over 45 years old! And if a person, say, 60 years old, has been using the wrist tonometer, he will receive completely incorrect results when measuring pressure.

Many older people do not know this; they use carpal tonometers and are guided by their indicators. And pills for pressure are also taken, focusing on the indicators of the carpal tonometer. And then they are surprised that from taking the pills they feel bad.

Mistake number 2. The habit of measuring pressure 2 or 3 times in a row. Many people, especially those who use automatic blood pressure monitors, like to immediately measure the pressure a second time after the first pressure measurement “for reliability”. It seems, in their opinion, it will be more accurate.

But it turns out the opposite – when re-measuring the pressure figures may differ from the previous result by 20-30-40 units! This scatter of numbers has led many people to consider automatic blood pressure monitors inaccurate.

“What kind of device is it that gives different indicators every time!” – indignant dissatisfied buyers of such a device who poorly studied the instructions for the electronic tonometer.

Meanwhile, the instructions for most such devices clearly indicate: repeated pressure measurements on the same arm can be carried out no earlier than 7-10 minutes after the previous measurement. Then everything will be in order with the readings of the device. If you really need to measure the pressure, then a second time measure the pressure on the other hand.

About methods and apparatus for measuring blood pressure

The apparatus for measuring blood pressure is called a sphygmomanometer or tonometer, the tonometer is a more established name, we will use it. In modern devices, one of two methods of fixing the level of blood pressure is used

Tonometers are of the following types:

  • Manual mercury
  • Manual blood pressure monitors with anero >

In manual blood pressure monitors, the method of fixing Korotkov noise is used, which is recorded by a person who measures pressure using a phonendoscope, in semi-automatic methods, the oscillographic method is used, when automation records the pressure in the arteries by changing (oscillation) of pressure in the cuff of the tonometer.

The devices for daily monitoring of blood pressure use the oscillographic method for measuring blood pressure.

Mercury tonometers are currently rare. They have no major advantages, and the risk of mercury leakage with subsequent environmental pollution has led them to simply be banned in a number of countries.

Modern tonometers, whether aneroid manometers, semi-automatic or automatic, are comparable both in accuracy and in ease of use.

The disadvantage of manual blood pressure monitors with an aneroid pressure gauge is the human factor, because the researcher fixes the level of blood pressure by ear, reducing the pressure in the cuff manually. It must be remembered that aneroid pressure gauges require technical monitoring every six months

The disadvantage of semi-automatic and automatic blood pressure monitors is the increased error of the results with arrhythmias, for example, with extrasystole or atrial fibrillation. The disadvantages of automatic systems include their relatively high cost.

Semi-automatic blood pressure monitors, as well as manual blood pressure monitors using the auscultatory method of fixing blood pressure, have a potential additional error of 5-10 mm Hg. Gives manual inflation of the cuff.

How to choose a tonometer

The difficulty of choosing a tonometer is determined, perhaps, only by a wide selection of different devices with a range of prices from several hundred rubles to several tens (.) Thousand.

We will begin our advice with those types of devices that we DO NOT RECOMMEND to purchase and use:

  • Mercury tonometers. Damage to the tonometer is accompanied by the risk of leakage of mercury and environmental pollution (in this case, the environment is not an abstract concept, but your apartment). Given the universal tradition of vacuuming spilled mercury (which is categorically NOT possible), acquiring a mercury tonometer seems unreasonable. Thus, we support the rejection of the use of mercury tonometers.
  • Finger blood pressure monitors. There are devices on the market that measure blood pressure on a finger. We cannot recommend them for use, as to date, none of the devices of this type have demonstrated the necessary accuracy and reliability in monitoring blood pressure
  • Tonometers watches, tonometers-fitness bracelets
  • Not tonometers, but . Currently, a number of programs for mobile devices declare the ability to measure and control pressure. None of the applications can be recommended for these purposes.

use mercury blood pressure monitors, blood pressure monitors that measure pressure on the finger, various applications for gadgets.

If everything is more or less clear with the economic factor, then additional explanations are not required, then we will try to deal with the rest.

If you plan to measure the pressure yourself, without outside help, then the best choice is automatic tonometers or semiautomatic devices. This choice is due to the fact that with independent measurement of pressure by the auscultatory method, the average error is 10 mmHg. The error, not at first glance, is small, but, given all the possible other errors, it may turn out to be significant.

The best choice for self-monitoring is automatic blood pressure monitors, the cuff of which is placed on the shoulder, but in some cases it is impossible or difficult (for example, due to surgical interventions for breast cancer or due to severe obesity that does not allow choosing the optimal cuff size). In this case, automatic blood pressure monitors remain that measure blood pressure on the wrist.

Tonometers measuring pressure on the wrist are very popular, but you should be aware that the measurement error of this type of tonometer exceeds the error of conventional devices with a cuff on the shoulder. Also, these devices require very careful adherence to instructions for measuring blood pressure, which, as practice shows, is not always achievable.

Accuracy! Accuracy is an option that interests patients first. To date, automatic tonometers have the best accuracy.

Many people need constant monitoring of blood pressure (BP). This is especially true in the presence of hypertension, hypotension, and diabetes. For self-measurement of pressure indicators, you can use a mechanical tonometer. This is an affordable device that is highly accurate. So, how to measure pressure with a hand tonometer?

Pressure indicators depend on gender and age. On average, normal parameters are 120/80 mm Hg. Art. However, in people older than 50 years, the norm is considered values ​​of the order of 135/85 mm RT. Art.

Blood pressure parameters are individual. However, significant deviations from the norm indicate the development of pathology. The following factors influence indicator changes:

  • stressful situations;
  • weather dependence;
  • smoking;
  • excessive drinking;
  • insufficient rest;
  • hypertension or hypotension (arterial hypertension or hypotension);
  • digestive diseases – peptic ulcer, gastritis, pancreatitis;
  • the use of medications;
  • kidney disease;
  • damage to the musculoskeletal system – osteochondrosis, scoliosis.

A manual blood pressure monitor includes a number of elements:

  • cuff with metal ring and tube;
  • a pear that pumps air – a wheel is attached to it to release air;
  • pressure gauge with a dial and an arrow;
  • stethoscope – has a binaural tube and a hearing aid.

To accurately measure systolic and diastolic (upper and lower) pressure, you must have certain skills. Equally important is special training. Doctors recommend following these rules:

  1. At least 1 hour before measuring the pressure, you should stop smoking, drinking alcohol and products containing caffeine. It is also worth refraining from physical exertion;
  2. Do not take measurements if you want to use the toilet. An overflowing bladder can increase by about 10 points.
  3. Measure pressure in a comfortable environment. This should be done at room temperature.
  4. Measurement should be carried out in a sitting position. In this case, the patient should relax and be at least 5 minutes before the manipulations.
  5. The arm on which it is planned to put on the cuff should be placed so that the elbow is located at the level of the heart.
  6. It is important to relax your hand well.
  7. It is forbidden to speak or move during the procedure.
  8. If you need to perform several measurements between them, you should take a break of 3-5 minutes. Due to this, the pressure in the vessels after compression by the cuff is normalized.

In the presence of deviations in the work of the heart and blood vessels, measure with a manual blood pressure monitor regularly. At home, it is recommended to adhere to such a schedule:

  1. In the morning. The first measurement is performed 1 hour after waking up. It is important to consider that before doing so, it is forbidden to take a hot shower, drink coffee, alcohol or heavy food.
  2. In the evening. The second time the measurement is performed in the evening. This allows you to compare the values ​​obtained.
  3. On health. Additional measurements should be carried out, focusing on the state of human health. Symptoms such as dizziness or headache may be the cause.

Important: In the absence of complaints in a person, pressure measurement should be carried out no more than 1 time in 2 days. With a more frequent procedure, there is a risk of high fragility of the vessels. There is also the possibility of swelling and stagnation of the lymph.

Many people are interested in how to properly measure pressure with a mechanical tonometer. The following is an instruction that steps out the steps necessary to obtain reliable results:

  1. Sit on a chair, sofa or bed. Rest your back against the back, and your feet on the floor. They are not recommended to throw on each other or to tighten.
  2. Release left hand from clothing, place it on a table or other flat surface. It is important that she does not remain on weight.
  3. Open the cuff, put your hand into it and fix it slightly above the elbow.
  4. Place a part of a stethoscope (phonendoscope) in the form of a small disk on the ins />
  5. You should listen to the pulse while venting. The mark at which the arrow will be at the first stroke is an indicator of systolic (upper) pressure. The pulse can be heard for some time. The indicator at which the arrow will be at the last sound is diastolic (lower) pressure.
  6. Measure blood pressure on the second hand. Reliable are higher parameters. Subsequently, it is necessary to take measurements on the hand on which the pressure is higher.

The pressure measurement procedure takes just a few minutes. It must be carried out every day. The obtained values ​​should be recorded. This will help determine the average parameters of the upper and lower blood pressure.

Pressure measurement with a tonometer can also be carried out in a horizontal position. This is usually required with a serious violation of health – for example, the appearance of severe dizziness.

The arm should be relaxed and located along the torso. It needs to be raised to the central part of the chest. To facilitate the process of measuring pressure will help the pillow, which is placed under the elbow and shoulder.

To use a manual mechanical tonometer correctly, you should know what typical mistakes people make. The following factors affect the result of the meter:

  1. Rolling up the sleeves. If it fits snugly on the arm, and the fabric of the clothes is thin enough, the cuff should be fixed on top. The raised sleeve should not squeeze the hand, as this will necessarily affect the results. If a person is going to the clinic and knows that they will be measured pressure, you should wear loose clothing.
  2. Too long cuff. When choosing a device, you must pay attention to the w />
  3. Loose buttoned cuff. To achieve accurate measurement results, it is important to ensure that the cuff is snug against the arm. If it seems to a person that it is not fixed too well, it is worth informing the medical professional about it.
  4. Arms above the heart. It is important that the hand is in a relaxed state at heart level. She should not hang in front of the table.
  5. Incorrect torso position. During the pressure measurement, you must sit upright, lean on the back of the chair, put your legs in parallel. It is forbidden to hunch, cross-leg, or cross them. You should sit comfortably, near the back of the chair. It is not recommended to sit on the edge.
  6. Quick release of air from a pear. In this case, blood pressure will be lower than real.
  7. Measurements too frequent. Measure the pressure with a break of 5 minutes. Starting from the third measurement, the interval should be increased to 7 minutes. Indications should be taken in the morning after waking up and in the evening before going to bed. People who suffer from hypotension should measure blood pressure in the morning.

Cuff selection (selection)

You can get the best tonometer available, but if you choose the cuff incorrectly, you will get an erroneous result. Unfortunately, as practice shows, unacceptably little attention is paid to this most important component of pressure measuring devices. Not only length is important, but also width. The size of the cuff chamber should be at least 80% of the circumference of the shoulder and at least 40% in width. Everything is simple here – we measure the circumference of the shoulder and select the cuff appropriate for the length.

  • Shoulder circumference 22 to 26 cm, cuff size 12 x 22 cm (small adult cuff)
  • Shoulder circumference from 27 to 34 cm, cuff size 16 x 30 cm (adult cuff)
  • Shoulder circumference from 35 to 44 cm, cuff size 16 x 36 cm (large adult cuffs)
  • Shoulder circumference from 45 to 52 cm, cuff size 16 x 42 cm (femoral cuff)

The error in the selection of the cuff is an error from 10 to 50 mm Hg. when measuring blood pressure. When purchasing a tonometer, do not forget to choose the right cuff!

There are three indications for measuring blood pressure:

  • Screening i.e. detection of the disease in healthy people without suspicion of hypertension
  • As part of the diagnosis of arterial hypertension
  • To control the treatment of hypertension

Starting from this age, it is necessary to measure blood pressure once a year. In the presence of additional risk factors, such as:

  • Obesity
  • Hypodynamia
  • Family history
  • Previously recorded blood pressure above 120 mmHg

measurements are made twice a year.

As part of the diagnosis and / or monitoring of blood pressure treatment, it is recommended that you measure your blood pressure 12-14 times a week (i.e., approximately twice a day), for two weeks, unless your doctor has recommended you otherwise. Similar measurements are taken every three months.


Accurate and reliable measurement Blood pressure is essential for the diagnosis and treatment of hypertension. A family doctor is ideal for detecting an early increase in blood pressure in asymptomatic people and can have a significant effect on reducing the incidence of complications associated with arterial hypertension. To achieve this goal, you need to pay great attention to the technique and tools for measuring blood pressure.

Sources of error can be associated with the equipment used or with an individual measurement of blood pressure. In this study, we examined two such sources of error that family doctors may encounter. The importance of minimizing errors is confirmed in a large meta-analysis showing that systolic blood pressure decreases by 10 mmHg. Art.

leads to a statistically significant reduction in the risk of coronary heart disease, stroke, and heart failure. [5] Another large study conducted by Greiver [6] showed that the errors of the last digit decreased from 26,6% to 15,4% since the acquisition of automatic devices, and patients in centers with a high level of errors of the last digit showed a higher the frequency of strokes, acute myocardial infarction and angina pectoris.

This emphasizes the relevance of the last digit errors and the clinical importance of minimizing or eliminating them. This study confirms and extends the previously described results regarding the nature and limitations of blood pressure measurements. [12] First, we found statistically significant last digit errors in all 3 nurses who performed blood pressure measurements using a hand-held device.

A systematic error was recorded for the digit zero as the last digit. Such a systematic error was not detected in any of the same 3 nurses using an automatic device. This error of the last digit was previously described in many other studies [19,21–29], most of which show that the errors of the last digit are reduced, but not completely eliminated by the introduction of automatic devices for measuring blood pressure.

Myers and Campbell [11] found signs of last-digit errors in 14% of measurements when using an automatic BpTRU device, with an expected fraction of zero-last digit of 10%. In another study, no errors in the last digit were found when measuring blood pressure with a BpTRU, although actual data are not shown.

We previously reported that the measurement results of Blood pressure in a patient sitting on a diagnostic table rather than a stool are often overestimated, which can lead to an erroneous classification of hypertension. Concern was expressed about the chosen sequence, first on the table, then on the chair, and whether the opposite sequence would have had the same effect.

The need for randomization of the measurement order Blood pressure has also been discussed in a recent review of various methods for measuring blood pressure. [10] Here we found that the sequence of measurements of blood pressure does not affect the difference in blood pressure between the two positions of the patient. None of the previous studies evaluated the difference in blood pressure between the positions on the diagnostic table and on the stool and the effect of such an incorrect position of the patient on the erroneous classification of prehypertension and arterial hypertension when blood pressure is measured using an automatic device. Lacruz et al [17] found a statistically significant increase in sitting blood pressure compared to lying.

Previously, we found that the patient’s position on the stool led to a statistically significant decrease in blood pressure compared with the position on the table in 30,4% of patients using a hand-held device. [9] In this study, we also found that the position on the stool resulted in a statistically significant and even greater decrease in blood pressure compared with the position on the table in 42,7% of patients using an automatic device.

In addition, we found a more pronounced erroneous classification of prehypertension and arterial hypertension when using the recommendations of JNC-7 or ACC / AHA, when blood pressure is mainly measured using an automatic device compared to the manual method. The reasons for these differences between the devices are not known, but may be due to another type of systematic error of the observer.

When using a hand-held device, the observer’s knowledge of blood pressure, originally measured at the patient’s position on the table, may affect the results of the assessment of blood pressure in subsequent measurements. This is an example of a binding effect, [16] which is not expected when using an automatic device. Further research is required using exclusively automatic devices to confirm the absence of a binding effect.


The weak side of our study is that blood pressure was measured only twice in each position. In other studies, 3 or more measurement results were obtained to ensure a stable and reliable blood pressure level. [13,17] However, in a recent study of blood pressure and mortality measurements, only 2 measurements were performed, and the mean value was calculated.


Numerous national and international recommendations have been developed for threshold values. Blood pressure in the diagnosis of hypertension, but regardless of the definitions used, it is important to obtain accurate and reproducible blood pressure measurement results. A common method for measuring blood pressure is 24-hour ambulatory monitoring.

In addition, errors in the last digit occur when measuring blood pressure manually, but not using the automatic device we use, which confirms the potential advantage of automatic devices to obtain an accurate and reliable result of measuring blood pressure in the doctor’s office. [19] Three repeated manual measurements. Blood pressure is also possible binding effect, which increases the doubtfulness of such measurements.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.