Accurate Measurement of Blood Pressure

1. Health care professionals who have been specifically trained to measure blood pressure (BP) accurately should assess BP in all adult patients at all appropriate visits to determine cardiovascular risk and monitor antihypertensive treatment (Grade D).
2. Use of standardized measurement techniques and validated equipment for all methods (automated office BP[AOBP], non-AOBP, home BP monitoring, and ambulatory BP monitoring) is recommended (Grade D; see Supplementary Table S2; section III. Home BP Measurement; section IV. Ambulatory BP Measurement). Measurement using electronic (oscillometric) upper arm devices is preferred over auscultation (Grade C). (Unless specified otherwise, electronic [oscillometric] measurement should be used.)
3. In patients with large arm circumference when standard upper arm measurement methods cannot be used, validated wrist devices (utilized with the arm and wrist supported at heart level) may be used for BP estimation (Grade D; new guideline).
4. Four approaches can be used to assess BP:
   1. AOBP is the preferred method of performing inoffice BP measurement (Grade D). When using AOBP (see Supplemental Table S2, AOBP), a displayed mean SBP ≥135 mmHg or DBP ≥85 mmHg DBP is high (Grade D).
   2. When using non-AOBP, a mean systolic BP (SBP) ≥140 mHg or a diastolic BP (DBP) ≥90 mmHg is high, and an SBP between 130-139 mmHg and/or a DBP between 85-89 mmHg is high-normal (Grade C).
   3. Using ambulatory BP monitoring (see Guidelines in Section IV, Ambulatory BP Monitoring), patients can be diagnosed as hypertensive if the mean awake SBP is ≥135 mmHg or the DBP is ≥85 mmHg or if the mean 24-hour SBP is ≥130 mmHg or the DBP is ≥80 mmHg (Grade C).
   4. Using home BP monitoring (see Guidelines in Section III, Home BP Monitoring), patients can be diagnosed as hypertensive if the mean SBP is ≥135 mmHg or the DBP is ≥85 mmHg (Grade C). If the office BP measurement is high and the mean home BP is <135/85 mm Hg, it is advisable to either repeat home monitoring to confirm the home BP is <135/85 mmHg or perform 24-hour ambulatory BP monitoring to confirm that the mean 24-hour ambulatory BP monitoring is <130/80 mmHg and the mean awake ambulatory BP monitoring is <135/85 mmHg before diagnosing white coat hypertension (Grade D).