Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association

Abstract

The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.

Keywords: AHA Scientific Statements; blood pressure; hypertension; monitoring, ambulatory.

Figure 1.

Cross-classification of office and out-of-office hypertension. Out-of-office hypertension is defined on the basis of home blood pressure (BP) monitoring or ambulatory BP monitoring. Reprinted from Pickering et al with permission. Copyright © 2008, Wolters Kluwer Health.

Figure 2.

Algorithm to screen for white-coat hypertension and masked hypertension in adults not on drug therapy. ABPM indicates ambulatory blood pressure monitoring; BP, blood pressure; and HBPM, home blood pressure monitoring. Reprinted from Whelton et al with permission. Copyright © 2017, by the American College of Cardiology Foundation and the American Heart Association, Inc.

Figure 3.

Detection of white-coat effect or masked uncontrolled hypertension in patients on drug therapy. The 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline used the term white-coat effect to refer to adults taking antihypertensive medication with hypertensive-level BP in the office with BP at goal when measured outside of the office. ABPM indicates ambulatory BP monitoring; CVD, cardiovascular disease; and HBPM, home BP monitoring. Reprinted from Whelton et al with permission. Copyright © 2017, by the American College of Cardiology Foundation and the American Heart Association, Inc.