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Blood pressure measurement

Introduction

  • Wash hands
  • Introduce self
  • Ask Patient’s name, DOB and what they like to be called
  • Explain procedure and obtain consent
  • Ensure the patient has been seated for 5 minutes
  • Ask them to try to relax and not speak or move during the measurement

Equipment

  • Sphygmomanometer – identify the correct cuff size for the patient
  • Stethoscope

Preparation 

  • Expose the patient’s arm and remove tight-fitting clothing
  • Apply the sphygmomanometer cuff 
    • The bladder should encircle at least 80% of the arm circumference 
    • The bladder must be placed over the mid-upper arm
    • The artery arrow marker (or mid-point of the cuff bladder) should be placed above the brachial artery pulsation
  • Ensure the patient is seated comfortably at rest with back supported and legs not crossed
  • Support their forearm horizontally on a surface at the level of their heart

Systolic blood pressure estimation

  • Palpate their brachial pulse (above the antecubital fossa) with index and middle finger 
  • While palpating the brachial pulse, inflate the blood pressure cuff until the pulse disappears
  • Systolic blood pressure estimate = the sphygmomanometer pressure when the brachial artery pulsation can no longer be palpated 
  • Deflate the sphygmomanometer cuff quickly by fully opening the valve

Measurement

  • Palpate their brachial pulse (above the antecubital fossa) with index and middle finger to identify and remember the point of maximal pulsation
  • Inflate the sphygmomanometer to 30mmHg above the systolic blood pressure estimate
  • Place the diaphragm or bell of the stethoscope over the point of maximal pulsation of the brachial artery 
  • Slowly deflate the sphygmomanometer cuff (2-3mmHg/s)
    • Systolic blood pressure = the sphygmomanometer pressure at which the first Korotkoff sound is heard (not when the sphygmomanometer dial starts to pulsate – ignore this)
    • Diastolic blood pressure = the sphygmomanometer pressure when the Korotkoff sounds disappear
  • When the diastolic pressure has been identified, quickly deflate the sphygmomanometer cuff by fully opening the valve

To complete

  • Remove the sphygmomanometer cuff
  • Thank patient and ask them to get dressed
  • Document procedure and result in patient’s notes
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Produced using NICE ‘CG127 Hypertension in adults: diagnosis and management’ 2011 (updated 2016)

Test your knowledge

What are the definitions of hypertensive urgency and hypertensive emergency?

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In which patients would you consider secondary causes of hypertension?

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Which screening tests would you consider to investigate secondary hypertension? Note which condition each test screens for.

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