A 63-year-old woman presents to the clinic for follow-up after a recent percutaneous coronary intervention to treat unstable angina. During her clinic intake, the nurse allows her to rest for 5 min with her back and feet supported before placing an appropriately sized blood pressure (BP) cuff on her bare upper arm. Using an automated machine, the nurse obtains three serial BP measurements while verbally confirming active medications with the patient.
Before entering the patient's room, the clinician reviews the techniques used by the nurse to obtain the BP readings.
All of the appropriate measurement techniques were used to obtain BP readings for this patient.
Show Answer
The correct answer is: Fiction
The nurse followed most, but not all, of the appropriate techniques to assess BP. The nurse correctly allowed the patient to rest for several minutes in the appropriate position (with feet and back supported, legs uncrossed), sized the cuff to the patient, placed the cuff on the bare arm, and performed multiple readings to overcome the alerting response. Talking during BP measurement, however, can increase the measured systolic blood pressure (SBP) by >5 mm Hg.
Table 1 lists common incorrect BP assessment techniques and the magnitude of potential effect on BP measurement.
Table 1
Technique
Effects on SBP
Incorrect cuff size
Use of a regular-sized adult cuff on a patient needing an extra-large cuff may increase SBP by 19.5 mm Hg1
Talking during measurement
May increase SBP by 5.3 mm Hg2
Cuff over sleeve
May increase SBP by 5 mm Hg3
Full bladder
May increase SBP by 4-15 mm Hg compared with the bladder being empty4
Unsupported arm
BP measured in an unsupported arm, located below the heart level, may increase the measured SBP by up to 9 mm Hg5,6
Crossed legs
Ankle crossed over the knee versus the uncrossed position: SBP 11.4±5.3 mm Hg (mean ± standard deviation) (95% confidence interval, 9.2-13.6)7
Unsupported back
May increase SBP by 2.4 mm Hg8
This patient case quiz is part of the larger Overcoming Challenges in Hypertension Management grant. Educational grant support is provided by Medtronic. To visit the Overcoming Challenges in Hypertension Management grant page and access additional educational activities on this topic, click here.
References
Ishigami J, Charleston J, Miller ER 3rd, Matsushita K, Appel LJ, Brady TM. Effects of cuff size on the accuracy of blood pressure readings: the Cuff(SZ) randomized crossover trial. JAMA Intern Med 2023;183:1061-8.
Zheng D, Giovannini R, Murray A. Effect of respiration, talking and small body movements on blood pressure measurement. J Hum Hypertens 2012;26:458-62.
Ozone S, Shaku F, Sato M, Takayashiki A, Tsutsumi M, Maeno T. Comparison of blood pressure measurements on the bare arm, over a sleeve and over a rolled-up sleeve in the elderly. Fam Pract 2016;33:517-22.
Bae KW, Choi JH, Jeong SW, Lee SY, Kim YJ. The effect ofurine-holding on blood pressure. J Korean Acad Fam Med 1999;20:1255-9.
Handler J. The importance of accurate blood pressure measurement. Perm J 2009;13:51-4.
Adiyaman A, Verhoeff R, Lenders JW, Deinum J, Thien T. The position of the arm during blood pressure measurement in sitting position. Blood Press Monit 2006;11:309-13.
Van Velthoven M, Thien T, van der Wilt GJ, Deinum J. The effect of crossing the ankle over the knee on blood pressure: pp.14.08. J Hypertens 2010;28:e251.
Wan TX, Wu YH, Wu YQ, Hu W, Su H. Differences in oscillometric blood pressure readings between unsupported and supported back conditions. Hypertens Res 2021;44:528-32.
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