Table 1.

Blood pressure measurement in challenging clinical scenarios

Scenario	Challenge	Solution
Atrial fibrillation and other pulse irregularities	Fluctuations in cardiac output and cardiac cycle length Reduced fidelity of oscillometric algorithms	Palpate radial or brachial pulse before measuring BP to detect pulse irregularities Use an auscultatory method with a calibrated analogue sphygmomanometer Cuff deflation should be ≤2–3 mmHg per second Average ≥3 BP measurements
Obesity	Increase in arm circumference More conical arm shape	Measure upper arm circumference Choose cuff with the bladder length covering 80–100% of the circumference Standard cuff: 27–34 cm Large cuff: 35–44 cm Extra-large cuff: 45–52 cm Leg cuff may be needed for bigger arms Use wrist BP device if cuff of suitable size is not available; the wrist should be rested at heart level for measurement
Pregnancy	Haemodynamic changes and oedema, including preeclampsia Effects on fidelity of oscillometric algorithms	Use oscillometric devices validated for use in pregnancy

BP = blood pressure.