Table 2.

Procedures for Use of HBPM^*

Instructions to staff

Patient training should occur under medical supervision and include:

• Information about hypertension

• Advice in selection of BP monitor

• Acknowledgment that individual BP readings may vary substantially

• Interpretation of results

Devices:

• Verify use of validated automated devices. Use of auscultatory devices (mercury, aneroid, or other) is not generally useful for HBPM because patients rarely master the technique required for measurement of BP with auscultatory devices.

• Monitors with provision for storage of readings in memory are preferred.

• Verify use of appropriate cuff size to fit the arm (Table 9).

• Verify that left/right inter-arm differences are insignificant. If differences are significant, instruct patient to measure BPs in the arm with higher readings.

Instructions Provided to Patients

Instructions on HBPM procedures:

• Avoid smoking, caffeinated beverages, or exercise within 30 min before BP measurements.

• Ensure ≥5 min of quiet rest before BP measurements.

• Sit correctly:

• Back straight and supported

• Sit with feet flat on the floor and legs uncrossed.

• Arm supported on a flat surface (such as a table), with the upper arm at heart level.

• Bottom of the cuff placed above the antecubital fossa (bend of the elbow).

• Remain still during BP measurement:

• Take multiple readings:

• At least 2 readings 1 min apart in morning before taking medications and in evening.

• Measure and record BP daily during week before a clinic visit and when instructed.

• Record all readings accurately:

• Monitors with built-in memory should be brought to all clinic appointments.

• BP should be based on an average of readings on ≥2 occasions for clinical decision making.

^*Adapted from: Whelton PK, Carey RM, Aranow W, et al: Hypertension. 2018;71:e13-e115

Note: We encourage training and certification through PAHO or AHA/AMA Target BP virtual courses.

AHA, American Heart Association; AMA, American Medical Association; BP, blood pressure; HBPM, home blood pressure monitoring; PAHO, Pan American Health Organization.