Home Blood Pressure Measurement: Common Errors That Skew Readings

Full analysis

Peter Attia argues that office blood pressure readings are often unreliable and that patients should take charge of their own monitoring at home over at least two weeks, two to three times per day, under consistent conditions. He lists specific errors that can inflate a reading: a cuff worn over clothing, an unsupported back or dangling feet (5–10 mmHg error), crossed legs (5–8 mmHg), skipping a 5-minute rest before measuring (10–20 mmHg), talking just before or during the reading (10–15 mmHg), being in pain (10–30 mmHg), and having a full bladder (10–15 mmHg). Arm position relative to heart level adds or subtracts about 2 mmHg per inch above or below the heart. Manual cuffs with a stethoscope remain the gold standard; some automated cuffs use algorithms that estimate from mean arterial pressure and can run 10–15 mmHg higher than manual readings. He recommends not drawing clinical conclusions from any single day's readings.