Evidence based treatment of hypertension: Measurement of blood presssure: an evidence based review

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Abstract
What can interfere with the accuracy of blood pressure measurement? Most people's blood pressure varies substantially throughout the day. Lowest readings occur during rest or sleep, while a variety of activities cause an increase (table 1). Additionally, numerous factors can affect the accuracy of measurements (table 2).3–9 A comprehensive literature search identified all studies describing potential sources of bias in measurement of blood pressure. The studies were evaluated using a standard hierarchy of evidence (that of the Centre for Evidence-Based Medicine; http://cebm.jr2.ox.ac.uk/docs/levels.html), and table 2 shows those factors which evaluated satisfactorily against a “gold standard.” Full listings of the search strategy and references, all factors which have been described, and the supporting evidence behind each factor are given in Evidence Based Hypertension.10 In a survey of 114 doctors the most common mistakes included use of an inappropriately sized cuff (97%), failure to allow a rest period before measurement (96%), deflating the cuff too fast (82%), not measuring in both arms (77%), and failure to palpate maximal systolic pressure before auscultation (62%).11