Proper measurement of BP

Q: While obtaining the blood pressure (BP) via the classical auscultatory method, the cuff should be deflated? - select one

A) 1 mmHg per second

B) 2 mmHg per second

C) 3 mmHg per second

Answer: B

It should always be appreciated that measuring BP via the classical auscultatory method is an art and requires precise external conditions and specific steps to perform. Careless, or in mild words, not following all steps correctly, may give wrong numbers and may harm the patient with an inappropriate prescription (or no prescription) of treatment. Readers are requested to refer pto the proper guidelines/checklists in this regard, but some vital components are:

• Avoid caffeine, exercise, and smoking for at least 30 minutes before measurement
• Empty bladder
• Sitting in a chair (feet on floor, back supported) for >5 minutes
• Remove all clothing covering the location of the cuff placement
• Reliable and calibrated device
• Arm resting on a desk
• The middle of the cuff on the patient's upper arm at the level of the right atrium (the midpoint of the sternum)
• Use the correct cuff size, such that the bladder encircles 80% of the arm
• Inflate the cuff 20 to 30 mmHg above the pulse obliteration pressure.
• Deflate the cuff pressure 2 mmHg per second, and listen for Korotkoff sounds.
• Use an average of ≥2 readings obtained on ≥2 occasions to estimate the individual's BP level

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References:

1.  Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol 2017. 

2. Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension 2025; 82:e212.