It is time to get the CORRECT BP at every visit: Why Positioning Matters + What the Research is Telling Us

August 25, 2025

What Every Clinician Should Know About BP Technique—and Why It Matters

Blood pressure(BP) readings are essential in patient care, guiding decisions related to diagnosis, medication prescriptions and the management of both acute and chronic conditions. This is particularly important given that nearly one in two US adults now has hypertension, according to national estimates published in the Journal of Clinical Hypertension. With such high stakes for measurement accuracy, it has never been more critical to ensure BP readings are as accurate as possible.

As both a clinician and a patient, I’ve seen firsthand how often BP is measured incorrectly. Dangling feet, unsupported backs, arms not supported and cuffs below heart level—small details that introduce big variability into what we consider routine vitals. To protect diagnostic integrity, we must adhere to best practices outlined by the American Heart Association (AHA) guidelines.

7 Essential Elements of Accurate BP Measurement:

1. Patient Positioning: Seated with feet flat on the floor, back supported and legs uncrossed.

2. Cuff Placement: Not over clothing

3. Arm Support: Arm supported with cuff at heart level, avoiding muscle tension

4. Resting Time: Quiet rest for at least 3-5 minutes before measurement

5. No Talking or Active Listening: Patient and care provider should remain silent during measurement

6. Avoiding Stimulants: No caffeine, exercise or smoking within 30 minutes before measurement

7. Correct Cuff Size: Must fit the patient’s arm circumference properly, snug but not too tight.

This blog explores how patient positioning equipment selection and adherence to evidence-based techniques directly influence diagnostic integrity, medication decisions and clinical outcomes. You’ll find not only insights from the CORRECT BP study—but also practical steps to raise the bar in your daily workflow.

Don’t Let Improper Positioning Lead to a Bad Diagnosis

The CORRECT BP study revealed that BP readings taken on a standard, fixed-height exam table—where proper AHA positioning could not be achieved—averaged 7.0 mmHg higher systolic and 4.5 mmHg higher diastolic than those taken in a properly designed clinical chair that supports proper AHA positioning (p < 0.0001). This level of variation is not trivial. It is enough to shift a patient from a normotensive classification to hypertensive status, potentially triggering unnecessary treatments.

These findings reinforce the 2017 AHA guidelines, which emphasize the need for standardized BP measurement techniques. The guidelines also lowered the numbers for the diagnosis of hypertension from 140/90 to 130/80 mmHg, a clinically significant change that makes small measurement deviations more likely to result in misdiagnosis.

The following chart illustrates how slight variations in BP readings can lead to different classifications, highlighting the importance of accurate measurements and adherence to AHA guidelines.

Blood Pressure Categories

Action: Clinicians must recognize the impact of patient positioning errors on BP readings and take proactive steps to ensure accurate measurements. Diagnostic integrity relies on accurate BP measurements, achieved by consistently following AHA guidelines. Using an adjustable exam chair can help maintain recommended positions for proper technique and compliance.

The Cost of Inaccurate BP: Overmedication + Patient Risk

Inaccurate BP readings can lead to overdiagnosis and unnecessary treatments, such as antihypertensive medications that often cause side effects like dizziness and fatigue. These side effects reduce a patient’s quality of life and can undermine their trust in both the treatment plan and healthcare team.

Hypertension remains one of the nation’s most costly health conditions, placing a significant strain on the healthcare system. The Centers for Disease Control and Prevention reports that hypertension is responsible for an estimated $219 billion in healthcare expenditures, based on the most recent comprehensive analysis available in 2019. This staggering figure highlights the ongoing burden of hypertension on both patients and the healthcare system.

Action: When BP readings are incorrect, treatment decisions can be compromised, leading to poor clinical outcomes. By ensuring accurate readings, clinicians can reduce unnecessary prescriptions to minimize medication burden and improve long-term patient management. This not only can enhance patient health but also helps reduce the financial burden associated with overtreatment and unnecessary healthcare interventions.

Overcoming Barriers to Accurate BP Measurement in Clinical Workflows

While the 2017 AHA guidelines stress the importance of technique fidelity, clinicians often face structural and procedural barriers that hinder consistent adherence in real-world settings. Fixed-height exam tables cannot allow for proper patient positioning, and high-volume workflows rarely accommodate additional BP measurement steps unless they are intentionally built into daily protocols.

Action:

• Equip exam rooms with height-adjustable chairs that enable AHA-compliant patient positioning.

• Embed BP measurement protocols into EHR workflows and triage checklists.

• Educate staff on proper patient positioning and reinforce positioning compliance.

The CORRECT BP study highlights the use of the Midmark 626 Barrier-Free Examination Chair to achieve proper patient positioning, aligning with AHA specifications for accurate BP management. This example illustrates how thoughtful equipment selection can support adherence to evidence-based clinical standards.

While implementing these changes may seem challenging, these updates are recommended to help be compliant to AHA guidelines, streamline workflows, minimize unnecessary follow-up visits or tests, and ultimately save time—leading to more efficient care and improved patient outcomes.

Extending Precision to the Home: Patient Education and Monitoring

While in-office BP readings remain essential, it’s often home monitoring that reveals long-term trends clinicians rely on for early intervention. For example, consistently elevated morning readings may signal underlying conditions such as obstructive sleep apnea, which is often linked to poor overnight ventilation and elevated CO₂ levels. Capturing these patterns requires proper technique and routine monitoring, allowing clinicians to detect issues that may not be apparent in a single office visit.

To ensure reliable home readings, it's essential to follow standardized measurement steps, such as proper positioning and cuff placement, as emphasized by the American Academy of Family Physicians. Consistency in technique is key to obtaining accurate, repeatable results for effective monitoring.

Key steps for consistent home monitoring:

• Use an appropriately fitting upper-arm cuff on a bare arm, snug but not tight.

• Rest for five minutes before taking the reading, with feet flat on the floor and legs uncrossed.

• Position the arm properly, ensuring it is supported with cuff at heart level and avoiding talking or actively listening during the reading.

• Avoid caffeinated beverages for at least 30 minutes before taking the reading.

• Take multiple readings, ideally two in the morning and again in the evening, separated by at least one minute, for one week.

• Track contextual details such as the time of day, posture during measurement, stress levels and recent physical activity (like caffeine intake), as these can impact BP readings.

Action: By incorporating these practices into home monitoring routines, clinicians can empower patients to take accurate, consistent readings, ultimately leading to better hypertension management and improved patient outcomes.

Restoring Integrity to BP Measurement: Final Insight for Clinicians

Emerging evidence reinforces what clinicians have long known: proper technique is as crucial as the BP reading. Yet despite its clinical importance, BP measurement is often treated as a routine task—just another box to check. This mindset can lead to inaccurate readings, resulting in misdiagnosis, unnecessary treatment, loss of patient trust and inefficient use of healthcare resources.

Meaningful improvement requires a shift from routine practice to precision, as inconsistencies in measurement continue across care settings despite clear guidelines. To achieve reliable readings, proper technique must become the standard—not the exception. This commitment to accuracy starts with consistency, leading to better care, improved outcomes and greater confidence in clinical decision-making. Achieving this requires not only educating clinicians but also providing the right tools, such as height-adjustable exam chairs, to support proper technique and ensure accurate measurements.

Additional Resources:

• eBook: Ensuring Accurate BP Measurement for Improved Patient Outcomes

• Webinar: Enhancing BP Measurement Accuracy to Improve Hypertension Control + Chronic Disease Outcomes

• Webinar: Enhancing the Patient Clinical Experience

• CORRECT BP Study

About the Author

With a background in critical care and trauma nursing, combined with an MBA focused on the medical device industry, I bring a unique combination of clinical expertise and business insight to my work. My experience in the ICU and as a flight nurse has given me a deep firsthand understanding of urgency, precision and reliability in patient care and the critical role medical equipment plays in that environment.

In my current role at Midmark, I support the Veterinary division, but my clinical background has also led me to collaborate with the Medical division on authoring a clinical blog aimed at improving healthcare practices. I'm passionate about the intersection of clinical accuracy and technology. I believe that how equipment is used is just as important as the tools themselves in achieving optimal clinical outcomes. This drives my work—ensuring healthcare professionals have both the tools and knowledge to improve patient care and deliver the highest standards of treatment.