Proper Positioning Has a Clinically Significant Impact on Blood Pressure Readings

Dr. Tom Schwieterman





Midmark is committed to helping bring increased standardization and accuracy to the measurement of blood pressure (BP). Through our Better BP initiative, we have been offering education to healthcare providers on the importance of consistent BP capture, as well as the clinical and monetary impact of inaccurate BP.

We have also focused our fully integrated point of care ecosystem on three main pillars of Better BP to help make it easier for providers to take the necessary steps to ensure a more consistently accurate BP measurement process. 

Most recently, we funded a study that affirms the guidelines for in-clinic BP measurement that the American Heart Association (AHA) published in 2017. The CORRECT BP study validates that proper positioning has a clinically significant impact on BP readings. A peer-reviewed report of the study was published in eClinical Medicine, part of The Lancet Discovery Science.


CORRECT BP Study Results

The study, independently executed by non-affiliated research scientists and clinicians, compared BP readings taken while adhering to AHA- and SPRINT-recommended patient positioning guidelines to BP readings obtained using a process typical in routine clinical care where recommended positioning procedures for BP attainment often are not followed.

In particular, the team evaluated the effect on BP when feet are not properly positioned flat on the floor, the back is not supported, and the arm is not supported with the BP cuff at heart level.

The study authors and designers chose to use the Midmark 626 Barrier-Free Examination Chair to ensure proper participant positioning following AHA recommendations. The Midmark 626 is the only exam chair of its kind designed to promote consistent proper patient positioning for a more accurate BP measurement.

The CORRECT BP study demonstrated that adhering to the positioning guidelines studied resulted in substantially lower BP values than when using a commonly employed technique with improper positioning.

BP readings taken on a fixed-height exam table where the proper AHA-recommended protocol could not be achieved (feet not flat on the floor, back unsupported and arm not supported with BP cuff at heart level) were significantly higher than readings taken using the proper technique with the patient seated in an exam chair with adjustable positioning options. Pooled systolic/diastolic BP readings taken with incorrect positioning (on a fixed-height exam table) were significantly and markedly higher by 7.0/4.5 mmHg (both p<0.0001).

Why is this important?

If improperly acquired higher BP readings are used, it could result in misclassifying a patient as having hypertension when they do not. Accurate BP measurement can help reduce instances where a patient might be overmedicated, which can increase the risk of side effects.

The observed benefit of proper positioning is sufficient to change the classification of BP disorders for millions of patients from hypertensive to normal. In fact, the study results support estimates that as many as 30 million or more Americans may be incorrectly classified as having hypertension.

It is important to stress that the CORRECT BP study is not a criticism of healthcare providers’ current measurement processes. It is a reminder that even with something as seemingly simple and routine as BP measurement, there is the risk of human errors and inaccuracies occurring when proper protocols are not followed. This study demonstrated that the effect of these errors are indeed substantial and can directly impact clinical decision-making.


Providers should also think about how they might redesign their system’s approaches with respect to patient care to find ways to implement proper positioning and other recommendations into their BP acquisition process in a way that is still efficient without negatively impacting patients or workflow.

For patients, the study is a reminder of how important it is for them to pay attention to BP measurements and understand why accurate BP measurement is important. It also illustrates the importance of patients understanding the proper process to take an accurate BP measurement and taking steps to own their own BP measurement process.

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