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Blood Pressure Monitoring

By

Catherine Spader, RN

What is blood pressure monitoring?

Blood pressure monitoring means taking your blood pressure on a regular or continuous basis. Blood pressure monitoring helps assess your overall health and your condition when you are sick or injured. Blood pressure monitoring can occur at a doctor’s appointment, at home on a regular basis, and in the hospital continuously if you are seriously ill or injured.    

Blood pressure is the force exerted on the walls of your arteries as your heart pumps blood through your body. Your blood pressure consists of two numbers followed by the units of pressure, such as 120/80 mmHg (millimeters of mercury): 

  • The top number is the systolic pressure—the highest pressure in your arteries as the heart is pumping blood.

  • The bottom number is the diastolic pressure—the lowest pressure in your arteries when the heart is at rest between beats.

A general guideline for normal blood pressure in adults is less than 120/80 mmHg. Regular blood pressure monitoring is important because a single blood pressure reading does not provide enough information to evaluate your health status. 

Noninvasive blood pressure monitoring is a safe, routine procedure. It is only one method of monitoring your general health and condition. Ask your doctor about all the methods of monitoring and evaluating your health status.  

Types of blood pressure monitoring

The types of blood pressure monitoring include:

  • Noninvasive blood pressure monitoring, which most often involves applying a blood pressure cuff to the upper arm. Some devices take readings in a finger, wrist or thigh. This type of monitoring usually occurs at specific points in time, such as weekly, daily, or every 15 minutes, depending on your health and condition. Specialized noninvasive devices can provide continuous 24-hour blood pressure monitoring, which offers a broader picture of your health.

  • Invasive intra-arterial pressure (IAP) monitoring, which measures blood pressure continuously through a catheter in an artery. The catheter is usually placed in the wrist. IAP is useful in certain major surgeries, such as open-heart surgery, and in critically ill or injured patients.

Why is blood pressure monitoring performed? 

Blood pressure monitoring is an important element in evaluating general health and most diseases and conditions. It also helps to diagnose and evaluate treatment for high blood pressure (hypertension) and related conditions, such as preeclampsia or pregnancy-induced hypertension. Your doctor may recommend home blood pressure monitoring for such conditions as hypertension, coronary heart disease, diabetes, and kidney disease. 

A general guideline for normal blood pressure in adults is less than 120/80 mmHg. However, blood pressure measurements change in response to many situations. Some changes are normal. Examples include a mild, temporary rise during strenuous activity or a fall in blood pressure during periods of relaxation or sleep. 

Other blood pressure changes can indicate an unhealthy condition. Examples include a consistent rise due to high blood pressure (hypertension) or a drop due to severe bleeding or shock.

Who performs blood pressure monitoring?

All qualified healthcare providers can check and monitor your blood pressure. You can also do it yourself using home blood pressure monitoring devices. Following is a partial list of healthcare providers who perform blood pressure monitoring:  

  • Cardiologists specialize in diagnosing and treating diseases or conditions of the heart and blood vessels.

  • Nurses are licensed healthcare professionals who ensure that patients attain, maintain, or recover optimal health and functioning.

  • Primary care providers offer comprehensive healthcare services and treat a wide range of illnesses and conditions. They include internists, family practitioners (family medicine), pediatricians, geriatricians, physician assistants (PAs), and nurse practitioners (NPs).

How is blood pressure monitoring performed?

Blood pressure monitoring is performed in most healthcare settings and in the home. 

Manual blood pressure monitoring on your arm generally includes these steps:

  1. Sit or recline in a comfortable position with your back supported, legs uncrossed, and your arm supported at the level of your chest. Turn your palm upward.

  2. Apply the blood pressure cuff to your upper arm, about one inch above the elbow. It should be snug but not tight.

  3. Put the stethoscope earpieces into your ears and position the stethoscope disk on the crease of your elbow in the area closest to your body.

  4. Squeeze the rubber bulb rapidly and smoothly until the pointer on the blood pressure gauge is 30 to 40 points higher than your last systolic reading. For example, if your last reading was 130/88 mmHg, inflate the cuff to 160 -170 mmHg. The cuff should feel tight, but not painful.

  5. Watch the blood pressure dial as you slowly loosen the valve. This releases air out of the cuff. The cuff should deflate slowly and consistently.

  6. As the cuff deflates, listen for your heartbeat in your arm using the stethoscope. When you hear the first heartbeat, note the number on the dial. This number is the first number of your blood pressure or systolic pressure.

  7. Continue to listen to your heartbeat until the cuff completely deflates. When you hear your heartbeat stop, note the number on the dial. This is the second number of your blood pressure reading or diastolic pressure.

  8. Make a note of your blood pressure in a journal or log. Write the reading with the systolic pressure before the diastolic pressure. For example, 118/76. Notify your doctor if your reading falls over or under the guidelines set for you. Be sure to ask your doctor for your guidelines.

  9. If you want to repeat your blood pressure measurement, wait several minutes between readings.

Automatic or digital blood pressure monitoring generally includes these steps:

  1. Sit or recline in a comfortable position with your back supported and legs uncrossed. If you are using an arm cuff, support your arm in a position at the level of your chest. Turn your palm upward.

  2. Apply the blood pressure cuff to your upper arm, about one inch above the elbow. It should be snug but not tight. If you are using devices for your finger or wrist, follow the instructions for proper positioning of the device.

  3. Push the button to start inflating the cuff.

  4. Your blood pressure reading will appear on a digital screen.

  5. Make a note of your blood pressure in a journal or log. Write the reading with the systolic pressure before the diastolic pressure. For example, 118/76. Notify your doctor if your reading falls over or under the guidelines set for you. Be sure to ask your doctor for your guidelines.

  6. If you want to repeat your blood pressure measurement, wait several minutes between readings.

Invasive intra-arterial pressure (IAP) monitoring involves inserting a special catheter, known as an arterial line, into an artery to measure blood pressure. The procedure is similar to inserting an IV. It  generally takes place in an intensive care unit (ICU), surgical area, or the emergency room. IAP monitoring measures arterial blood pressure every few seconds and shows the readings on a monitor screen.

Will I feel pain with blood pressure monitoring?

Your comfort and relaxation is important to you and your care team. In fact, being relaxed is important for getting an accurate blood pressure reading. 

You will feel pressure as the blood pressure cuff inflates during noninvasive blood pressure monitoring. The pressure disappears quickly as it deflates. Blood pressure monitoring should not be painful. If it is, tell a member of your care team.

Doctors insert a special catheter (tube) into an artery to take intra-arterial (IAP) blood pressures. IAP monitoring takes continuous blood pressure readings in seriously ill or injured patients. Your doctor will use a local anesthetic to numb the area when he or she places the catheter in an artery.

Your care team will keep you comfortable with pain or sedative medications as needed. Tell your care team if you are uncomfortable or the arterial line is painful. 

What are the risks and potential complications of blood pressure monitoring?  

Noninvasive blood pressure monitoring is a safe, routine procedure for most people. It is sometimes important to avoid using a particular arm for blood pressure monitoring. Tell all of your care providers and do not allow anyone to measure your blood pressure in an arm or leg with any of the following devices or conditions:

  • A deep, serious, or non-healing wound

  • Arteriovenous (AV) graft or fistula, which is used for dialysis

  • IV line, peripherally inserted central catheter (PICC line), or any other medical device

  • Lymphedema, which is a blockage of the lymphatic system that causes swelling of an arm or leg. This includes an arm or leg at risk for lymphedema. This includes the arm on the side in which lymph nodes have been removed as part of breast cancer treatment.

Invasive intra-arterial pressure (IAP) monitoring is an invasive procedure that has some potential risks and complications. These are uncommon but include:

  • Allergic reaction to the local anesthetic

  • Bleeding

  • Blockage of the artery and reduced blood supply to tissues

  • Blood clots

  • Infection or injury to the extremity that the catheter is in

Reducing your risk of complications

You can reduce the risk or the seriousness of certain complications of invasive intra-arterial pressure (IAP) monitoring by: 

  • Avoiding pulling on the arterial line or scratching at the insertion site

  • Ensuring that your care team is aware of your complete medical history including a history of blood clots and any allergies

  • Following activity and movement restrictions while the arterial line is in place

  • Notifying your care team immediately of any concerns such as bleeding, pain, swelling or redness of the arterial line insertion site, or pain, coldness or numbness of the area below the insertion site

How do I prepare for my blood pressure monitoring?

You are an important member of your own healthcare team. The steps you take before blood pressure monitoring can help you get the most accurate blood pressure readings. You can prepare for blood pressure monitoring by:

  • Not eating or using caffeine, alcohol, or tobacco products for 30 minutes before taking your blood pressure

  • Emptying your bladder before taking your blood pressure

  • Relaxing for several minutes before taking your blood pressure

Questions to ask your doctor

It is common for patients to forget some of their questions about blood pressure monitoring during a doctor’s office appointment. Contact your doctor with any questions or concerns about blood pressure monitoring between appointments. 

It is also a good idea to bring a list of questions to your appointments. Common questions include:

  • Why do I need blood pressure monitoring?

  • For home blood pressure monitoring, what type of device is best for me?

  • How often should I check my blood pressure?

  • What blood pressure readings are abnormal for me? When should I contact you for abnormal readings? Ask for numbers to call during and after regular hours.

  • If you are having major surgery, ask your doctor if he will use intra-arterial pressure (IAP) monitoring. Ask if noninvasive blood pressure monitoring is an option for you.

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 11, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. A comparison of a continuous non-invasive arterial pressure (CNAP) monitor with and invasive arterial blood pressure monitor in the cardiac surgical ICU. Annals of Cardiac Anesthesia. http://www.annals.in/article.asp?issn=0971-9784;year=2012;volume=15;issue=3;spage=180;epage=184;aula...
  2. High Blood Pressure/Blood Pressure Monitoring at Home. American Academy of Family Physicians. http://familydoctor.org/familydoctor/en/diseases-conditions/high-blood-pressure/diagnosis-tests/bloo....
  3. Home Blood Pressure Monitoring. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/SymptomsDiagnosisMonitoringofHighBloodPre...
  4. Wearable blood pressure sensor offers 24/7 continuous monitoring. Massachusetts Institute of Technology. http://web.mit.edu/newsoffice/2009/blood-pressure-tt0408.html.

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