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Updated: Jul 17, 2026

Quantitative Autonomic Testing
Published on: July 19, 2011
How should we measure blood pressure in the doctor's office?
W Gerin1, R M Marion, R Friedman
1Cornell University Joan and Sanford I. Weill Medical College-New York Presbyterian Hospital, New York 10021, USA. wgerin@med.cornell.edu
Background:
Blood pressure is the most ubiquitous diagnostic recording made in the doctor's office, but the measurement is subject to a number of sources of bias, which may lead to over- or underestimation. The current study examined the systematic influence of the way in which the measurements were taken - by the physician, by a nurse, or with the patient sitting alone, using an automated device.
Subjects And Methods:
Blood pressure was measured in 17 essential hypertensive and 10 white-coat hypertensive individuals. On separate clinic visits, measurements were taken by the attending physician, by a nurse and using an automated device (Arteriosonde 1216).
Results:
A repeated-measures ANOVA revealed that, for systolic pressure, there was a significant effect of measurement modality on blood pressure. Physician systolic pressures were on average approximately 10 mmHg higher than those taken by a nurse, nurse pressures being approximately 7 mmHg higher than those recorded using Arteriosonde. The effect on diastolic pressure was similar but smaller, and no nurse-Arteriosonde difference was observed.
Conclusions:
We conclude that the routine clinical assessment of blood pressure would be more representative of daily ambulatory pressure if an automated device, without doctor or nurse present, were used.
Related Concept Videos
Sites for measuring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
Equipments Used To Measure Blood Pressure
This invasive approach involves cannulating a peripheral artery. During each cardiac contraction, pressure generates mechanical motion within the catheter, transmitted through rigid, fluid-filled tubing to a transducer. This transducer converts mechanical motion into electrical signals displayed as waveforms on a monitor. An automatic flushing system prevents blood backflow. Due to the potential risk of unexpected arterial blood loss, this method is primarily used in intensive...
Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
Assessment of blood pressure in brachial artery(two-step method)
Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
Measurement of Blood Pressure

