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Updated: Jan 19, 2026
Errors occurring during blood pressure monitoring
Sources of Error in Office Blood Pressure Measurement.
Roy N Morcos1, Kimbroe J Carter2, Frank Castro2
1From the Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (RNM, SK); Department of Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (RNM); Medical Decision Making Society of Youngstown Ohio, c/o Jeghers Medical Index, St. Elizabeth Youngstown Hospital, Youngstown, OH (FC, KJC); Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (SK, DS); Department of Pathology, Northeast Ohio Medical University, Rootstown, OH (KJC). Roy_Morcos@mercy.com.
Manual blood pressure (BP) measurement shows terminal digit bias, while automated devices do not. Patient positioning significantly impacts BP readings, with chair measurements yielding lower results than table measurements.
Area of Science:
- Clinical Medicine
- Cardiovascular Research
- Medical Measurement
Background:
- Accurate blood pressure (BP) measurement is crucial for diagnosing and managing hypertension.
- Common sources of error in clinical BP measurement are often overlooked.
- Terminal digit bias (TDB) and patient positioning can affect BP readings.
Purpose of the Study:
- To assess the impact of improper patient positioning on BP measurements.
- To evaluate the frequency of terminal digit bias (TDB) in manual versus automated BP devices.
- To identify potential errors in hypertension classification due to measurement techniques.
Main Methods:
- Three nurses measured BP using both manual and automated devices, with readings analyzed for TDB.
- 294 patients had BP measured twice in a seated chair position and compared to measurements taken in a supine table position.
- A randomized controlled trial was used to control for measurement sequence effects.
Main Results:
- Significant TDB was observed with manual BP devices but not with automated devices.
- BP measurements in the chair position were significantly lower than those in the table position (42.7% of patients).
- Using table positioning could lead to misclassification of hypertension in 15.3% and prehypertension in 16% of patients.
Conclusions:
- Manual BP measurement is prone to terminal digit bias, unlike automated devices.
- Patient positioning significantly affects BP readings, with table positioning leading to elevated systolic and diastolic BPs.
- Standardizing patient positioning and utilizing automated devices can improve BP measurement accuracy.
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