When measuring BP in the office, care should be taken
(i) to allow the patients to sit for 3–5 minutes before beginning BP measurements;
(ii) to take at least two BP measurements, in the sitting position, spaced 1-2 min apart, and additional measurements if the first two are quite different. Consider the average BP if deemed appropriate;
(iii) to take repeated measurements of BP to improve accuracy in patients with arrhythmias, such as atrial fibrillation;
(iv) to use a standard bladder (12-13 cm wide and 35 cm long), but have a larger and a smaller bladder available for large (arm circumference >32 cm) and thin arms, respectively;
(v) to have the cuff at the heart level, whatever the position of the patient;
(vi) when adopting the auscultatory method, use phases I and V (disappearance) Korotkoff sounds to identify systolic and diastolic BP, respectively;
(vii) to measure BP in both arms at first visit to detect possible differences. In this instance, take the arm with the higher value as the reference;
(viii) to measure at first visit BP 1 and 3 min after assumption of the standing position in elderly subjects, diabetic patients, and other conditions in which orthostatic hypotension may be frequent or suspected;
(ix) to measure, in case of conventional BP measurement, heart rate by pulse palpation (at least 30 s) after the second measurement in the sitting position.
