Apollo health city   Center for Blood Pressure Management
Blood Pressure


"The measurement of BP is likely clinical procedure of greatest importance that is performed in the sloppiest manner”
Norman Kaplan Lancet 2007; 370:591



If you measure blood pressure at home as per expert recommended technique, it will be far more accurate
than your physician office blood pressure measurement!

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 Accurate Home Blood Pressure Measurement

Two most important issues in measuring blood pressure accurately at home :

  A good automatic blood pressure monitor
  Correct technique to measure blood pressure

Hypertension experts have identified several blood pressure monitors that were tested and found to be accurate. Some of those are listed below

In 2008 US and European hypertension experts came out with consensus statements that illustrate how home blood pressure can be measured accurately. A summary of these statements for patients can be found on this page.

  Home Blood Pressure Monitoring Devices  

Recommended Home Blood Pressure DevicesCanadian Hypertension
Education Program (CHEP) :

Monitors A&D® or LifeSource® Models:

767* $84.95

767PAC* $59.99

774AC* $84.95

779 $69.95

787AC* $94.99

Monitor Omron® Models:

HEM-705 PC* $79.95

HEM-711* $69.99


Monitor Microlife® Model:

BP 3BTO-A $79.95


by Consumer Reports 2008

Consumer Reports tested available blood pressure monitors and found the following automatic arm models to be accurate, consistent and convenient in measuring blood pressure.

This report is in September 2008 issue of Consumer Report

Following are the top ranking monitors, their cost and available blood pressure cuff sizes.

These models are ranked in order of their performance.

Brand & model     Price Cuff size, inches (medium/large) 
Omron Women’s Advanced Elite  $100   9-13/13-17 (both included)

CVS by Microlife Deluxe Advanced
344534 Microlife Ultimate 3MCi-PC


9,5-13.25/12-16 (both included)

Omron Hem-711AC

$ 90  


ReliOn HEM- 741CREL (Wal-Mart)

$ 40 9-13/13-17 (lg.cuff$10)

Panasonic EW 3152 A

$ 150

One size 7.75-13.25

Life Source premium UA-853AC


9.4-14.2/14.2-17.7 (lg.cuff $20)

Homedics BPA-200 HoMedics BPA-250


One size,8.7-18.1

Walgreens by HoMedics BPA-430WGN


One size, 8.7-18.1

Lumiscope AccuRead 1134


One size ,9.5-18.2


A comprehensive list of validated home BP devices is provided at www.dableducational.com


  Correct Technique of Home Blood Pressure Measurement   


Cleveland Clinic's Video on Home Blood Pressure Monitoring

The following video details AHA /ASH  (2008) on home blood pressure monitoring.

It was produced by Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic. Dr Rafey and Physician Assistant Ms. Caryl Richards can be seen interacting with the patient.




American Heart Association's Video on Home Blood Pressure Monitoring

The following video was produced by AHA. Dr Thomas Pickering is the physician evaluating home blood pressure readings.



Take Control of Your Hypertension Today
Buy a validated automated blood pressure device

Patient Instructions for Home Blood Pressure Monitoring (HBPM)

 Blood pressure measuring device:

  Only arm monitors are recommended, unless any other monitor is recommended by your physician
  List of validated devices tested by recommended by experts is provided on on this website
  Please make sure that you bring in the device initially and once every year to you physician's office so that we will check and see if it is working optimally. 
  You have to make sure that the blood pressure cuff size is appropriate for your arm circumference (See the cuff specification diagram below)

Technique of measuring blood pressure:

  You should not have indulged within the 30 minutes preceding the measurement in activities such as smoking, drinking coffee, or exercising
  Please sit quietly and rest for 5 minutes in a chair with back rest, with the arm supported on a flat surface, such that the upper arm is supported at the level of the heart
  It may be easiest to measure BP in the non-dominant arm
  At least 2 and preferably 3 readings be taken at 1 time. Please and the value for each reading written down in a diary
  The interval between readings can be as little as 1 minute
  Readings should routinely be taken first thing in the morning (preferably before you  take medications) and at night before you go to bed (preferably before you  take medications)
  The frequency of readings will be determined by your physician.
  Please do not measure blood pressure at times, such as when you think you are under stress or the BP is high
  Please note that the variability of blood pressure readings is high and that individual high or low readings have little significance
  Recent American Heart Association guidelines recommend that before your next physician office visit, you record at least 2 morning and 2 evening readings every day for 1 week but to discard the readings of the first day, which gives a total of 12 readings on which your physician can make decisions.
  Long-term observation:
  For stable normotensive (controlled) patients, patients should conduct  HBPM a minimum of 1 week per quarter (an average of 12 morning and  evening measurements under conditions described above)

Please do not use wrist monitors......


White Coat Effect

The first blood pressure measured in physician office is usually high. Major clinical trials discard the first measurement and instead rely on second and third blood pressure reading.

If your blood pressure is measured without following blood pressure measurement guidelines, it is likely that a falsely high
reading will be obtained.

Here are some examples that raise your blood pressure during blood pressure measurement:



 A video provided by NEJM on correct technique for accurate measurement of office blood pressure:




24 hour Ambulatory Blood Pressure Monitoring :
The gold standard for accurate blood pressure measurement !


This device is the size of a cell phone, is attached to a blood pressure cuff and is worn by a patient for a 24 hour period on a regular day when he goes about his usual activities and work. The 24 hour ambulatory monitor measures and records the person’s blood pressure automatically several times during the day and during the night during sleep. These serial blood pressure measurement  data are then uploaded to a computer and analyzed.

The average value of these 70-80 readings during the 24 hour period is now considered the most accurate blood pressure measurement for that person and is considered the gold standard for blood pressure measurement.


High Blood Pressure measured at your physician’s office: Is this bad for you ?

Dr Mohammed A. Rafey* MD, MS, FASH

For many years, we have been told that high blood pressure as measured in your doctor’s office is harmful to your heart, kidneys and brain and could lead to heart attacks, heart failure and kidney disease. Like most things in this world, there are multiple facets to everyday life and your true blood pressure level is not as simple and easy to measure as we may think.
New and novel ways of measuring a person’s blood pressure have identified different patterns of blood pressure variation. Some of these patterns of high blood pressure are bad for a person’s health, a few being potentially worse than others, while at the opposite end of the spectrum there are some which are harmless and do not need medication.

Blood pressure measurement in the physician’s office has been a longstanding and usual practice. In fact, the most common reason a patient visits a physician’s office is for management of his blood pressure. World experts in hypertension have outlined very specific  guidelines for the method to be followed in measuring a person’s blood pressure. If the correct method is not utilized, then there could be inaccuracies in the blood pressure measurement.

Very briefly, the patient whose blood pressure is to be measured should avoid tobacco, coffee and tea at least for a few hours before this is done. The person should rest for 5-10 minutes in a comfortable chair with a back-rest, feet flat on the ground. The blood pressure monitor should be placed at the level of the heart and the blood pressure cuff should be of appropriate size. Blood pressure should be measured several times at intervals of at least 1-2 minutes between readings/measurements. Ideally, the first blood pressure reading should be discarded and then all the subsequent readings averaged to give the person’s blood pressure measurement. Blood pressure should not be measured when a patient is anxious, or under stress.

It is clear to see, that none of these basic requirements for measuring blood pressure are followed during general visits to the doctor. Often, only a single reading is taken, the person may not be given time to relax and blood pressure may be measured in a rushed manner due to lack of time. This leaves scope for much inaccuracy in blood pressure measurement and often a high reading may be obtained if the patient is tired, stressed, rushed or anxious. This will result in a person being wrongly informed that he has high blood pressure and antihypertensive medications may be started when they may not actually be necessary. What is ideally required is that a true blood pressure reading be obtained first as recommended by expert guidelines.

An important device that has been introduce recently and has grown in acceptance as being vital for accurate blood pressure measurement is the 24 hour ambulatory blood pressure monitoring system. This device is the size of a cell phone, is attached to a blood pressure cuff and is worn by a patient for a 24 hour period on a regular day when he goes about his usual activities and work. The 24 hour ambulatory monitor measures and records the person’s blood pressure automatically several times during the day and during the night during sleep. These serial blood pressure measurement  data are then uploaded to a computer and analyzed. The average value of these 70-80 readings during the 24 hour period is now considered the most accurate blood pressure measurement for that person and is considered the gold standard for blood pressure measurement.

Several patterns of blood pressure can be noted in patients who have their blood pressure measured in their doctor’s office. A patient may have elevated high blood pressure when measured in the doctor’s office but normal blood pressure readings when measured in out of office settings, such as at home.This phenomenon is termed as white coat hypertension. Studies show that this is generally a benign condition that does not require treatment. The problem with White Coat hypertension is that, if physicians rely only on office blood pressure measurements, they may add or increase antihypertensive medications based on this, which is not necessary. Such patients with white coat hypertension often end up experiencing unwanted side effects and adverse effects related to excessive antihypertensive medications, which were not necessary in the first place. On the other hand, there are a few patients who have normal blood pressure and appear to be well controlled on treatment for hypertension, when their blood pressure is measured in the doctor’s office. However, it is interesting to note that on 24 hour ambulatory blood pressure monitoring, these patients may actually have an elevated blood pressure average which needs to be addressed for optimal blood pressure control. This pattern of high blood pressure has been termed as Masked Hypertension, and such patients could be missed if their doctors relied only upon usual office blood pressure measurement techniques. Measurement of 24 hour blood pressure has recently identified a new pattern of blood pressure, now termed as nocturnal hypertension. The patients who have nocturnal hypertension are relatively well controlled, but their blood pressure levels are elevated at night. Nocturnal hypertension like masked hypertension is harmful to vital organs. Trials are underway to see if controlling night time blood pressure offers protection and preserves these organs.

In summary, careful and thorough evaluation of a patient with hypertension is fundamental in providing optimal care to those with truly elevated blood pressure.

* Dr Mohammed A. Rafey is a American Board certified nephrologist and a leading hypertension expert at Nephrology Department
at Apollo Hospitals Hyderguda, Hyderabad. He also runs Apollo’s Center for Blood Pressure Management.


The Concept and Need for Specialized Hypertension Management Centers

Dr Mohammed A. Rafey* MD, MS, FASH



World experts in hypertension and high blood pressure from the United States and Europe now recommend the establishment of Hypertension Centers coordinated and led by trained hypertension experts. Such specialized centers will have clinical expertise backed by the latest technology and therefore the ability to perform advanced testing that will guide optimal management of hypertension according to international standards.

In the past century, high blood pressure or hypertension has evolved from being thought of as a simple disease and an innocent bystander to the present day understanding and recognition that hypertension is an important cause of disease and death worldwide. The underlying reason for this change in thought are the results from several large clinical trials which show that control of high blood pressure with appropriate antihypertensive therapy will reduce the adverse effects of long standing hypertension. 

Hypertension, if untreated affects our vital organs especially the heart, kidneys and brain and can lead to heart attack, heart failure, kidney disease and stroke. It is notable in the results of hypertension clinical trials, that even a slight lowering reduction in blood pressure reduced these adverse clinical events significantly. Results showed that a 5 mmHg lowering in blood pressure can reduce a person’s risk of dying from heart disease by 9% and risk of dying from stroke by 14%. 

A complete and thorough evaluation of patients with hypertension is fundamental for the optimal management of patients. It is extremely important to measure a person’s blood pressure in a ideal setting to get a true and accurate reading. If blood pressure measurement is not done according to the method recommended by expert hypertension guidelines, it can result in spuriously high blood pressure readings. It is also recommended that baseline followed by periodic evaluations of the eyes, vascular system, heart and kidneys should be an integral part of hypertension management as this helps guide better therapy. For example, there may be two patients with the same blood pressure level, but based on changes in the size of the heart or the presence of protein in urine, the treatment and management of these two patients will be entirely different according to this evidence of organ involvement and damage.  Patients with changes in the heart muscle thickness and protein in urine will necessarily require more intense antihypertensive therapy with medications that are specific in action to help revert some of these target organ changes or at least to slow down the progression of these abnormalities.

It is ideal that patients with hypertension should undergo a 24 hour blood pressure monitoring test to confirm that their blood pressure as measured during their typical 24 hour-day in an out of office setting is truly well controlled. This 24 hour ambulatory blood pressure monitoring is accepted as the gold standard for blood pressure measurement. A patient is required to wear a device the size of a cell phone that is attached to a blood pressure cuff for a period of 24 hours on a regular day. This device measures and records the patient’s blood pressure automatically several times during the day and the night. These blood pressure measurement data are then uploaded on a computer and analyzed. The average value of these 70-80 readings obtained throughout the day and night provide a better picture of the patient’s blood pressure levels and control and guide the physician in altering medication prescription.

In recent years, a new concept that has evolved in blood pressure measurement appears to be revolutionizing the way in which we can now measure blood pressure. The traditional method in which we have been measuring blood pressure has remained unchanged for the past one hundred years. 

The rise in blood pressure that occurs in patients with hypertension often reflects worsening in the  condition of blood vessels that carry blood away from the heart. Changes in blood vessels may occur as a result of the aging process, diabetes mellitus, excess cholesterol and due to untreated hypertension itself. Elevated blood pressure in essence is a marker that reflects blood vessel changes and disease. Sometimes, by the time elevated blood pressure levels are identified, the damage to blood vessels and the vital organs that they supply may have already occurred and may be irreversible. Hence, the need to identify markers of early changes in blood vessel stiffness such that  appropriate interventions may be initiated and treatment started earlier than it normally would be by traditional blood pressure assessments. Several devices that measure blood vessel (arterial) stiffness have been tested and obtained FDA approval.  Data from large clinical trials now demonstrate that these arterial stiffness measures are more sensitive than traditional blood pressure measurement in identifying patients who are at a higher risk for heart disease.

There is a worldwide consensus amongst hypertension experts on the recommendation and clear need for comprehensive hypertension management centers led by a trained hypertension specialists. Such specialized centers will follow international standards of care in hypertension management and incorporate state-of the-art technology and devices for 24 hour blood pressure monitoring and arterial stiffness measures. This will assist and guide the physician to individualize hypertension therapy for each patient, providing better blood pressure control and thereby minimize damage to vital organs to maintain optimal health.


*Dr Mohammed A. Rafey is a American Board certified nephrologist and a leading hypertension expert at Nephrology Department, Apollo Hospitals Hyderguda, Hyderabad. He also runs Apollo’s Center for Blood Pressure Management.


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