How Accurate is Your Blood-Pressure Reading? A Deeper Look at Common Errors and Their Consequences

How Accurate is Your Blood-Pressure Reading? A Deeper Look at Common Errors and Their Consequences

Edited by: TJVNews.com

Your blood-pressure reading might not be as accurate as you think, according to insights from The Wall Street Journal. Many patients—and even medical professionals—often skip key steps needed to ensure an accurate measurement. These missteps can lead to readings that are either artificially high or low, potentially impacting the diagnosis and management of hypertension, a leading risk factor for cardiovascular disease and other health complications.

As reported by The Wall Street Journal, proper blood-pressure measurement is critical for preventing life-threatening conditions such as heart attacks, strokes, chronic kidney disease, and dementia. Dr. Tammy Brady, a pediatric nephrologist at Johns Hopkins Children’s Center, emphasized the importance of getting accurate readings, stating, “To really make a dent at improving people’s cardiovascular health, we need to screen and treat people for hypertension, but we need to do it correctly.”

Hypertension, or high blood pressure, is the leading global risk factor for premature death and disability. In the U.S. alone, nearly half of adults have high blood pressure, yet only 20% have it under control, according to the Centers for Disease Control and Prevention (CDC), as cited by The Wall Street Journal.

A variety of seemingly minor factors can significantly influence blood-pressure readings, according to the recently published report in The Wall Street Journal. These include how a person sits, whether their arm is supported, and even recent activities such as consuming caffeine or engaging in conversation. Anxiety, especially in a clinical setting, can also play a role. This phenomenon, known as white-coat hypertension, occurs when blood pressure rises in a doctor’s office but reads normal at home.

Blood pressure naturally fluctuates throughout the day due to activities such as exercise and stress. However, the goal is to capture a person’s usual blood pressure, independent of these variations, according to guidelines from the American Heart Association (AHA), as highlighted by The Wall Street Journal.

To ensure accurate blood-pressure readings, The Wall Street Journal outlined several best practices recommended by the AHA and other health organizations.  Sit with both feet flat on the ground, legs uncrossed, and back supported. Your arm should rest on a table or other surface, with the cuff positioned at heart level.  Refrain from talking, scrolling on your phone, or engaging in other activities during the measurement. Ensure your bladder is empty and that you’ve had adequate rest before the reading. Take blood pressure multiple times during a sitting to capture a more accurate average. The cuff should be placed on a bare arm, free from clothing that might interfere with its function.

As explained in The Wall Street Journal report, a blood-pressure reading measures the force of blood against artery walls during two phases of the heart’s activity: systolic (when the heart beats) and diastolic (when the heart rests). While fluctuations are normal, consistently elevated readings can indicate hypertension.

Dr. Michael Rakotz, group vice president for improving health outcomes at the American Medical Association, emphasized  the dangers of uncontrolled blood pressure. “Left uncontrolled, it can lead to heart attacks, strokes, chronic kidney disease, heart failure, and dementia,” he told The Wall Street Journal.

Inaccurate readings can lead to misdiagnoses, unnecessary treatments, or, conversely, missed opportunities to manage hypertension effectively. The Wall Street Journal reported that capturing an individual’s usual blood pressure over time is essential to tailoring appropriate medical interventions and improving overall health outcomes.

James Young II, now a clinical-research retention coordinator, credits his life to a realization about the proper way to measure blood pressure. As reported by The Wall Street Journal, his journey underscores the critical importance of accurate blood-pressure readings—a seemingly simple task that, when done incorrectly, can lead to dire health consequences.

At the age of 40, Young began experiencing troubling symptoms, including shortness of breath and persistent headaches. When he started monitoring his blood pressure at home, his readings appeared abnormal but not alarming enough to warrant immediate action, as was noted in The Wall Street Journal report. However, during a doctor’s visit, he discovered his blood pressure was dangerously high, prompting a diagnosis of congestive heart failure and other conditions.

What caused the oversight? Young had been using the wrong cuff size and an outdated device, errors that significantly affected the accuracy of his readings. “I was really playing Russian roulette with my life,” he reflected, as recounted by The Wall Street Journal.

Young’s story highlights the dangers of incorrect blood-pressure measurement, an issue that affects millions of Americans. The Wall Street Journal report indicated that improper technique, such as using an ill-fitting cuff, can skew results in critical ways. A cuff that is too small often leads to readings that are falsely high, while a cuff that is too large underestimates blood pressure levels. Even subtle errors, such as resting an arm in one’s lap or letting it dangle during measurement, can overestimate systolic readings by as much as 3.9 millimeters of mercury (mmHg) and diastolic readings by 4 mmHg, as shown in studies conducted by Dr. Tammy Brady and her colleagues.

According to the information provided in The Wall Street Journal report, these inaccuracies have far-reaching consequences. Misreadings can lead to patients being incorrectly diagnosed with hypertension and placed on unnecessary medication, potentially dropping their blood pressure too low. Dr. Jennifer Cluett, a hypertension specialist at Beth Israel Deaconess Medical Center, explained that overtreatment can cause side effects like fatigue, dizziness, and lightheadedness, increasing the risk of falls and other injuries.

On the flip side, underdiagnosis due to inaccurately low readings means that patients may not receive the critical care they need, leaving them vulnerable to complications such as heart failure, stroke, or chronic kidney disease. “It’s about making sure that you’re appropriately treating the patient in front of you,” Dr. Cluett told The Wall Street Journal, emphasizing the delicate balance required in hypertension management.

Experts stress the need for standardized, accurate blood-pressure measurement practices. Dr. Brady, a pioneer in blood-pressure research, even carries a measuring tape to check patients’ arm circumferences and ensure they use the right cuff size. As The Wall Street Journal report highlighted, consistent and accurate readings are vital to avoiding misdiagnosis and ensuring effective treatment.

Paul Muntner, a visiting professor of epidemiology at the University of Alabama at Birmingham, likened the current state of blood-pressure measurement to tolerating errors in cholesterol or diabetes testing—something the medical community would never accept.

James Young’s story does not end with his diagnosis. Motivated to improve his health, he adopted a healthier lifestyle, focusing on nutrition and exercise. Now 53, he holds a master’s degree in public health and works at Wayne State University in Detroit, using his personal journey to inspire and educate others. As The Wall Street Journal reported, his experience serves as a powerful reminder of the life-saving potential of accurate blood-pressure monitoring.

A 2017 study led by Dr. Michael Rakotz found that only 1 out of 159 medical students from 37 U.S. states performed all the necessary steps to measure blood pressure correctly. On average, these students correctly executed only 4.1 of the 11 steps required for an accurate reading, such as ensuring proper positioning of the arms and legs. The Wall Street Journal reported that this troubling discovery spurred professional organizations and medical schools to intensify education on proper blood-pressure measurement techniques.

Despite these efforts, challenges persist. Hypertension specialists note that accurately measuring blood pressure can take up to 10 minutes—a significant time investment in fast-paced medical environments. Yet, the importance of these 10 minutes cannot be overstated, as inaccurate readings can lead to misdiagnosis and inappropriate treatments.

Clinical environments often present logistical barriers to proper blood-pressure measurement, according to the report in The Wall Street Journal. Many exam rooms lack the setup required for accurate readings, such as a chair placed next to a table where a patient’s arm can be properly supported. Barbara Wise, a professor of graduate nursing at Indiana Wesleyan University, observed that many medical facilities rely on wall-mounted devices next to exam tables, which do not provide the necessary support for a patient’s arm. “I haven’t seen anybody take a blood pressure with a patient’s arm on a table in years,” Wise remarked  to The Wall Street Journal.

Doctors and nurses often improvise solutions in these constrained settings. Adjustable exam tables are sometimes lowered to support a patient’s arm, or chairs with wide armrests are utilized. In other cases, medical staff hold the patient’s arm manually, though this can make it difficult for the patient to relax fully—a critical component for an accurate reading.

Recognizing these challenges, the American Medical Association (AMA) has partnered with healthcare providers and community health centers to address gaps in infrastructure. According to The Wall Street Journal report, these efforts include ensuring that exam rooms are equipped with chairs and tables that facilitate proper positioning for blood-pressure measurements.

Home blood-pressure monitoring is another area of focus. While it offers patients a convenient way to track their blood pressure, many individuals lack proper guidance on how to measure it accurately. Compounding the problem, a 2023 study cited by The Wall Street Journal found that nearly 80% of blood-pressure devices sold online had not been validated for accuracy. To address this, the AMA has compiled a list of validated devices to help consumers make informed choices.

Inaccurate blood-pressure readings can have serious consequences. Overestimated readings may lead to unnecessary medication, which can cause side effects such as dizziness, fatigue, or dangerously low blood pressure. Conversely, underestimated readings may leave hypertension untreated, increasing the risk of heart attacks, strokes, and kidney disease. As The Wall Street Journal report emphasized, these errors undermine the efficacy of hypertension management, a cornerstone of preventive medicine.

. With nearly half of American adults affected by hypertension, these improvements are not just desirable—they are imperative. By investing in better infrastructure, education, and awareness, the medical community can take a significant step toward reducing the burden of cardiovascular disease and improving overall health outcomes.