What causes falsely high blood pressure (BP) readings?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

Improper BP measurement may result in falsely high readings, such as when the wrong-sized cuff is used, when patients have heavily calcified or arteriosclerotic brachial arteries, or in cases of white-coat hypertension (observed in 20-30% of patients [63] ).

In one study, investigators determined that a true diagnosis of resistant hypertension with ambulatory BP monitoring (ABPM) is associated with a more severe degree of vascular dysfunction (versus white-coat resistant hypertension), as measured by hyperemia-induced forearm vasodilation (HIFV) and serum biomarkers. [116]  However, there is no direct association between BP levels and other types of abnormalities in vascular function (eg, compliance). [116]

Falsely high readings due to white-coat hypertension may be avoided by having patients rest before the measurement, by having a nurse check the blood pressure, or by arranging to have the blood pressure monitored at home. Development of hypotensive symptoms with the patient on medication is an indication of this type of hypertension. White-coat hypertension can also be evaluated by the use of a 24-hour ambulatory monitor.


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