Sources of Error in Office Blood Pressure Measurement

Roy N. Morcos, MD, FAAFP; Kimbroe J. Carter, MD; Frank Castro, MS; Sumira Koirala, MD; Deepti Sharma, MD; Haroon Syed, MD


J Am Board Fam Med. 2019;32(5):732-738. 

In This Article


There are numerous national and international guidelines about BP thresholds for diagnosing hypertension, but regardless of the definitions used, it is essential to accurately and reproducibly obtain BP measurements. The commonly accepted method of choice for BP measurement is ambulatory 24-hour monitoring.[14,15] It is however used mostly in research, and its implementation to the general population remains challenging because of equipment cost and other difficulties. Office measurements remain the most widely adopted method and are often supplemented by home BP monitoring.[19] These results confirm the importance of proper patient positioning in a comfortable chair when measuring BP. Further, TDB occurs with manual but not with the automated device we used, thus confirming the potential advantage of automated devices in obtaining an accurate and reliable office BP measurement.[19] Anchoring bias may also occur with repeated manual BP measurements, adding to the uncertainty of such measurements.