Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association
Open accessAbstract
The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.
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Blood pressure was collected in accordance with the American Heart Association guidelines wherever possible.
“Wherever possible, blood pressure was collected in accordance with the American Heart Association guidelines [ 37 ].”
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Muntner, P., Levitan, E. B., Joyce, C., Holt, E. W., Mann, D., Oparil, S., & Krousel-Wood, M. A. (2012) · Journal of Clinical Hypertension · doi:10.1111/jch.12037 · Cited by 84 · see citing works
Self-citationManagement of hypertension in adults in primary care: NICE guideline
McCormack, T., Krause, T., & O’Flynn, N. (2012) · British Journal of General Practice · doi:10.3399/bjgp12x630232 · Cited by 84 · see citing works
Challenges in standardization of blood pressure measurement at the population level
for the EHES Pilot Project, Tolonen, H. K., Koponen, P., Naska, A., Männistö, S., Broda, G., Palosaari, T., & Kuulasmaa, K. (2015) · BMC Medical Research Methodology · doi:10.1186/s12874-015-0020-3 · Cited by 84 · see citing works
Andreadis, E. A., Agaliotis, G. D., Angelopoulos, E. T., Tsakanikas, A. P., Chaveles, I., & Mousoulis, G. P. (2011) · American Journal of Hypertension · doi:10.1038/ajh.2011.38 · Cited by 84 · see citing works
Levitan, E. B., Kaciroti, N., Oparil, S., Julius, S., & Muntner, P. (2012) · The Journal of Clinical Hypertension · doi:10.1111/jch.12005 · Cited by 83 · see citing works
Self-citationClark, C. E., Taylor, R. S., Shore, A. C., & Campbell, J. L. (2016) · British Journal of General Practice · doi:10.3399/bjgp16x687553 · Cited by 82 · see citing works
Schwartz, J. E., Burg, M. M., Shimbo, D., Broderick, J. E., Stone, A. A., Ishikawa, J., Sloan, R., Yurgel, T., Grossman, S. R., & Pickering, T. G. (2016) · Circulation · doi:10.1161/circulationaha.116.023404 · Cited by 82 · see citing works
Self-citationBruining, N., Caiani, E., Chronaki, C., Guzik, P., & van der Velde, E. (2014) · European Journal of Preventive Cardiology · doi:10.1177/2047487314552604 · Cited by 81 · see citing works
Handler, J., Zhao, Y., & Egan, B. M. (2012) · Journal of Clinical Hypertension · doi:10.1111/jch.12009 · Cited by 80 · see citing works
Validation of the Welch Allyn ‘Vital Signs’ oscillometric blood pressure monitor
Jones, C., Taylor, K. S. M., Poston, L., & Shennan, A. H. (2001) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001141 · Cited by 78 · see citing works
Toward Noninvasive Blood Pressure Assessment in Arteries by Using Ultrasound
Beulen, B. W. A. M. M., Bijnens, N., Koutsouridis, G. G., Brands, P. J., Rutten, M. C. M., & van de Vosse, F. N. (2011) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2011.01.020 · Cited by 78 · see citing works
Booth, J., Diaz, K. M., Seals, S., Sims, M., Ravenell, J., Muntner, P., & Shimbo, D. (2016) · HYPERTENSION · doi:10.1161/hypertensionaha.116.07553 · Cited by 78 · see citing works
Self-citationThe history of blood pressure measurement.
O'Brien, E. T., & Fitzgerald, D. (1994) · PubMed · Cited by 77 · see citing works
What will replace the mercury sphygmomanometer?
Pickering, T. G. (2003) · Blood Pressure Monitoring · doi:10.1097/00126097-200302000-00005 · Cited by 76 · see citing works
Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes
Tsioufis, C. P., Andrikou, I., Thomopoulos, C., Syrseloudis, D., Stergiou, G. S., & Stefanadis, C. (2010) · Journal of Human Hypertension · doi:10.1038/jhh.2010.113 · Cited by 75 · see citing works
Consistent relationship between automated office blood pressure recorded in different settings
Myers, M. G., Valdivieso, M., & KISS, A. J. (2009) · Blood Pressure Monitoring · doi:10.1097/mbp.0b013e32832c5167 · Cited by 75 · see citing works
Self-citationPrevalence of Masked Hypertension Among US Adults With Nonelevated Clinic Blood Pressure
Wang, Y. C., Shimbo, D., Muntner, P., Moran, A. E., Krakoff, L. R., & Schwartz, J. E. (2016) · American Journal of Epidemiology · doi:10.1093/aje/kww237 · Cited by 73 · see citing works
Self-citationA proposed algorithm for diagnosing hypertension using automated office blood pressure measurement
Myers, M. G. (2010) · Journal of Hypertension · doi:10.1097/hjh.0b013e328335d091 · Cited by 72 · see citing works
Self-citationBlood pressure measurement in very obese patients: a challenging problem
Palatini, P., & Parati, G. (2011) · Journal of Hypertension · doi:10.1097/hjh.0b013e3283435b65 · Cited by 72 · see citing works
Accuracy of Automated Blood Pressure Measurement in Children: Evidence, Issues, and Perspectives
Stergiou, G. S., Boubouchairopoulou, N., & Kollias, A. (2017) · Hypertension · doi:10.1161/hypertensionaha.116.08553 · Cited by 72 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Stergiou, G. S., Palatini, P., Parati, G., O’Brien, E., Januszewicz, A., Lurbe, E., Persu, A., Mancia, G., Kreutz, R., & on behalf of the European Society of Hypertension Council and the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability (2021) · Journal of Hypertension · doi:10.1097/hjh.0000000000002843 · Cited by 859 · see citing works
Jones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., et al. (2025) · JACC · doi:10.1016/j.jacc.2025.05.007 · Cited by 280 · see citing works
Self-citationFlynn, J. T., Urbina, E. M., Brady, T. M., Baker-Smith, C., Daniels, S. R., Hayman, L. L., Mitsnefes, M., Tran, A., Zachariah, J. P., & on behalf of the Atherosclerosis, H. (2022) · Hypertension · doi:10.1161/hyp.0000000000000215 · Cited by 202 · see citing works
Self-citationYe, N., Jardine, M. J., Oshima, M., Hockham, C., Heerspink, H. J. L., Agarwal, R., Bakris, G., Schutte, A. E., Arnott, C., Chang, T. I., et al. (2021) · Circulation · doi:10.1161/circulationaha.120.048740 · Cited by 115 · see citing works
Drawz, P. E., Agarwal, A., Dwyer, J. P., Horwitz, E., Lash, J., Lenoir, K., McWilliams, A., Oparil, S., Rahbari-Oskoui, F., Rahman, M., et al. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.5028 · Cited by 105 · see citing works
Cuffless Blood Pressure Monitoring: Promises and Challenges
Pandit, J. A., Lores, E., & Batlle, D. (2020) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.03680320 · Cited by 101 · see citing works
International Consensus on Standardized Clinic Blood Pressure Measurement – A Call to Action
Cheung, A. K., Whelton, P. K., Muntner, P., Schutte, A. E., Moran, A. E., Williams, B., Sarafidis, P., Chang, T. I., Daskalopoulou, S. S., Flack, J. M., et al. (2023) · The American Journal of Medicine · doi:10.1016/j.amjmed.2022.12.015 · Cited by 96 · see citing works
Self-citationFormulas to Explain Popular Oscillometric Blood Pressure Estimation Algorithms
Chandrasekhar, A., Yavarimanesh, M., Hahn, J.-O., Sung, S.-H., Chen, C.-H., Cheng, H.-M., & Mukkamala, R. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2019.01415 · Cited by 84 · see citing works
TensioBot: a chatbot assistant for self-managed in-house blood pressure checking
Echeazarra, L., Pereira, J., & Saracho, R. (2021) · Journal of Medical Systems · doi:10.1007/s10916-021-01730-x · Cited by 66 · see citing works
de Lemos, J. A., Linetzky, B., le Roux, C. W., Laffin, L. J., Vongpatanasin, W., Fan, L., Hemmingway, A., Ahmad, N. N., Bunck, M. C., & Stefanski, A. (2024) · Hypertension · doi:10.1161/hypertensionaha.123.22022 · Cited by 64 · see citing works
Goupil, R., Tsuyuki, R. T., Santesso, N., Terenzi, K. A., Habert, J., Cheng, G., Gysel, S. C., Bruneau, J., Leung, A. A., Campbell, N. R. C., et al. (2025) · Canadian Medical Association Journal · doi:10.1503/cmaj.241770 · Cited by 60 · see citing works
Severin, R., Sabbahi, A., Albarrati, A., Phillips, S. A., & Arena, S. (2020) · Physical Therapy · doi:10.1093/ptj/pzaa034 · Cited by 43 · see citing works
Human Errors in Automated Office Blood Pressure Measurement: Still Room for Improvement
Elias, M. F., & Goodell, A. L. (2021) · Hypertension · doi:10.1161/hypertensionaha.120.16164 · Cited by 31 · see citing works
Sakhuja, S., Jaeger, B. C., Akinyelure, O. P., Bress, A. P., Shimbo, D., Schwartz, J. E., Hardy, S. T., Howard, G., Drawz, P., & Muntner, P. (2022) · The Journal of Clinical Hypertension · doi:10.1111/jch.14418 · Cited by 28 · see citing works
Self-citationSafety of exercise for adults with thoracic aortic aneurysms and dissections
Li, J., Boyd, A., Huang, M., Berookhim, J., & Prakash, S. K. (2022) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2022.888534 · Cited by 13 · see citing works
Shantharam, S. S., Mahalingam, M., Rasool, A., Reynolds, J. A., Bhuiya, A. R., Satchell, T. D., Chapel, J. M., Hawkins, N. A., Jones, C. D., Jacob, V., et al. (2022) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.06.025 · Cited by 13 · see citing works
Rogers, E. M., Banks, N. F., Tomko, P. M., Sciarrillo, C. M., Emerson, S. R., Thomas, E. B. K., Taylor, A., Teague, T. K., & Jenkins, N. D. M. (2023) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00524.2022 · Cited by 11 · see citing works
Currie, K. D., Soave, K. M., & Slade, J. M. (2023) · Journal of Human Hypertension · doi:10.1038/s41371-021-00623-3 · Cited by 11 · see citing works
Automated blood pressure measuring devices: how are they clinically validated for accuracy?
Ringrose, J. S., & Padwal, R. (2022) · Journal of Human Hypertension · doi:10.1038/s41371-022-00761-2 · Cited by 9 · see citing works
Banks, N. F., Rogers, E. M., Helwig, N. J., Schwager, L. E., Alpers, J. P., Schulte, S. L., Trachta, E. R., Lockwood, C. M., & Jenkins, N. D. M. (2024) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2023.2297988 · Cited by 4 · see citing works
“Wherever possible, blood pressure was collected in accordance with the American Heart Association guidelines [37].”
Method
- Authors
- Muntner, P., Shimbo, D., Carey, R. M., Charleston, J. B., Gaillard, T., Misra, S., Myers, M. G., Ogedegbe, G., Schwartz, J. E., Townsend, R. R., Urbina, E. M., Viera, A. J., White, W. B., Wright, J. T., & on behalf of the American Heart Association Council on Hypertension; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; and Council on Quality of Care and Outcomes Research
- ORCID
- Venue
- Hypertension
- Published
- 2019-05
- Volume
- 73
- Issue
- 5
- Pages
- e35-e66
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC11409525
- OpenAlex
- W2920258695
- Cited by
- 1,512
- References
- 323
- Citations by year
- 2026: 209 · 2025: 255 · 2024: 240 · 2023: 190 · 2022: 223 · 2021: 199 · 2020: 139 · 2019: 52
- FWCI
- 27.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Heart Association
- European Society of Cardiology
- National Institutes of Health (UL1TR001070)
- Office of Science
- National Heart, Lung, and Blood Institute (R01HL098967)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK107870, R56DK107870)
- National Center for Research Resources (UL1RR025755)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- blood pressure measurement, hypertension diagnosis, oscillometric blood pressure devices, auscultatory method, ambulatory blood pressure monitoring, home blood pressure monitoring, white coat hypertension, masked hypertension, nocturnal blood pressure, cardiovascular risk, children and adolescents, technician training, device calibration
- MeSH terms
- American Heart Association, Blood Pressure, Blood Pressure Determination, Humans, Hypertension, United States, Disease Management, Consensus
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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