Beyond the Cuff: Measuring and Monitoring Blood Pressure

Blood pressure is one of the most commonly measured — and most commonly misread — vitals in healthcare.

In this episode, TRC Healthcare Associate Editor and Clinical Pharmacist Vickie Danaher, PharmD, discusses how pharmacists and pharmacy technicians can help patients better manage hypertension. She goes over how to choose the right home blood pressure monitor, ways to use it correctly, and tips for getting the most accurate readings.

This is an excerpt from our March 2026 Pharmacy Essential Updates continuing education webinar series.

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TRC Healthcare offers CE credit for this podcast for pharmacist subscribers at our platinum level or higher and pharmacy technician subscribers. Log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses. None of the speakers have anything to disclose.

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Clinical Resources from Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights: 

• Article: Avoid Common Blood Pressure Measurement Errors
• Checklist: Measuring Blood Pressure

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Transcript

This transcript is automatically generated.

00:00:04 Narrator

Welcome to Clinical Capsules from TRC Healthcare, your trusted source for practical, evidence-based updates.

00:00:11 Narrator

On this episode, Associate Editor and Clinical Pharmacist, Vicki Danaher, reviews how blood pressure is often measured incorrectly and what pharmacists and pharmacy technicians can do to help.

00:00:22 Narrator

She talks about what monitors to choose, proper timing and technique, and tips to help patients take their blood pressure at home, in an excerpt from our popular Pharmacy Essential Updates webinar series.

00:00:32 Narrator

This podcast offers continuing education credit for pharmacists and pharmacy technicians.

00:00:37 Narrator

Please log in to your pharmacist letter or pharmacy technician's letter account and look for the title of this podcast in the list of available CE courses.

00:00:45 Narrator

None of the speakers have anything to disclose.

00:00:48 Narrator

Catch new episodes of Clinical Capsules every 2nd and 4th Tuesday, bringing concise, actionable insights from TRC experts straight to your ears.

00:00:57 Narrator

With that, let's get started.

00:01:05 Vickie Danaher

I'm excited to talk about measuring and monitoring blood pressure, which is a topic that impacts a lot of our patients and comes up pretty often in our practices.

00:01:15 Vickie Danaher

And like our article says, blood pressure is often measured incorrectly, which can lead to overtreatment or undertreatment of hypertension or high blood pressure.

00:01:25 Vickie Danaher

But we as pharmacists and technicians can help change that by getting patients set up with an appropriate home blood pressure monitor and teaching them how to get an accurate measurement.

00:01:35 Vickie Danaher

And our involvement is important because we know that hypertension is a silent killer.

00:01:40 Vickie Danaher

Most of the time, there's no obvious signs or symptoms, and many patients don't even know they have it.

00:01:44 Vickie Danaher

But left untreated, high blood pressure can lead to serious problems, including heart attack, heart failure, and stroke.

00:01:52 Vickie Danaher

So that's why checking blood pressure is key to early detection and management.

00:01:58 Vickie Danaher

But one problem is that errors with blood pressure measurement are common in general.

00:02:02 Vickie Danaher

The accuracy of blood pressure readings can be affected by things like how it's measured, the technique that's used, and other patient factors.

00:02:09 Vickie Danaher

So we want to make sure that patients know how to measure their blood pressure correctly.

00:02:15 Vickie Danaher

So today we're going to look at a few things that we can do to help patients make sure they're getting accurate results, whether that's monitoring their blood pressure at home, as well as checking their blood pressure at the pharmacy.

00:02:26 Vickie Danaher

And then we'll talk about how we can help patients with interpreting those results and work closely with the patient and their prescriber to suggest changes if needed.

00:02:36 Vickie Danaher

So let's think about how this might show up in your practice with a quick case.

00:02:40 Vickie Danaher

Our patient today is Lynn.

00:02:41 Vickie Danaher

She's 48 years old.

00:02:44 Vickie Danaher

And she's picking up a new prescription for lisinopril 10 milligram daily since she was just diagnosed with high blood pressure today at her prescriber's office.

00:02:53 Vickie Danaher

And as you're talking with Lynn about the lisinopril prescription, she mentions that her prescriber wants her to start checking her blood pressure at home.

00:03:00 Vickie Danaher

And she asks if you can help her pick out a good monitor to use.

00:03:04 Vickie Danaher

She says she saw a lot of different options on your OTC shelves, and she doesn't know which one to choose.

00:03:10 Vickie Danaher

So what information would you want to share with Lynn about the different types of home blood pressure monitors?

00:03:14 Vickie Danaher

And what tips would you want to highlight to help her use a home blood pressure monitor correctly?

00:03:22 Vickie Danaher

So like Lynn in our case, patients will often ask whether they should monitor blood pressure at home and what type of machine to get.

00:03:29 Vickie Danaher

And it is a good idea for patients to do home monitoring since it may reinforce adherence to BP-lowering meds.

00:03:35 Vickie Danaher

It gives patients feedback about how well their meds are working, and it may help improve blood pressure control.

00:03:42 Vickie Danaher

Plus, it can help confirm results that patients might be getting at the prescriber's office or pharmacy, and to see multiple measurements over days, weeks, or months, rather than just a one-time snapshot.

00:03:53 Vickie Danaher

So for patients who are going to be checking their blood pressure at home, it's important that they start with the right equipment and know what type of monitor to use.

00:04:02 Vickie Danaher

So continue to recommend or help patients find an upper arm blood pressure monitor since the upper arm monitors are the most accurate.

00:04:11 Vickie Danaher

And for majority of patients, an automatic option is easier to use and a better choice than a manual one.

00:04:19 Vickie Danaher

Another type of BP monitor that we often see or get questions about are wrist monitors.

00:04:23 Vickie Danaher

But we want to discourage these.

00:04:26 Vickie Danaher

Wrist monitors are less accurate than arm monitors.

00:04:30 Vickie Danaher

One exception, though, where a wrist monitor might be considered is when arm cuffs, including larger-sized ones, don't fit the patient properly, such as could be the case for patients who have severe obesity.

00:04:44 Vickie Danaher

If a wrist monitor is used in this situation, emphasize that the wrist must stay still and support it at heart level during the reading.

00:04:53 Vickie Danaher

Patients might also look to finger home blood pressure monitors for convenience or ease of use.

00:04:59 Vickie Danaher

But finger monitors should be avoided, since they're notoriously inaccurate.

00:05:05 Vickie Danaher

And then cuffless monitors, such as blood pressure smartwatches, are starting to gain traction and growing in popularity.

00:05:12 Vickie Danaher

But for now, tell patients not to rely on these, since data on their reliability and precision are mixed.

00:05:21 Vickie Danaher

Once we've narrowed down the choice of monitors to the upper arm monitor, we'll then want to focus on finding a device that's been tested and evaluated for accuracy.

00:05:30 Vickie Danaher

And we can do this by using the validatebp.org website, which is supported by the American Medical Association.

00:05:38 Vickie Danaher

It lists blood pressure devices that have met the highest standards and are validated for clinical accuracy.

00:05:46 Vickie Danaher

And then of course, we can also help patients sort through some of the features of the various blood pressure monitors.

00:05:51 Vickie Danaher

So things like backlit displays, large digits, whether it can connect to a mobile device, and so on, to see what makes most sense for the individual patient.

00:06:02 Vickie Danaher

Many upper arm blood pressure monitors also come with a blood pressure cuff.

00:06:06 Vickie Danaher

We'll want to make sure that the cuff size is right for the patient, since this can also impact the accuracy of the measurement.

00:06:12 Vickie Danaher

A cuff that's too small for a patient may overestimate blood pressure, but a cuff that's too large may underestimate blood pressure.

00:06:23 Vickie Danaher

Now, one way to check this would be to measure the patient's arm by wrapping a tape measure around the patient's bicep at midarm to determine the arm circumference.

00:06:34 Vickie Danaher

And the rule of thumb is that the inflatable rubber bladder inside the cuff should encircle or cover about 80% of the arm circumference.

00:06:43 Vickie Danaher

And the width should be about 40% of the arm circumference.

00:06:49 Vickie Danaher

But this method isn't always practical, especially in a busy pharmacy.

00:06:53 Vickie Danaher

So a simpler way to check is by using the index marker and range lines indicated on most cuffs.

00:06:59 Vickie Danaher

And that can help determine if the cuff is too big or too small.

00:07:04 Vickie Danaher

So when the cuff is placed around the patient's arm, the index line on the cuff should fall completely within the range markings on the inside.

00:07:14 Vickie Danaher

If the index line falls below the minimum range lines, the cuff is too big and a smaller size is needed.

00:07:22 Vickie Danaher

On the other hand, if the index line falls above the maximum range lines, the cuff is too small and a larger size is needed.

00:07:33 Vickie Danaher

And then once we have the correct cuff size, keep in mind that the cuff should just be tight enough that you can fit 2 fingers under the edge.

00:07:42 Vickie Danaher

All right, so once we've got patients set up with the right equipment, the next area is to hone in our timing and technique.

00:07:49 Vickie Danaher

So let's go over timing first.

00:07:51 Vickie Danaher

And regardless of whether the patient's checking their blood pressure at home or on a machine in your pharmacy, or if you're checking their blood pressure manually, we want to make sure that patients are resting quietly for at least 5 minutes first, without talking, scrolling on their phone, or even listening to someone else talk.

00:08:09 Vickie Danaher

All of these things can stimulate the brain and mental engagement, which can increase blood pressure readings by 10 to 15 millimeters of mercury or more.

00:08:20 Vickie Danaher

Patients should also wait at least 30 minutes after exercise, smoking, or caffeine to take their blood pressure.

00:08:26 Vickie Danaher

For example, having a full bladder or using nicotine within 30 minutes before a reading can increase systolic BP, so the top number, by 25 millimeters of mercury or more.

00:08:38 Vickie Danaher

So we want to try to minimize these and other factors that can raise BP if possible.

00:08:47 Vickie Danaher

And then in terms of positioning, tell patients that during the measurement they should sit still with uncrossed legs, have both feet flat on the floor, and also have the back supported, such as against a backrest.

00:08:59 Vickie Danaher

Educate that patients should keep the arm supported at heart level, such as by resting it on the table.

00:09:05 Vickie Danaher

Lowering the arm below heart level may lead to falsely high BP numbers,

00:09:10 Vickie Danaher

And conversely, having the arm higher than heart level may lead to falsely low BP numbers.

00:09:18 Vickie Danaher

In addition, remind patients not to place the cuff over clothing, since this may throw off the reading by 10 to 50 millimeters of mercury.

00:09:27 Vickie Danaher

But at the same time, they should also avoid rolling uptight sleeves, since this can restrict blood flow, causing falsely high readings.

00:09:35 Vickie Danaher

So bottom line is if the rolled up sleeve is too thick or too tight, it's usually better for the patient to remove the garment or remove the arm from the sleeve rather than risk an inaccurately high reading.

00:09:48 Vickie Danaher

So everything we just talked about with proper timing and positioning for home blood pressure monitoring also applies just as much in the pharmacy setting.

00:09:55 Vickie Danaher

But we know the challenge is that when patients use automatic blood pressure kiosks at the pharmacy, we often see them walk straight up, sit down, take the measurement without taking time to rest.

00:10:05 Vickie Danaher

They might also still be talking, crossing their legs, or placing a cuff over a long sleeve shirt or sweater.

00:10:10 Vickie Danaher

So all things that can easily push the readings higher than they really are.

00:10:14 Vickie Danaher

This is where pharmacy staff and technicians in particular can make a big difference by watching for improper technique and listening for patients who mention high readings.

00:10:24 Vickie Danaher

We can step in, encourage a quick rest period, adjust positioning, or suggest patients talk with the pharmacist about their numbers if needed.

00:10:34 Vickie Danaher

And then in terms of tracking and verifying results, encourage patients to take twice daily measurements when they're just starting out taking their blood pressure or when starting a new medication or making a dose change.

00:10:46 Vickie Danaher

But this frequency can go down to just a few times each week when monitoring and blood pressure is more established and managed.

00:10:54 Vickie Danaher

Suggest checking BP in the morning before meds and breakfast, and in the evening before dinner or sleep, and taking at least two readings one minute apart and averaging the numbers.

00:11:06 Vickie Danaher

Also suggest that patients document and track the results using a paper blood pressure log or a smartphone app, along with any factors that could have impacted the results, so things like being sick, missing their medication, or being in a period of high stress.

00:11:23 Vickie Danaher

Encourage patients to bring their home blood pressure monitor to you or to a prescriber office visit to check it against a reading taken by a healthcare professional in order to confirm the accuracy of the home monitor.

00:11:34 Vickie Danaher

This can also help us see how the patient is measuring at home and whether they're taking their blood pressure properly, especially if there's questions about how the home readings compare to the readings at the pharmacy or at the prescriber's office.

00:11:48 Vickie Danaher

That's because we want to make sure the numbers are accurate first before we take a closer look at the data and assess the results.

00:11:57 Vickie Danaher

After that, we can then use the home readings to see if patients are reaching their blood pressure goal and identify if any side effects like dizziness are due to blood pressure going too low.

00:12:08 Vickie Danaher

We can also help patients look for patterns and any mismatches between office and home readings.

00:12:14 Vickie Danaher

So for example, if patients have what we call white coat hypertension, where the blood pressures are normal at home but high at the office, we can advise just monitoring blood pressure closely.

00:12:26 Vickie Danaher

But if there's a situation of mass hypertension where blood pressures are high at home but goal in the office, we can suggest more frequent monitoring and cautious med titration along with lifestyle changes.

00:12:40 Vickie Danaher

Home readings along with in-office measurements can also help us assess if lifestyle changes are enough, when blood pressure medications should be started or adjusted, and what blood pressure goal we're aiming for.

00:12:51 Vickie Danaher

And when we're looking at blood pressure numbers, the key is to focus on patterns and averages, not just a single reading.

00:12:57 Vickie Danaher

So if blood pressure readings are consistently under 120 over 80, we can continue to reinforce healthy habits like exercise and weight loss.

00:13:06 Vickie Danaher

If they're in that 120 to 129 systolic range, that's a cue to double down on lifestyle changes and look for things that might be pushing blood pressure up.

00:13:16 Vickie Danaher

So meds like NSAIDs, like ibuprofen, decongestants, like pseudoephedrine, or excess sodium.

00:13:25 Vickie Danaher

Once readings are in the 130s or higher, that's when guidelines support medication, especially if the patient has diabetes, kidney disease, or elevated cardiovascular risk.

00:13:36 Vickie Danaher

And then if readings are consistently 140 over 90 or higher, that's a signal that more aggressive treatment or combination therapy is likely needed.

00:13:47 Vickie Danaher

So these guidelines help us decide when and how to treat hypertension, but the next step is just as important, which is deciding what blood pressure goal we're actually aiming for.

00:13:57 Vickie Danaher

That's not always a one-size-fits-all.

00:14:00 Vickie Danaher

So for most patients, we can advise aiming for a goal of less than 130 over 80 and encouraging a goal of less than 120 over 80 if practical.

00:14:09 Vickie Danaher

But keep in mind, this may not be safe for everyone, and factors like age, comorbidities, cardiovascular risk, and medication tolerability all matter.

00:14:18 Vickie Danaher

So for example, we can consider a looser goal, such as less than 140 over 90, or even less than 150 over 90 for patients with limited life expectancy or in a long-term care facility due to frailty.

00:14:34 Vickie Danaher

And then once we know the patient's individualized blood pressure goal, the next thing we got to think about is how to get the patient there.

00:14:39 Vickie Danaher

Now, we're not going to have time today to walk through specific medication choices or combinations,

00:14:45 Vickie Danaher

But I want you to know that a step-by-step hypertension treatment algorithm is available on our website.

00:14:51 Vickie Danaher

It pulls together blood pressure levels, patient risk, and next steps in a clear visual way.

00:14:55 Vickie Danaher

And it's a quick reference to review recommended blood pressure meds and help guide decisions about therapy.

00:15:02 Vickie Danaher

You'll also want to check out our modernized and redesigned measuring blood pressure checklist for more tips that you can use while teaching patients how to properly measure their blood pressure or when taking a patient's blood pressure in the pharmacy.

00:15:16 Narrator

Thanks for listening. We hope today's episode gave you practical insights you can use right away.

00:15:21 Narrator

Now that you've listened, pharmacists and pharmacy technicians can receive CE credit.

00:15:25 Narrator

Just log into your pharmacist letter or pharmacy technician's letter account and look for the title of this podcast in the list of available CE courses.

00:15:33 Narrator

We've linked the resources we mentioned and more on today's topic right in the show notes.

00:15:38 Narrator

Those links will take you straight to our websites where you'll find even more concise, evidence-based charts, articles, and tools.

00:15:45 Narrator

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00:15:53 Narrator

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00:16:01 Narrator

Looking for more? Check out our other TRC podcasts like Medication Talk, Rumor vs Truth, and Natural Medicine's Evidence in Practice.

00:16:11 Narrator

Or dive deeper with our full Pharmacy Essential Updates webinar series.

00:16:16 Narrator

Thanks for listening. Stay sharp, stay current, and join us next time on Clinical Capsules.