Intended for healthcare professionals

Clinical Review ABC of hypertension

Blood pressure measurement

BMJ 2001; 322 doi: (Published 05 May 2001) Cite this as: BMJ 2001;322:1110

Part IIIAutomated sphygmomanometry: ambulatory blood pressure measurement

  1. Eoin O'Brien,
  2. Gareth Beevers,
  3. Gregory Y H Lip

    In recent years, the accuracy of the conventional Riva-Rocci/Korotkoff technique of blood pressure measurement has been questioned and efforts have been made to improve the technique with automated devices. In the same period, recognition of the phenomenon of white coat hypertension, whereby some subjects with apparent elevation of blood pressure have normal, or reduced, blood pressures when measurement is repeated away from the medical environment, has focused attention on methods of measurement that provide profiles of blood pressure behaviour rather than relying on isolated measurements under circumstances that may in themselves influence the level of blood pressure recorded.

    This article has been adapted from the newly published 4th edition of ABC of Hypertension. The book is available from the BMJ bookshop and at

    These methodologies have included repeated measurements of blood pressure using the traditional technique, self measurement of blood pressure in the home or workplace, and ambulatory blood pressure measurement (ABPM) using innovative automated devices.1

    Essential messages

    • Consider carefully which monitor to buy

    • Consider which type of service is best suited to your needs

    • Consider analysis and presentation of data

    • Exclusion of white coat hypertension is a major indication

    • The technique is valuable in the elderly

    • The technique is being increasingly used in pregnancy

    Setting up an ambulatory blood pressure measurement service

    Which monitor to buy?

    A large variety of ambulatory blood pressure measurement devices are now available on the market, and the number will increase as the technique of ambulatory blood pressure measurement becomes more widespread. A number of factors should influence this choice, among which the most important is to ensure that the device has been validated independently according to either the protocol of the British Hypertension Society (BHS),2 and/or that of the Association for the Advancement of Medical Instrumentation (AAMI).3

    Which monitor to choose

    • Check for independent validation by BHS/AAMI protocols

    • How much will it cost?

    • How expensive is …

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