• Higher blood pressures are normal during exertion or other stress. Systolic blood pressures below 80 may be a sign of serious illness or shock.
• Blood pressure should be taken in both arms on the first encounter. If there is more than 10 mmHg difference between the two arms, use the arm with the higher reading for subsequent measurements.
• It is frequently helpful to retake the blood pressure near the end of the visit. Earlier pressures may be higher due to the "white coat" effect.
• Always recheck unexpected blood pressures yourself. Don't rely on others for this critical piece of information.

Blood Pressure Classification in Adults

In situations where auscultation is not possible, you can determine systolic blood pressure by palpation alone. Inflate the cuff until the pulse disappears. Deflate the cuff until you feel the radial or brachial pulse return. Record the pressure indicating it was taken by palpation (60/palp). This should be approximately 10 mmHg lower than the pressure measured by ausculation.

When the baseline blood pressure is already known, it is acceptable to inflate the cuff to 30 mmHg above the anticipated pressure and go directly to auscultating the blood pressure. Be aware that there could be an auscultory gap (a silent interval between the true systolic and diastolic pressures, see figure).

Auscultory Gap