Why In-Office Blood Pressure Readings Are Often Wrong—And How Healthcare Teams Can Finally Fix It
- Vipal Desai, MD
- 3 days ago
- 4 min read
Getting a correct reading on one's blood pressure (BP) seems like an easy task. All that seems to be required is a cuff, a chair, a piece of quiet, and a moment of calm. Nothing seems to be complicated, so all that seems to be needed is a little time. However, studies show that BP readings taken in offices are among the most misinterpreted vitals in American medicine. This is a huge issue, as it can lead to misdiagnosis, unnecessary medications, and costly bills (Sources of Error in Office Blood Pressure Management, 2025)
This problem became worse when the American College of Cardiology (ACC) and American Heart Association (AHA) stated that 130/80 mm Hg is the clinical threshold for high BP in their most recent guidelines (2025). For patients whose BP stays that way for three to six months after lifestyle adjustments, the guidelines recommend the use of medications prescribed based on that standard (American College of Cardiology, 2025 Hypertension Guideline).
But what happens if the readings themselves are inaccurate?
In a commentary for Medscape, John Mandrola, MD, clinical electrophysiologist, stated, “It boggles my mind how badly BP is taken in the healthcare setting… Mediocrity has become the norm."
And he is not the only one.
A 2021 paper in the American Journal of Preventive Cardiology noted that blood pressure measurement precision, even in the hands of professionals, remains substandard. Research states that 10 to 50 percent of patients with hypertension in-office are normotensive when measured outside the clinic. (Hwang & Kevin, 2021) This phenomenon is inaccurately labeled as hypertension in these patients.
The AMA further states that flawed measurement results in erroneous clinical judgment 20 to 45 percent of the time, an outrageous number for a measurement that correlates with cardiovascular, cerebrovascular, and nephrovascular morbidity and mortality.
Why is blood pressure, as a measure of morbidity, miscalculated so often, and what can be done to fix it, if anything at all?
Why Errors Happen: Inside the “Perfect Storm” of In-Office BP Inaccuracy
1. The Clock Works Against You
Hwang, Kevin O. (MD, MPH) (UT Health Science Center) states that obtaining an accurate blood pressure measurement requires time, and that’s the resource many clinics just don’t have. Preparing the patient, ensuring correct posture, appropriate cuff size, and obtaining multiple measurements adds time to an already overstretched schedule, workflow, or system.
Staff usually have to “room quickly.” This leads personnel to take just one reading in a rush, often skipping all best practice steps for measurement.
2. Workflow, Training, and Layout Problems
Hwang surveyed six clinics, and it seems there are challenges in every layer of the system:
Staff having uncertainty about protocol (Hwang et al., 2018)
Behavior inconsistency
Equipment improperly placed
Room layouts that don’t allow proper patient posture
Competing priorities during intake
These problems are in no way the fault of the nurse or medical assistant taking the readings.
3. Patients Aren’t Ready in the Right Way
According to Ian Kronish, MD, MPH, co-director of the Columbia Hypertension Center, people do not generally remain in the same position for the minimum three minutes required before taking a blood pressure reading. Rather, they may be:
walking quickly down the hall
talking with family
drinking coffee
feeling anxious after check-in
All of these activities could cause blood pressure to spike.
4. The “White Coat Effect” Is Real
For decades, cardiovascular studies have demonstrated the phenomenon wherein blood pressure increases simply by the presence of an individual who fits the stereotype of a physician. (How a doctor’s presence may alter blood pressure readings, 2021)
5. Equipment Problems: Aneroid Devices & Poor Maintenance
A 2025 study in the Annals of Family Medicine claims aneroid sphygmomanometers often generally change shape with time, causing them to be less reliable unless recalibrated every year, which is rarely done.
Fixing the Problem: Evidence-Backed Solutions Practices Can Implement Now
1. Standardize the Process (and Audit It)
Practices need to implement a single, rigid BP strategy, ideal and efficient for rare and quick checklist audits. The AMA/AHA Target: The BP initiative provides free resources for BP measurement.
device procurement
staff training and certification
workflow optimization
equipment maintenance
2. Use the Right Cuff, Every Time
The AMA claims the major cause of measurement errors is either the incorrect cuff size, which is a common problem. (For millions with hypertension, home BP cuffs aren’t a good fit, 2025) Cuff size should not be a guess; it should match the circumference of the arm.
3. Reduce Noise, Movement, and Distraction
Whenever possible:
Allow patients to rest quietly for 3–5 minutes
Make sure their feet are flat on the floor
Position their arm at heart level
Don’t talk before taking the measurement
Small adjustments make a difference in consistency.
4. Take More Than One Reading
Blood pressure changes. When averaging BP, one squeeze of the cuff is less valuable than multiple measures.
5. Incorporate Home Monitoring
Matthew Francis Muldoon, MD, MPH, discusses the benefits of home monitoring:
improves diagnostic accuracy
removes white coat bias
increases patient engagement
provides a larger data sample
prevents overtreatment
This is why many cardiologists now rely on validated home monitoring just as much, and perhaps even more.
Remote Patient Monitoring (RPM) programs, like Enable Healthcare's medical-grade, cellular BP devices, help provide this service. With RPM, doctors can:
view real-time trends
Cut down on unnecessary medication changes
Focus on actual hypertension
provide earlier intervention
The Real Cure: Change Systems, Not Scold Staff
To ensure correct office blood pressure readings, physicians need more than just a reminder to “do it the right way.” Hwang argues that for change to last, we need to:
Rethink how patients flow through the system
redesign physical spaces
Invest in proven devices
Get leadership aligned on its importance
Educate staff continuously
Measuring blood pressure in many cases increases the time spent on a visit by about 7 minutes. (Mahe et al., 2017) But as Hwang notes, the investment is worth it.
“Nobody would knowingly use an inaccurate glucometer,” he says. “We owe patients the same accuracy with BP.”
Final Takeaway
Taking an accurate blood pressure reading is a clinical risk, with rising rates of poorly controlled hypertension and lower treatment thresholds. Practices need to implement systems that capture accurate data, in and out of the office.
While standardizing workflows, using validated devices, and implementing home monitoring technologies like EHIs AI-enabled RPM platform, clinicians are able to close the differential and provide accurate, trustworthy hypertension care.