[37,38] In one SR, SBP readings using research quality manual or oscillometric technique averaged 7 mm Hg higher than fully automated oscillometric technique; however, in the one study included in the SR in which the order was randomized, there was very little difference between these two techniques, suggesting the others may have been biased by regression to the mean.[38] In addition, another SR/meta-analysis concluded that, when fully automated oscillometric readings were obtained, there was not a significant difference in blood pressure levels when an observer was in the room (attended) or the patient was alone in the room (unattended).[39] As a good summary of standard measurement technique used in research studies, the 2019 AHA recommendations for blood pressure measurement include the following key steps about proper seated blood pressure measurement in the office (adapted).[36] Table 2. Key Steps for Proper Blood Pressure Measurements Key Steps Specific Instructions Step 1: Properly prepare the patient 1. Have the patient relax, sitting in a chair with feet flat on floor and back supported. The patient should be seated for 3-5 min without talking or moving around before recording the first blood pressure reading. 2. The patient should avoid caffeine, exercise, and smoking for at least 30 min before measurement. 3. Ensure that the patient has emptied his/her bladder. 4. Neither the patient nor the observer should talk during the rest period or during the measurement. 5. Remove clothing covering the location of cuff placement. 6. Measurements made while the patient is sitting on an examining table do not fulfill these criteria. Step 2: Use proper technique for blood pressure measurements 1. Use an upper-arm cuff blood pressure measurement device that has been validated and ensure that the device is calibrated periodically. 2. Support the patient s arm (e.g.