Support the patient s arm (eg, resting on a desk). 3. Position the middle of the cuff on the patient s upper arm at the level of the right atrium (the midpoint of the sternum). 4. Use the correct cuff size, such that the bladder encircles 80% of the arm, and note if a larger- or smaller-than-normal cuff size is used. 5. Either the stethoscope diaphragm or bell may be used for auscultatory readings.137,138 Step 3: Take the proper measurements needed for diagnosis and treatment of elevated BP/hypertension 1. At the first visit, record BP in both arms. Use the arm that gives the higher reading for subsequent readings. 2. Separate repeated measurements by 1 2 min. For auscultatory determinations, use a palpated estimate of radial pulse obliteration pressure to estimate SBP. Inflate the cuff 20 30 mmHg above this level for an auscultatory determination of the BP level. 4. For auscultatory readings, deflate the cuff pressure 2 mmHg per second, and listen for Korotkoff sounds. (Continued) 33 Step 4: Properly document accurate BP readings Record SBP and DBP. If using the auscultatory technique, record SBP and DBP as onset of the first Korotkoff sound and disappearance of all Korotkoff sounds, respectively, using the nearest even number. 2. Note the time of most recent BP medication taken before measurements. Step 5: Average the readings 1. Use an average of 2 readings obtained on 2 occasions to estimate the individual s level of BP. Step 6: Provide BP readings to patient 1. Provide patients the SBP/DBP readings both verbally and in writing. Clinical Recommendations 2017 Hypertension Clinical Practice Guidelines4 Recommendation for Accurate Measurement of BP in the Office (Guideline Section 4) For diagnosis and management of high BP, proper methods are recommended for accurate measurement and documentation of BP. 