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CLINICAL STATEMENTS AND GUIDELINES Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 September 16, 2025 e127 device (ie, aneroid). More recently, the use of oscillometric devices has become more common. Oscillometric devices estimate BP by measuring oscillations during cuff infla tion or deflation. At the point of maximum cuff oscillations, the BP in the cuff is equivalent to the mean BP in the ar tery, and SBP and DBP are estimated using proprietary manufacturer algorithms. For this reason, only oscillometric devices that were validated with a rigorous standardized protocol with BP measurement using a reference standard are recommended for use (termed validated devices).4,5 Os cillometric devices can obtain an office BP reading after the device is manually triggered, and typically, the device needs to be triggered repeatedly if multiple measurements are taken. However, some oscillometric devices automatically obtain multiple readings after the device is triggered (ie, automated office blood pressure [AOBP] measurement). In published papers, AOBP is typically measured6 without a clinician present (ie, unattended AOBP). Regardless of the measurement approach, errors in measurement technique are common if the measurements are taken incorrectly in terms of patient preparation and positioning, environment, and equipment and can result in a misleading estimation of an individual’s true in-office BP level. Recommendation-Specific Supportive Text 1 Accurate measurement of BP is essential to diagnose high BP, ascertain BP-related CVD risk, and assess response to therapy. Many errors in BP measurement, which have been examined in 2 systematic reviews,2,3 can be avoided by following a standardized protocol that has been a mainstay of clinical trials that include BP measurement.1 A standardized protocol, pro vided in Figure 3, includes proper patient preparation, standardized measurement technique and approach, documentation of BP, analysis of the readings, and providing the readings to the patient. The use of a BP device validated against a reference standard with an appropriately sized cuff is paramount for accurate BP measurement (see https://www.validatebp.org for a carefully vetted list of validated devices available in the United States).5,7–9 Further, because individual BP measurements may vary in an unpredictable or ran dom manner, a single reading is inadequate for clini cal decision-making. Office BP should be based on the average of available readings, and an average of ≥2 BP measurements obtained on ≥2 separate occa sions may minimize error and provide a more accu rate estimation of office BP.10,11 Regardless of the office BP measurement approach, clinicians and staff should have initial and ongoing training,12 including competency checks ideally every 6 to 12 months to maintain best practices for measuring BP. 2. The use of oscillometric devices has become com mon in clinical trials, national surveys, and consumer marketplaces1,13,14 because the use of auscultatory measurements with a calibrated mercury column is Figure 3. Checklist for Accurate Office Blood Pressure Measurement. BP indicates blood pressure; DBP, diastolic blood pressure; and SBP, systolic blood pressure. Sourced from Pickering et al.20 Adapted with permission from Whelton et al.21 Copyright 2018 American College of Cardiology Foundation and American Heart Association, Inc. Adapted from Mancia et al22 by permission of Oxford University Press. Copyright 2013 Oxford University Press. Adapted with permission from Weir et al23 from Annals of Internal Medicine. Copyright 2014 American College of Physicians. All Rights Reserved. Adapted with permission of American College of Physicians. Created by Sceyence Studios. Downloaded from http://ahajournals.org by on October 7, 2026