Editing Hypertension (section)

=== Measurement technique ===
For an accurate diagnosis of hypertension to be made, proper [[blood pressure measurement]] technique must be used.<ref name="Viera2017">{{cite journal | vauthors = Viera AJ | title = Screening for Hypertension and Lowering Blood Pressure for Prevention of Cardiovascular Disease Events | journal = The Medical Clinics of North America | volume = 101 | issue = 4 | pages = 701–712 | date = July 2017 | pmid = 28577621 | doi = 10.1016/j.mcna.2017.03.003 | type = Review }}</ref> Improper measurement of blood pressure is common and can change the blood pressure reading by up to 10 mmHg, which can lead to misdiagnosis and misclassification of hypertension.<ref name="Viera2017"/> Correct blood pressure measurement technique involves several steps. Proper blood pressure measurement requires the person whose blood pressure is being measured to sit quietly for at least five minutes which is then followed by the application of a properly fitted blood pressure cuff to a bare upper arm.<ref name="Viera2017"/> The person should be seated with their back supported, feet flat on the floor, and with their legs uncrossed.<ref name="Viera2017"/> The person whose blood pressure is being measured should avoid talking or moving during this process.<ref name="Viera2017"/> The arm being measured should be supported on a flat surface at the level of the heart.<ref name="Viera2017"/> Blood pressure measurement should be done in a quiet room so the medical professional checking the blood pressure can hear the [[Korotkoff sound]]s while listening to the [[brachial artery]] with a [[stethoscope]] for accurate blood pressure measurements.<ref name="Viera2017"/><ref name="Vischer2017">{{cite book| vauthors = Vischer AS, Burkard T |title=Hypertension: From basic research to clinical practice |chapter=Principles of Blood Pressure Measurement – Current Techniques, Office vs Ambulatory Blood Pressure Measurement |series=Advances in Experimental Medicine and Biology|date=2017|volume=956|pages=85–96|doi=10.1007/5584_2016_49|pmid=27417699|type=Review|isbn=978-3-319-44250-1}}</ref> The blood pressure cuff should be deflated slowly (2–3 mmHg per second) while listening for the Korotkoff sounds.<ref name="Vischer2017"/> The [[urinary bladder|bladder]] should be emptied before a person's blood pressure is measured since this can increase blood pressure by up to 15/10 mmHg.<ref name="Viera2017"/> Multiple blood pressure readings (at least two) spaced 1–2 minutes apart should be obtained to ensure accuracy.<ref name="Vischer2017"/> Ambulatory blood pressure monitoring over 12 to 24 hours is the most accurate method to confirm the diagnosis.<ref name="ReferenceA">{{cite journal | vauthors = Siu AL | title = Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement | journal = Annals of Internal Medicine | volume = 163 | issue = 10 | pages = 778–786 | date = November 2015 | pmid = 26458123 | doi = 10.7326/m15-2223 | doi-access = free }}</ref> An exception to this is those with very high blood pressure readings, especially when there is poor [[organ (anatomy)|organ]] function.<ref name="NICE127 full"/>

With the availability of 24-hour [[ambulatory blood pressure]] monitors and [[bloodpressure#Home monitoring|home blood pressure]] machines, the importance of not wrongly diagnosing those who have [[white coat hypertension]] has led to a change in protocols. In the United Kingdom, the current best practice is to follow up a single raised clinic reading with ambulatory measurement, or less ideally with home blood pressure monitoring over 7 days.<ref name="NICE127 full">{{cite book |author=National Clinical Guidance Centre |title=Hypertension (NICE CG 127) |publisher=[[National Institute for Health and Clinical Excellence]] |chapter=7 Diagnosis of Hypertension, 7.5 Link from evidence to recommendations |pages=102 |date=August 2011 |chapter-url=http://www.nice.org.uk/nicemedia/live/13561/56007/56007.pdf |access-date=22 December 2011 |url-status=dead |archive-url=https://web.archive.org/web/20130723014309/http://www.nice.org.uk/nicemedia/live/13561/56007/56007.pdf |archive-date=23 July 2013 }}</ref> The [[United States Preventive Services Task Force]] also recommends getting measurements outside of the healthcare environment.<ref name="ReferenceA"/> [[Pseudohypertension in the elderly]] or noncompressibility artery syndrome may also require consideration. This condition is believed to be due to [[calcification]] of the arteries resulting in abnormally high blood pressure readings with a blood pressure cuff while intra arterial measurements of blood pressure are normal.<ref>{{cite journal | vauthors = Franklin SS, Wilkinson IB, McEniery CM | title = Unusual hypertensive phenotypes: what is their significance? | journal = Hypertension | volume = 59 | issue = 2 | pages = 173–178 | date = February 2012 | pmid = 22184330 | doi = 10.1161/HYPERTENSIONAHA.111.182956 | doi-access = free }}</ref> [[Orthostatic hypertension]] is when blood pressure increases upon standing.<ref>{{cite journal | vauthors = Kario K | title = Orthostatic hypertension: a measure of blood pressure variation for predicting cardiovascular risk | journal = Circulation Journal | volume = 73 | issue = 6 | pages = 1002–1007 | date = June 2009 | pmid = 19430163 | doi = 10.1253/circj.cj-09-0286 | doi-access = free }}</ref>