Arm Support for Blood Pressure Measurement

Sir .—Because it has become evident that children and adolescents have hypertension more often than was previously recognized, 1 it is important that routine blood pressure measurement be as accurate as possible. An important factor that is often overlooked is the proper positioning and support of the forearm of the patient during a blood pressure determination. 2 It has been reported that incorrect arm position can cause as much as a 10–mm Hg error in both systolic and diastolic pressures. 3 The American Heart Association recommends that the entire forearm be supported at heart level on a smooth surface during a blood pressure measurement. 4 Standard positioning of the forearm at the horizontal level of the fourth intercostal space at the sternum is therefore recommended for blood pressure measurements with the patient in the sitting and standing positions. 4 Adequate support of the forearm during blood pressure determination is often difficult to achieve