Mar 19, 2026
3 min read
If you get a high reading at the doctor's office, it may not be accurate.Here's what you need to know about your risk and how to check your blood pressure at home.
I'm worried about the pressure.Can I test it at home?
Do you have a medical question that you would like an honest answer from a doctor?Dr. Mara Gordon, a family physician in Camden, N.J., answers readers' health questions each month.Email us at: thrive@npr.org.
Question: I recently had high blood pressure at my annual physical, but my doctor did not start me on medication.What can I do to stay on it?Do I check my blood pressure at home?
Doctors call hypertension "the silent killer."That's because it can cause serious medical problems, but people with high blood pressure feel perfectly healthy.
It's creepy, isn't it?Without treatment, high blood pressure can put people at risk of heart attack, stroke and kidney disease.It is also very common, affecting about 31% of adults worldwide.Many of my patients are living with this deadly condition and have no idea until they come for a primary care appointment.
That's why it's important to regularly check your blood pressure.The U.S.The Preventive Services Task Force — a non-governmental organization that provides preventive guidance — recommends that all adults over the age of 18 be screened for hypertension with a blood test at a doctor's office.(They're not specific about how often, but they say it's reasonable for anyone over 40 to do this at least once a year.)
But, surprisingly, checking blood pressure in the doctor's office is not the best way to diagnose hypertension.Getting the right diagnosis is more difficult than you might imagine.
Let's consider how to think about this deceptively complex condition.
Diagnosing hypertension can be difficult
While in-office measurements are recommended to screen for hypertension, that is, to determine who is at risk, actually diagnosing it is another matter.
This is because high blood pressure is determined by repeated blood pressure measurements, not just one.It is normal for your blood pressure to fluctuate throughout the day.
"Blood pressure is a dynamic measurement," said Dr. Ryan McCormick, a family physician in New Jersey who writes for the Journal of Investigation."They go up and down all day, minute by minute."
When you get your blood pressure checked at the doctor's office or emergency room, it's often high because of stress or pain.This may be a normal physiological reaction.
"He's in the spotlight," McCormick said. "It can cause a lot of stress."
This phenomenon has a name: white coat hypertension.It means that the doctor's white coat makes you nervous and raises your blood pressure.People who frequently suffer from white-coat hypertension are at higher risk of developing true hypertension, but it is not the same as high blood pressure.
That's why you were told you had a high reading, but your doctor didn't immediately prescribe medication.
This blood pressure measurement is just one data point.To confidently diagnose high blood pressure, your doctor will need more.
Check at home
Checking your blood pressure at home can help add valuable information to distinguish between blood pressure readings at your annual doctor's visit.
Not everyone needs to run out and buy a blood pressure monitor.But if you experience elevated or borderline readings at a healthcare facility, it may be helpful to monitor them at home from time to time.
In 2025, the American College of Cardiology published updated guidelines on high blood pressure.It was noted that readings at home improved."Accuracy and accuracy in detecting the patient's actual and normal blood pressure levels"
McCormick says that if he sees a patient with an elevated reading in the office, he recommends checking their blood pressure at home a few times a week.Then, when they come back to see him again, they will review the data together and determine whether the patient has a true diagnosis or not.
"That's a luxury you have as a family physician," McCormick told me.
Whether you measure your blood pressure in the doctor's office or at home, proper technique is important.
For example, wearing a cap that is too small for your arm can cause your systolic blood pressure to drop by up to 20 points.
The American Heart Association recommends several steps to ensure that your blood pressure reading is as accurate as possible.
First, it is recommended to avoid caffeine, exercise, or smoking for at least 30 minutes before checking your blood pressure.And make sure you pee!A full bladder can definitely increase your blood pressure.
You should rest quietly for at least five minutes before the test.This is a mistake I often see in my practice—people rush for their appointment and don't have enough time to calm down.You should sit with your feet on the floor and your back should be supported by a chair.
And don't talk, please!Neither you nor the person taking your blood pressure should talk to each other during the measurement.
Which cuff is best?
If you are buying a bracelet for home use, there are many on the market.Several Omron wristbands have been proven in scientific studies, such as the Microlife models.If you are not sure which brand to use, ask your doctor.
It is important to use the correct size cuff, which can be tricky to determine.The guidelines recommend that the cuff—the part that inflates when you squeeze your arm—is 75% to 100% of the length of your arm's circumference.The whole thing should comfortably wrap around the upper arm about one and a half times.People with a very large arm circumference may need conical cuffs instead of the cylindrical cuffs you usually see.
The cuff should be placed on bare skin, so wear short sleeves when you go to the doctor.And when you're taking measurements, your arm should be resting at heart level, ideally resting on a table.
I do not recommend wrist cuffs.For a good reading, the cuff should go around your upper arm.So-called "crab" blood pressure monitoring methods, such as using an Apple Watch to calculate blood pressure, are not accurate and are not currently recommended by doctors.
When you start medicine
Over the past decade, doctors have redefined hypertension.
The change comes in response to growing research showing low blood pressure goals help prevent serious cardiovascular events such as heart attacks or strokes.So this is how the American College of Cardiology defines things:
- Normal blood pressure: Below 120/80
- High reading = 120-129/80
- Hypertension = 130/80 or more
I usually recommend that patients start taking medication if they have had multiple blood pressure readings in more than a month.The goal of treatment is to get their blood pressure below 130/80.
Sometimes a new patient's reading is too high.In this case, I would repeat the blood pressure measurement to make sure it was accurate using the correct technique!If I'm sure it's really high, I'll prescribe medication immediately, even without multiple blood pressure readings.I will especially do this if I am worried that the patient will be bothered to return for another blood pressure test.
If you have multiple readings above 130/80 at home, you should visit your doctor to discuss treatment options.
Treatment goals depend on your age
In older patients, I sometimes avoid aggressive antihypertensive therapy.Many doctors recommend that blood pressure levels be slightly higher in older people, supported by guidelines from primary care organizations such as the American College of Physicians and the American Academy of Family Physicians.
That's because the risks of blood pressure treatment sometimes outweigh the benefits.Blood thinners can sometimes cause lightheadedness, which is less common in younger patients.But in the elderly, lightheadedness can lead to falls, which can have serious consequences such as fractures or head injuries.
Blood pressure medication can also cause electrolyte abnormalities, which are more likely to be life-threatening in elderly patients.
There are many good reasons for intensive treatment of high blood pressure, but the benefits accrue over many years. For a 40-year-old patient, aggressive treatment of hypertension can prevent a heart attack or stroke at age 60. But for a 95-year-old patient with a likely life expectancy of less than 10 years, the side effects of the drugs may cause immediate harm, while the long-term benefits are less clear.
Prevention is the best medicine.
Regular exercise and reducing alcohol intake can reduce the risk of high blood pressure.
Hypertension "is informed and influenced by many things, including mood, mood, stress level, diet, exercise," says McCormick, a family physician.
When it comes to diet, the Dietary Approaches to Prevent Hypertension, or DASH, eating plan is research-backed and effective.It emphasizes vegetables, fruits, fiber and whole grains.
Although reducing sodium intake can help, you don't need to cut out all salt.I have found that sometimes it comes back.I have seen my patients stop cooking at home if the food tastes good!However, I recommend cutting out processed foods and making a habit of making delicious meals at home using fresh ingredients.
Reducing stress is also key (which, of course, is easier said than done).There are several active stress management techniques that ACC supports, including transcendental meditation and yoga.
But if you've been diagnosed with high blood pressure even after doing all of the above, don't be hard on yourself.Hypertension is a genetic disease.Medication is an important tool to help keep blood pressure at a healthy level.
Dr. Mara Gordon in Camden, NJ. She is a family doctor and writes the newspaper Doutor Amigo.
