CP 4.5: Blood Pressure Monitoring

Updated: April 2026
Reviewed: 

Purpose

• To provide guidelines for monitoring of patients with suspected or actual hypertension.
• To assist the health care team in the diagnosis of hypertension or to evaluate effectiveness of treatment for hypertension.
  
  

Policy Statements

In response to a referral from a primary health care provider or from authorized referral sources within a Health Authority, the Community Paramedic (CP) will follow the monitoring guidelines outlined below when a request for blood pressure monitoring is identified on the Request for Service form and care plan. 

Procedure

1. OBTAIN and REVIEW the patient’s health history and care plan prior to the appointment. 
2. REFER to Request for Service form and care plan for direction with respect to assessments requested and acceptable blood pressure (BP) ranges for systolic and diastolic BP. 
3. OBSERVE patient’s physical state/general well-being. Ensure the patient has voided their bladder and that they are sitting in a relaxed state for at least 5 minutes with both feet flat on the floor, with their arm outstretched and supported at heart level. If the patient is bed-bound, have them lay face up in bed with the arm supported and no contact between cuff and bed or patient. 
4. For orthostatic hypotension evaluation: MEASURE BP in lying position and then immediately on standing. Report to primary care provider if systolic decreases more than 20 mmHg, or if the patient is symptomatic. If the patient complains of dizziness when going from lying to sitting, take and record BP. Do not proceed to standing. 

5. PATIENT POSITION: initial BP monitoring screening should include pressures taken on each arm to compare for difference - which arm the pressure was done on should be documented. Caveat to this is if there has been a mastectomy or lymph node removal on one side (Avoid BP on this arm), or if there is a fistula or injury to the arm.

6. MEASURE BP: Blood pressures should be done 3 times with 1 minute between each reading - the recorded reading is the average of the three.  

   • initial B/P monitoring screening should include pressures taken on each arm to compare for difference- which arm the pressure was done on should be documented. Caveat to this is if there has been a mastectomy or lymph node removal on one side (Avoid B/Ps on this arm), or if there is a fistula or injury to the arm. 
   • A consistent variation of more than 10mmHg systolic between arms should be reported to the primary care provider. A single variation of more than 20mmHg should be reported as this may indicate circulatory compromise.
7. Monitoring Schedule: timing, frequency, and duration
   
   • MEASURE BP twice daily (morning and late afternoon, prior to antihypertensive medications if patient taking any) at about the same times every day or every other day over 2 weeks. 
   • RECORD readings on BP Monitoring Log. 
   • CALCULATE average of readings, ignoring the 1st day. 
   • REPORT readings to Health Care Provider if outside acceptable ranges as per care plan. 

Documentation

RECORD date, right (R) or left (L) arm, time, BP, pulse (P), patient position (lying - L; sitting - S; standing - Std) or any changes in position (L → Std), and patient symptoms in log.

NOTIFY primary health care provider of findings and any concerns.

Example documentation on log:

References

1. American Heart Association. Home Blood Pressure Monitoring. 2016. [Link]
2. British Hypertension Society. Home Blood Pressure Monitoring Protocol. 2017. [Link] 
3. National Institute for Health and Clinical Excellence. The clinical management of primary hypertension in adults: Clinical Guideline. 2011. [Link]
4. Singh, V. (2015). Home blood pressure monitoring, practical aspects. 2015. [Link]