To take blood pressure manually, pump the cuff to at least 30 mmHg above the point where the wrist pulse disappears, let the air out at 2 mmHg per second while listening over the inner elbow, and read the gauge at the first of at least two consecutive taps (systolic) and at the last sound you hear (diastolic). Those figures come from the American Heart Association's 2019 scientific statement on blood pressure measurement. It takes practice, and MedlinePlus notes that digital monitors are the best choice for home use for most people.
What do I need to take blood pressure manually?
A manual blood pressure reading needs four things: an arm cuff, a rubber squeeze bulb, a gauge (manometer) with a dial, and a stethoscope to hear blood pulsing through the artery, which is the list MedlinePlus gives for manual devices. Cuff, bulb and gauge together make up a sphygmomanometer. The bulb has a valve for letting air out, and for a manual reading the cuff's bladder must reach 75–100% of the way round the arm (AHA 2019).
| Part | What it does | Check before you start |
|---|---|---|
| Cuff | Squeezes the upper arm with an inflatable bladder | It fits the arm (see the size check below the table) |
| Bulb and valve | Pumps air in, then lets it out | The valve opens in small, controllable turns |
| Gauge (manometer) | Shows cuff pressure in mmHg | It has been checked for calibration |
| Stethoscope | Carries the sounds from the artery to your ears | The earpieces angle forward, towards your nose |
If the bladder falls short of the arm, see which cuff size you need. Aneroid dials, common in clinics since mercury gauges were removed, are prone to losing calibration, especially when handled harshly; the AHA says handheld ones in clinical use need calibrating every 2 to 4 weeks and wall-mounted ones every 6 months. At home, have your clinic or supplier check the gauge rather than adjusting it yourself.
Where do the cuff and stethoscope go for a manual reading?
For a manual blood pressure reading, the cuff goes on the bare upper arm with its lower edge 2 to 3 cm above the elbow crease, and the stethoscope goes over the brachial artery at the inner elbow, just below the cuff. The American Heart Association's 2019 statement gives that spacing so the stethoscope has room, because a cuff touching the stethoscope produces noise that confuses the reading.
- Find the artery first. Feel for the brachial pulse on the inner side of the elbow crease and centre the cuff's artery mark over that line.
- Bare skin, not a sleeve. Cuffing over thick clothing can add up to 5–50 mmHg, according to PAHO/WHO HEARTS; estimates of these errors vary by study.
- Snug, not tight. One finger should slide easily under the top and bottom edges; two fingers fit but are very snug (AHA 2019).
- Arm supported at heart level, resting on a table. An unsupported arm can add up to 10 mmHg (PAHO/WHO HEARTS).
- Stethoscope below the cuff edge, not tucked under it. That is the standard position the AHA's 2–3 cm gap leaves room for. In a small 2014 study of recorded sounds from 30 healthy people, diastolic read 2.8 mmHg lower with the chest piece under the cuff; the authors suggested that might be closer to pressure measured inside the artery, but standard guidance still keeps the chest piece below the cuff.
- Bell or diaphragm. The AHA accepts either; a 2016 study put the difference in diastolic at 0.66 mmHg, not clinically significant. Hold the bell lightly or the diaphragm firmly, either way with a complete seal (open textbook, Lapum et al.).
How do I take a manual reading, step by step?
Using a manual blood pressure cuff takes two passes: first estimate systolic by feeling the wrist pulse while pumping, then let the cuff down, place the stethoscope, pump to at least 30 mmHg above that estimate and release at 2 mmHg per second, noting the gauge at the first repeated taps and at the last sound. These steps follow the AHA's 2019 statement and an open nursing textbook.
These steps assume someone else takes the reading while you sit still. The person being measured cannot feel the wrist pulse on the cuffed arm, hold the chest piece and work the valve at the same time.
- Prepare. No caffeine, exercise or smoking in the 30 minutes before (AHA 2019) and no meal in that time (MedlinePlus), and empty your bladder; a full bladder can add up to 10 mmHg (PAHO/WHO HEARTS). Sit for at least 5 minutes, 10 if possible, with your back supported, feet flat and legs uncrossed. Neither of you should talk during the rest or the reading (AHA 2019). Timing is covered in when to take blood pressure at home.
- Fit the cuff on the bare, supported arm at heart level, lower edge 2–3 cm above the elbow crease. At a first check, measure both arms and use the higher-reading arm from then on (AHA 2019); see when the two arms read differently.
- Find systolic by feel. The person taking the reading rests their fingertips on the pulse at the thumb side of the cuffed arm's wrist, closes the valve and pumps until the pulse disappears, then notes that number.
- Let all the air out by opening the valve fully.
- Place the stethoscope, earpieces angled forward, chest piece over the brachial artery just below the cuff.
- Close the valve and pump to at least 30 mmHg above the number from step 3. Pumping too slowly or not high enough can give a false reading (MedlinePlus).
- Open the valve slightly so the needle falls at 2 mmHg per second, or 2 mmHg per beat if the pulse is very slow. Faster than 2–3 mmHg per second makes the sounds hard to place (AHA).
- Note systolic at the first of at least two consecutive taps.
- Note diastolic at the last sound heard, then open the valve fully.
- Wait 1–2 minutes and repeat, writing both readings down (AHA 2019).
What are the Korotkoff sounds?
Korotkoff sounds are the noises heard through a stethoscope over the brachial artery as a cuff deflates and blood flow returns. The American Heart Association's 2019 statement describes five phases, and usually only two are written down: the first taps of phase 1 give systolic pressure, and the point where all sound stops (phase 5) gives diastolic. In the rare case that sounds carry on to 0 mmHg, an open nursing textbook says to take diastolic at muffling (phase 4).
| Phase | What you hear | What you write down |
|---|---|---|
| 1 | Sudden, sharp tapping | Systolic, at the first of at least two consecutive taps |
| 2 | Swishing | Nothing |
| 3 | Regular, louder sounds | Nothing |
| 4 | Abrupt muffling | Nothing, unless sounds continue to 0 mmHg (then diastolic, per the open textbook) |
| 5 | All sounds gone | Diastolic, at the last sound heard |
What if the Korotkoff sounds fade and then come back?
A silent stretch in which the Korotkoff sounds disappear and then return while the cuff deflates is called an auscultatory gap. The open textbook Vital Sign Measurement Across the Lifespan (2021) calls a gap an abnormal finding and warns that, if missed, it can make blood pressure read lower than it really is. Finding systolic by feel first, then pumping 30 mmHg past it, starts the reading above the gap.
- The sounds carry on down to 0 mmHg. Vital Sign Measurement Across the Lifespan calls this rare; take diastolic at muffling (phase 4).
- You noticed a gap. Record the first taps and the last sound as usual, not the point where the sound came back, and note the gap for your clinician.
- You missed the first taps. Let the cuff empty completely and start again after 1 to 2 minutes, the gap the AHA gives between repeated readings.
- You hear nothing at all. Check that the earpieces point forward, that a two-sided chest piece is turned to the side you are using, and that it sits over the artery with a full seal. A cuff edge rubbing the chest piece causes extra noise rather than silence.
Can I take my own blood pressure manually?
You can take your own blood pressure manually, but it is hard to do well on your own, and it is not the home method guidance recommends. MedlinePlus, from the US National Library of Medicine, says manual devices are very accurate when used correctly but are not the recommended type of monitor for home use, and that digital monitors are the best choice for most people. It also suggests practising with your provider or nurse.
The difficulty is practical: with the cuffed arm relaxed and supported, one free hand cannot work the bulb and valve and also hold the chest piece, while you listen for faint sounds and watch a falling needle. The WHO's 2020 device specifications add that the manual method needs training, steady hands to control deflation, and excellent hearing and vision, and is prone to observer bias and terminal digit preference (rounding to favourite end digits such as 0).
Clinics are moving the same way: the AHA's 2019 statement says automatic (oscillometric) devices are replacing manual measurement, and the 2025 AHA/ACC guideline says it is reasonable to use an automated oscillometric device rather than the manual method for office readings. If you are choosing a device, see how to check a monitor is validated.
How do I record a manual blood pressure reading?
Write a manual blood pressure reading as systolic over diastolic, each to the nearest even number, as the American Heart Association's 2019 statement asks, for example 128/82. Add the date, time and arm used, and note it if diastolic was taken at muffling because the sounds continued to 0 mmHg, or if you heard a gap.
A manual gauge keeps no memory, so write each reading down straight away. The free printable blood pressure log has columns for systolic, diastolic and notes (put the arm used there), plus an optional pulse column if you count the pulse separately. To chart the readings, type them into the Monitor2Log diary or photograph the page: the scan reads handwritten blood pressure pages, and nothing is saved until you have checked and confirmed every row, because the scan can misread handwriting.
Sources
- American Heart Association (Muntner et al., Hypertension), 2019, scientific statement on measuring blood pressure, including the manual method.
- American Heart Association and American College of Cardiology, 2025, high blood pressure guideline, including automated versus manual office measurement.
- Lapum et al., Toronto Metropolitan University, 2021, Vital Sign Measurement Across the Lifespan, 2nd Canadian edition, open textbook chapter on manual measurement.
- World Health Organization, 2020, technical specifications for automated blood pressure devices, with the limits of manual measurement.
- MedlinePlus, US National Library of Medicine, 2025, blood pressure monitors for home, with its blood pressure measurement page (2024) on preparing for a reading.
- PAHO/WHO HEARTS in the Americas, accessed 2026 (page undated), sizes of common blood pressure measurement errors.
General information only, not medical advice. Whether a manual cuff suits you, and what your readings mean, are questions for your own clinician.