How to track blood pressure at home

The 2025 AHA/ACC guideline retires and replaces the 2017 ACC/AHA guideline (2025 AHA/ACC guideline, Circulation, August 14, 2025). It recommends home blood pressure monitoring to help confirm an office diagnosis of high blood pressure and to monitor, track progress and tailor care (AHA newsroom, August 14, 2025). The AHA and AMA had already called self-measured blood pressure at home a validated approach for out-of-office measurement, and noted that blood pressure may differ considerably between the office and home and that higher out-of-office readings are associated with increased cardiovascular risk independent of office readings (AHA/AMA joint policy statement, Circulation, July 2020).

The two numbers can disagree in either direction. White-coat hypertension means office readings in the hypertensive range with out-of-office readings below it, and it shows up in 15% to 30% of people whose office readings are high (AHA scientific statement on blood pressure measurement, Hypertension, May 2019). Masked hypertension is the reverse, and it is present in about 15% to 30% of adults whose office readings are normal (AHA, 2019).

None of this makes a diagnosis at home. Providers diagnose high blood pressure from two or more readings at separate medical appointments (NHLBI, updated June 26, 2025).

The adult categories were set in the 2017 ACC/AHA guideline, and the 2025 guideline kept them unchanged (AHA newsroom, August 14, 2025). All figures are in mm Hg (AHA newsroom; NHLBI, June 26, 2025):

• Normal: less than 120/80
• Elevated: 120 to 129 systolic and less than 80 diastolic
• Stage 1: 130 to 139 systolic or 80 to 89 diastolic
• Stage 2: 140 or higher systolic or 90 or higher diastolic
• Hypertensive crisis: higher than 180 systolic or higher than 120 diastolic, and NHLBI says readings above 180/120 are dangerously high and require immediate medical attention (NHLBI, June 26, 2025)

Home readings map onto office readings through a published table, and the match is exact only at the lower end. For an office reading of 120/80 the corresponding home reading is 120/80, for 130/80 it is 130/80, for 140/90 it is 135/85, and for 160/100 it is 145/90 (AHA scientific statement, May 2019). The NHS uses the same 135/85 line for UK readers, saying you have high blood pressure at 140/90 or higher when checked by a healthcare professional and 135/85 or higher when checked at home (NHS, Blood pressure test, last reviewed 25 November 2025).

What to do about a high number is on the companion page on lowering blood pressure, and what a number means for you is your clinician's call.

The AHA's measurement statement asks for an upper-arm cuff oscillometric device that has been validated, one that automatically stores all readings, and ideally one that can print results or send them electronically to the healthcare provider (AHA scientific statement, May 2019). It says providers should advise patients to use only validated upper-arm devices because many nonvalidated devices do not provide accurate measurements (AHA, 2019). MedlinePlus calls digital monitors the best choice for home use for most people (MedlinePlus, Blood pressure monitors for home, reviewed July 1, 2025).

The US list of validated devices is the AMA's US Blood Pressure Validated Device Listing, a free resource at validatebp.org (AMA, updated July 24, 2023). Manufacturers submit devices voluntarily, and a committee of 13 physician experts decides whether each one meets the listing's criteria for clinical accuracy (AMA). The AMA's advice to patients is to check a monitor there, and to use an upper-arm device that inflates automatically (AMA, What doctors want patients to know, March 13, 2026).

Validation shows up in real use. In a study of 331 monitors owned by patients in central England, 40% of testable monitors were not validated, and validated monitors passed the pressure accuracy test 96% of the time against 64% for unvalidated ones (ACCU-RATE study, Br J Gen Pract, 2020). Monitors in use for 4 years or less passed 95% of the time, against 74% for older ones, and 12% of cuffs failed (ACCU-RATE, 2020).

Wrist, finger, and cuffless devices each have a caution attached. Strong reservations have been raised about wrist devices in routine practice unless measurements in the upper arm are not feasible (AHA scientific statement, May 2019), and the AMA's guide says wrist cuffs are not recommended for clinical use unless patients cannot use upper arm cuffs, and that finger devices are less accurate than upper arm devices (AMA, 7-step SMBP quick guide: ensure accuracy, updated August 6, 2025). On smartwatches, the AMA's Dr. Michael Rakotz says there is not yet enough evidence to recommend these wearables for the diagnosis or clinical management of high blood pressure (AMA, March 13, 2026), and a review of the 2025 guideline reports that cuffless devices are not recommended for diagnosing or treating elevated blood pressure (Brown, Clark and Jones, Curr Hypertens Rep, March 2026).

The AHA's measurement statement sizes the cuff by the circumference of the upper arm (AHA scientific statement, May 2019):

• Small adult: 22 to 26 cm
• Adult: 27 to 34 cm
• Large adult: 35 to 44 cm
• Extra-large adult: 45 to 52 cm

The AMA's guide asks for the mid-upper arm to be measured and matched to a cuff (AMA, 7-step SMBP quick guide: ensure accuracy, August 6, 2025). The wrong size moves the number. Dr. Kenny Cole, quoted by the AMA, warns that too big a cuff on a small arm can give falsely low readings (AMA, March 13, 2026).

The full step list, with the AHA's wording, is on the page about lowering blood pressure. The version the sources share is short:

• The 30 minutes before. No caffeine or cigarettes, and an empty bladder (AMA, March 13, 2026). MedlinePlus adds stress and meals to that window (MedlinePlus, reviewed July 23, 2024).
• Rest. At least 5 minutes sitting quietly, without talking or texting (AHA scientific statement, May 2019). MedlinePlus says 5 minutes and adds that 10 minutes is better (MedlinePlus, July 23, 2024).
• Position. Back supported, feet flat on the floor, legs uncrossed, and the cuff on a bare arm (AHA, 2019), with the arm at heart level (AMA, March 13, 2026).
• Two readings. At least 1 minute apart (AHA, 2019). The CDC says at least two readings, 1 or 2 minutes apart (CDC, Measure your blood pressure, September 4, 2026), and MedlinePlus says 2 or 3 readings at a sitting (MedlinePlus, July 23, 2024).
• Write them down. The CDC asks for a blood pressure log and for readings at the same time every day (CDC, September 4, 2026).

MedlinePlus notes why the time matters. Blood pressure tends to be higher at work, lower at home, lowest during sleep, and it is normal for it to rise suddenly when you wake up (MedlinePlus, July 23, 2024).

This is where the sources give different numbers, so each one is printed with its owner.

AHA scientific statement, May 2019. Two readings at least 1 minute apart in the morning before taking blood pressure medication, and two at least 1 minute apart in the evening before bed. The preferred period is 7 days or more, 28 or more scheduled readings, with a minimum of 3 days, 12 readings, ideally in the period immediately before the next appointment. Some guidelines drop the first day's readings, which makes the minimum and preferred periods 4 and 8 days.

AMA, March 13, 2026, and August 6, 2025. Two readings a minute apart, morning and evening, for seven days, which is 28 readings. The AMA's guide asks for a device that stores at least 7 days of measurements, 28 or more readings.

MedlinePlus, Blood pressure monitors for home, July 1, 2025. At least 2 readings 1 minute apart in the morning before taking medicines and in the evening before eating supper, daily for 5 days.

MedlinePlus, Blood pressure measurement, July 23, 2024. Before breakfast and dinner for 5 days, which gives at least 10 readings.

NHS, 25 November 2025. Twice a day, morning and evening, two readings a minute apart, for the number of days your doctor or nurse tells you.

CDC, September 4, 2026. Talk with your health care team about how often to measure.

Seven days of morning and evening pairs is the schedule with the AHA statement and the AMA behind it. Five days is MedlinePlus's. If your clinician gave you a schedule, theirs is the one that counts.

The AHA's statement says the home device and the readings should both be brought to healthcare visits (AHA scientific statement, May 2019). Bringing the device lets someone watch your technique. MedlinePlus says to practice using the monitor with your provider or nurse (MedlinePlus, July 1, 2025) and to ask your provider to compare your home readings with those taken in the office (MedlinePlus, July 23, 2024).

The readings can travel several ways. The AMA lists a written log, the device's memory reviewed at the office, a secure app or portal, and automatic wireless transmission where the device supports it (AMA, March 13, 2026).

The clinician does the math. For each monitoring period, the average of all readings should be obtained (AHA scientific statement, May 2019), which is why every reading goes on the log, the high ones and the low ones. The AMA's Dr. Rakotz says patients and physicians should make a plan together for readings that come in higher or lower than expected, and that the instructions will vary from patient to patient (AMA, March 13, 2026).

An individual patient data meta-analysis of 25 trials found no effect from self-monitoring alone, a change of 1.0 mm Hg in clinic systolic pressure, while self-monitoring combined with intensive support lowered clinic systolic pressure by 6.1 mm Hg at 12 months (Tucker et al., PLOS Medicine, September 2017). The support that made the difference included medication adjustment by doctors, pharmacists, or patients, education, and lifestyle counselling (Tucker et al., 2017).

The AHA and AMA reached the same reading: the benefits of self-measured monitoring are greatest when it is done along with cointerventions (AHA/AMA joint policy statement, July 2020). The AMA adds that self-measured monitoring lets patients take part in managing their blood pressure and has been shown to improve adherence to blood pressure medications (AMA, 7-step SMBP quick guide, August 6, 2025).

I keep the log. I text you at the times you pick, morning before your medication and evening before bed if you follow the AHA's schedule, ask for both readings, and keep each pair with its date and time. I make sure we get the full stretch in, usually the seven days right before your appointment, because that is the window the AHA statement prefers (AHA, May 2019). Before the visit I hand you every reading as a list you can show or send, since the AHA says the device and the readings should come to the visit (AHA, May 2019).

I never tell you what a reading means for you, never set your target, and never touch a medication. The averaging and the reading of it belong to your clinician. If you send me a number above 180/120, I tell you what NHLBI and MedlinePlus say to do with it, including calling 911 when the symptoms are there.

No clinician reviewed this page. It restates the 2025 AHA/ACC guideline and AHA's release on it, the AHA and AMA statements, the AMA's pages, NHLBI, MedlinePlus, the CDC, the NHS, and the studies linked below, and those are the documents to trust over anything here.