Only 14% of online stock images showing blood pressure monitoring demonstrate proper measurement techniques according to clinical guidelines, according to new research published in Hypertension, an American Heart Association journal. The study analyzed over 1,000 images from major stock photo websites and found widespread inaccuracies that could contribute to incorrect blood pressure readings both at home and in clinical settings.
Lead author Alta Schutte, Ph.D., professor of cardiovascular medicine at the University of New South Wales Sydney, expressed concern about the findings. "We expected that about 50% of images would be accurate, however, our findings were worse than expected," Schutte said. "Because people tend to remember images better than words — a phenomenon known as the picture-superiority effect — inaccurate visuals could have serious public health consequences."
The analysis revealed multiple deviations from the 2023 International Consensus on Standardized Clinic Blood Pressure Measurement guidelines. Common errors included the individual's back not being supported (73%), the whole forearm not resting on a flat surface (55%), using manual self-pumping devices instead of electronic upper-arm devices (52%), and feet dangling rather than flat on the floor (36%). Additional inaccuracies involved talking during measurement (23% for healthcare professionals, 18% for patients), mid-arm not at heart level (19%), crossed legs (13%), and blood pressure cuffs placed over clothing (12%).
Notably, images depicting home blood pressure monitoring showed significantly higher accuracy rates than those in clinical settings. Twenty-five percent of home measurement images were accurate compared to only 8% of images showing measurements in physician's offices, healthcare facilities, or hospitals. Images showing blood pressure measurements taken by patients themselves or other non-professionals were six times more likely to show accurate techniques compared to those showing healthcare professionals taking measurements.
The implications of these findings are substantial given that nearly half of all U.S. adults have high blood pressure. According to American Heart Association statistics from 2017-2020, 122.4 million adults in the U.S., or 46.7%, had high blood pressure. With more people checking their blood pressure at home, inaccurate online images could lead to widespread incorrect measurement techniques and subsequent improper treatment decisions.
Daniel Jones, M.D., FAHA, chair of the American Heart Association's 2025 high blood pressure guideline writing committee, emphasized the importance of accurate imagery. "This study highlights the importance of using accurate images to demonstrate the proper technique for measuring blood pressure," said Jones, who was not involved in the study. "Home blood pressure monitoring is recommended for patients to help confirm an office diagnosis of high blood pressure and to monitor, track progress and tailor care as part of an integrated care plan."
The American Heart Association provides resources to help people learn proper blood pressure measurement techniques at https://www.heart.org. Researchers urge healthcare organizations, media outlets, stock photo creators, and web developers to review their online images to ensure they accurately represent proper blood pressure measurement techniques, potentially reducing the likelihood of incorrect readings in both home and clinical settings.
