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Research Highlights:

• Only 1 in 7 online stock images of blood pressure monitoring aligned with the procedures recommended by clinical guidelines.
• Online stock images depicting blood pressure monitoring in the home were approximately three times more accurate than images depicting blood pressure monitoring in a physician’s office, health care facility or hospital.
• This study is among the first to review online images of people having their blood pressure measured from major stock photo websites.

DALLAS, September 8, 2025 — Only 1 in 7 online stock photo images of blood pressure monitoring correctly show how blood pressure should be measured, contributing to potentially inaccurate readings at home and in physicians’ offices, health care facilities or hospitals, according to new research published today in Hypertension, an American Heart Association journal.

The study is one of the first to systematically evaluate the accuracy of online images depicting blood pressure measurements on major stock photo websites based on the 2023 International Consensus on Standardized Clinic Blood Pressure Measurement.

“We expected that about 50% of images would be accurate, however, our findings were worse than expected,” said lead author Alta Schutte, Ph.D., a professor of cardiovascular medicine at the University of New South Wales Sydney, and co-lead of the cardiovascular program at The George Institute for Global Health in Australia. “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.”

Nearly half of all adults in the U.S. have high blood pressure, according to the American Heart Association. (From 2017 to 2020, 122.4 million adults in the U.S., or 46.7%, had high blood pressure; source: American Heart Association’s 2025 Heart Disease and Stroke Statistics)

“More people are checking their blood pressure at home. But because of the inaccurate depictions online – even on reputable websites – it is very likely that people who look for information on the internet about blood pressure will see these images and may use the incorrect technique at home. If this happens, people will get blood pressure readings that are either too high or too low, which can lead to wrong conclusions about their blood pressure and possibly too much or too little treatment when these blood pressure measures are shared with their health care team,” Schutte said.

The analysis found:

• Only 14% of more than 1,000 images depicting adults having their blood pressure measured were accurate.
• Deviations from clinical guidelines that contributed to photo inaccuracy included:
  • the individual’s back was not supported (73%);
  • the whole forearm was not resting on a flat surface or table (55%);
  • using a manual self-pumping device instead of an electronic or battery-operated upper-arm device (52%);
  • feet were dangling rather than flat on the floor (36%);
  • the health care professional (23%) and patient (18%) were talking while taking the measurement;
  • mid-arm was not at heart level (19%);
  • people had their legs crossed (13%);
  • the patient was not sitting (5%); and
  • the blood pressure cuff was placed over clothing (12%) rather than the bare arm.
• 25% of images showing self-measurement of blood pressure at home were accurate compared to only 8% of images depicting blood pressure measurements in a physician’s office, health care facility or hospital.
• Images depicting blood pressure measurements taken by the patient themselves or another person were 6 times more likely to show accurate techniques compared to images showing blood pressure measured by a health care professional.

“There have been many interesting studies about errors in blood pressure measurement and the blood pressure effect of such errors, for example, if the cuff on the upper arm is not held at heart level. This is the first evaluation of publicly available images of blood pressure measurement to highlight the problem with inaccurate images,” Schutte said.

“It is important for people to understand how to measure their blood pressure correctly. Inaccurate readings in clinics are also a very common problem. We want everyone to know how health care professionals should take blood pressure measurements so they can identify any mistakes if the procedure is not followed correctly,” she said.

Chair of the American Heart Association’s 2025 high blood pressure guideline writing committee released last month, Daniel Jones, M.D., FAHA, said, “This study highlights the importance of using accurate images to demonstrate the proper technique for measuring blood pressure. 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.” Jones, who was not involved in this study, is also a past volunteer president of the American Heart Association (2007-2008) and currently dean and professor emeritus of the University of Mississippi School of Medicine.

The American Heart Association has resources to help people learn proper blood pressure measurement techniques.

The study has several limitations. Some images were incomplete; for instance, less than a quarter of them showed whether the person had their feet crossed or flat on the floor. If these details were clear, it might affect accuracy levels. Although the included photos were not penalized based on features that were not visually assessable, the findings may be affected. Additionally, the stock images used in this study were probably not created with the International Consensus Guidelines in mind. So, any errors found likely do not stem from an intentional misrepresentation of proper technique, yet these are the images that are typically used by the media and website developers.

Study background and details:

• The analysis used a Google search conducted on July 22, 2024, to identify a comprehensive list of 11 major online stock photo sites (123rf, Adobe Stock, Alamy, Bigstockphoto, Dreamstime, Flickr, Freepik, Getty Images, iStock, Pikwizard and Shutterstock).

• The first 100 photos from each online stock photo site were downloaded for further screening. Stock photo sites with more than 10% duplicate images were excluded. Cartoon or fictional images, AI-generated images or photos without people were also excluded.

• Of 121,000 images, 1,106 photos identified with the search term “blood pressure check” in adults were each reviewed by two reviewers. Overall, about 63% of the images were in a physician’s office or hospital, while about 37% showed home blood pressure monitoring in a home setting.

• Blood pressure measurements were performed by a health care professional in 72.8% of the photos, 24.5% were done by the patient and 2.7% were taken by other people.

• Conflicts (reviewers not agreeing) of each online image were resolved in two stages. First, two reviewers independently examined the stock photos, then met as a group to discuss the screening criteria and determine if the image accurately depicted correct blood pressure measuring techniques. Blood pressure measurements depicted in the images were checked for accuracy based on: whether the patient or the person taking the measurement was talking or laughing; the patient’s position: sitting, whether their whole forearm was resting on the table, mid-arm at heart level, back supported by a chair, legs uncrossed, and feet flat on the floor; the type of blood pressure measurement device: an electronic upper-arm device instead of a manual device; and the blood pressure cuff: placed on a bare arm.

“We have noted photos with wrong techniques on the websites of major health organizations and universities. We urge these organizations, media outlets, stock photo creators, web developers, medical journalists, and researchers to take a closer look at their online images. They should check that all images show how to measure blood pressure accurately and represent the proper techniques to reduce the likelihood of incorrect blood pressure readings at home and in clinical settings,” Schutte said.

Co-authors, disclosures and funding sources are listed in the manuscript.

Research Highlights:

• Only 1 in 7 online stock images of blood pressure monitoring aligned with the procedures recommended by clinical guidelines.
• Online stock images depicting blood pressure monitoring in the home were approximately three times more accurate than images depicting blood pressure monitoring in a physician’s office, health care facility or hospital.
• This study is among the first to review online images of people having their blood pressure measured from major stock photo websites.

Embargoed until 2 p.m. CT/3 p.m. ET Monday, September 8, 2025

DALLAS, September 8, 2025 — Only 1 in 7 online stock photo images of blood pressure monitoring correctly show how blood pressure should be measured, contributing to potentially inaccurate readings at home and in physicians’ offices, health care facilities or hospitals, according to new research published today in Hypertension, an American Heart Association journal.

The study is one of the first to systematically evaluate the accuracy of online images depicting blood pressure measurements on major stock photo websites based on the 2023 International Consensus on Standardized Clinic Blood Pressure Measurement.

“We expected that about 50% of images would be accurate, however, our findings were worse than expected,” said lead author Alta Schutte, Ph.D., a professor of cardiovascular medicine at the University of New South Wales Sydney, and co-lead of the cardiovascular program at The George Institute for Global Health in Australia. “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.”

Nearly half of all adults in the U.S. have high blood pressure, according to the American Heart Association. (From 2017 to 2020, 122.4 million adults in the U.S., or 46.7%, had high blood pressure; source: American Heart Association’s 2025 Heart Disease and Stroke Statistics)

”More people are checking their blood pressure at home. But because of the inaccurate depictions online – even on reputable websites – it is very likely that people who look for information on the internet about blood pressure will see these images and may use the incorrect technique at home. If this happens, people will get blood pressure readings that are either too high or too low, which can lead to wrong conclusions about their blood pressure and possibly too much or too little treatment when these blood pressure measures are shared with their health care team,” Schutte said.

The analysis found:

• Only 14% of more than 1,000 images depicting adults having their blood pressure measured were accurate.
• Deviations from clinical guidelines that contributed to photo inaccuracy included:

  • the individual’s back was not supported (73%);
  • the whole forearm was not resting on a flat surface or table (55%);
  • using a manual self-pumping device instead of an electronic or battery-operated upper-arm device (52%);
  • feet were dangling rather than flat on the floor (36%);
  • the health care professional (23%) and patient (18%) were talking while taking the measurement;
  • mid-arm was not at heart level (19%);
  • people had their legs crossed (13%);
  • the patient was not sitting (5%); and
  • the blood pressure cuff was placed over clothing (12%) rather than the bare arm.

• 25% of images showing self-measurement of blood pressure at home were accurate compared to only 8% of images depicting blood pressure measurements in a physician’s office, health care facility or hospital.
• Images depicting blood pressure measurements taken by the patient themselves or another person were 6 times more likely to show accurate techniques compared to images showing blood pressure measured by a health care professional.

“There have been many interesting studies about errors in blood pressure measurement and the blood pressure effect of such errors, for example, if the cuff on the upper arm is not held at heart level. This is the first evaluation of publicly available images of blood pressure measurement to highlight the problem with inaccurate images,” Schutte said.

“It is important for people to understand how to measure their blood pressure correctly. Inaccurate readings in clinics are also a very common problem. We want everyone to know how health care professionals should take blood pressure measurements so they can identify any mistakes if the procedure is not followed correctly,” she said.

Chair of the American Heart Association’s 2025 high blood pressure guideline writing committee released last month, Daniel Jones, M.D., FAHA, said, “This study highlights the importance of using accurate images to demonstrate the proper technique for measuring blood pressure. 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.” Jones, who was not involved in this study, is also a past volunteer president of the American Heart Association (2007-2008) and currently dean and professor emeritus of the University of Mississippi School of Medicine.

The American Heart Association has resources to help people learn proper blood pressure measurement techniques.

The study has several limitations. Some images were incomplete; for instance, less than a quarter of them showed whether the person had their feet crossed or flat on the floor. If these details were clear, it might affect accuracy levels. Although the included photos were not penalized based on features that were not visually assessable, the findings may be affected. Additionally, the stock images used in this study were probably not created with the International Consensus Guidelines in mind. So, any errors found likely do not stem from an intentional misrepresentation of proper technique, yet these are the images that are typically used by the media and website developers.

Study background and details:

• The analysis used a Google search conducted on July 22, 2024, to identify a comprehensive list of 11 major online stock photo sites (123rf, Adobe Stock, Alamy, Bigstockphoto, Dreamstime, Flickr, Freepik, Getty Images, iStock, Pikwizard and Shutterstock).

• The first 100 photos from each online stock photo site were downloaded for further screening. Stock photo sites with more than 10% duplicate images were excluded. Cartoon or fictional images, AI-generated images or photos without people were also excluded.

• Of 121,000 images, 1,106 photos identified with the search term “blood pressure check” in adults were each reviewed by two reviewers. Overall, about 63% of the images were in a physician’s office or hospital, while about 37% showed home blood pressure monitoring in a home setting.

• Blood pressure measurements were performed by a health care professional in 72.8% of the photos, 24.5% were done by the patient and 2.7% were taken by other people.

• Conflicts (reviewers not agreeing) of each online image were resolved in two stages. First, two reviewers independently examined the stock photos, then met as a group to discuss the screening criteria and determine if the image accurately depicted correct blood pressure measuring techniques. Blood pressure measurements depicted in the images were checked for accuracy based on: whether the patient or the person taking the measurement was talking or laughing; the patient’s position: sitting, whether their whole forearm was resting on the table, mid-arm at heart level, back supported by a chair, legs uncrossed, and feet flat on the floor; the type of blood pressure measurement device: an electronic upper-arm device instead of a manual device; and the blood pressure cuff: placed on a bare arm.

“We have noted photos with wrong techniques on the websites of major health organizations and universities. We urge these organizations, media outlets, stock photo creators, web developers, medical journalists, and researchers to take a closer look at their online images. They should check that all images show how to measure blood pressure accurately and represent the proper techniques to reduce the likelihood of incorrect blood pressure readings at home and in clinical settings,” Schutte said.

Co-authors, disclosures and funding sources are listed in the manuscript.

Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.

Additional Resources:

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