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Appendix 3.1 Example of the Blood Pressure Data Recording Form

Cuff selection rules*:

Cuff width	8 cm	12 cm	16 cm
Arm circumference	less than 25 cm	25 cm - 35 cm	over 35 cm

* It is suggested that the cuff selection rules are printed on the top of the form. The rules shown here are an example, and the numbers should be substituted by those of of the cuff sizes actually used in the survey.

Data recording form:

Participant's identification code

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Person measuring blood pressure (identification code)

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Date (ddmmyyyy)

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Room temperature (^oC)

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Arm used for blood pressure measurement
1 = right
2 = left

|__|

Position of subject
1 = sitting
2 = supine

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Maximum arm circumference (cm)

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Cuff size used
1 = 8 cm
2 = 12 cm
3 = 16 cm

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30 second pulse count

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Was the pulse regular?
1 = Yes
2 = No

|__|

Peak inflation pressure (mmHg)

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Blood pressure measurement

	Time of day (hh:mm)	Systolic (mmHg)	Diastolic (mmHg)
1st measurement
2nd measurement
3rd measurement

Describe special conditions, if any:

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