Be sure that the width of the bladder inside the pressure cuff is about two-thirds the length of the upper arm. The bladder should also completely encircle the arm. Cuffs that are too narrow or encircle the arm incompletely result in erroneously elevated blood pressures. In cases of extreme obesity, the only cuff large enough for the arm may be a thigh cuff. If the blood pressure is elevated in the arm when the patient is sitting, ask the patient to lie quietly for 5 or 10 minutes and repeat the measurement. A single elevated blood pressure is not diagnostic of hypertension, but should be repeated at least twice over a 2-week period. It is sometimes convenient to have the blood pressure measured on a repeated basis by the school nurse. The patient can bring these recordings to the office for follow up. Moderate elevation of blood pressure is not a contraindication for sports participation. Persistent blood pressure elevations are a concern and warrant a medical evaluation.