More is body fat or muscle, more is the pressure dissipated during inflation to reach the systolic level.  It has been observed and also shown in one of our study that the subsequent blood pressure measured by a sphygmomanometer is always low as compared to the 1st one.  The details can be found in the attached document.  Thanks & regards,

Bharti

Dear Gabriel

The blood pressure measurements by sphygmomanometer  wiil always decline to as compared to the the First reading and Second reading. This variation wıll be different from time to time and may differ from person to person at different level or proportion. It is impossible to get three reading  the same at different time.

A. Bener

Elevated blood pressure (BP) is a major risk factor for cardiovascular (CV) events and mortality (1) and a leading contributor to the global disease burden (2). Overwhelming evidence is now available showing that BP measured in the office shows a linear relationship with a number of CV and renal outcomes as well as with overall mortality and that lowering of office BP (OBP) with treatment is effective in reducing morbidity and mortality (3,4). However, application over the last 40 years of techniques for out-of-office BP monitoring including home BP monitoring (HBPM) and 24-h ambulatory BP monitoring (ABPM) has led to further important findings. In particular, 1) average BP measured in everyday life conditions may be an even better predictor of CV outcomes than isolated OBP readings and 2) the extent of fluctuations of BP over time may provide additional, independent prognostic information compared with both isolated office readings and average ambulatory BP (ABP) levels, respectively. These findings are of upmost relevance in the case of diabetic patients who are characterized by a significantly higher risk of CV events compared with nondiabetic individuals, with diabetes itself currently considered a CV disease equivalent (5,6). The aim of the present article is to review the available evidence on the prognostic importance of BP mean levels and of BP variability (BPV) estimates and to critically evaluate whether antihypertensive treatment strategies should be targeted at reducing not only average BP levels but also the degree of BPV in order to optimize CV protection in diabetic patients.