Blood pressure measurement is one of the most frequently performed medical procedures. However, oscillometric BP measuring devices have some technical limitation and alternative techniques should be considered. Manual auscultatory measurement is the preferred technique in atrial fibrillation. The BP in patients with left ventricular assist device can be estimated using a manual sphygmomanometer combined with Doppler opening signal. In patients with stenosing arterial disease of the upper limbs, the systolic BP can be estimated at lower extremities using a manual sphygmomanometer on the leg combined with pulse oximetry on the toe.