A 78-year-old man presents to the office for a new patient visit to rule out resistant HTN. His treatment regimen includes four antihypertensive medications in addition to lifestyle modifications.
As part of the evaluation to determine whether he has difficult-to-control versus truly resistant HTN, the clinician teaches the patient how to implement home BP monitoring to obtain out-of-the-office measurements. When reviewing the proper technique for obtaining home measurements, the patient asks what cuff size he should use.
Routine home BP monitoring can be measured using a regular-sized adult cuff as long as the device has been validated by the manufacturer.
Show Answer
The correct answer is: Fiction
The 2017 Multisociety guideline on HTN strongly recommends the use of an automated oscillometric BP device to obtain BP measurements.1 Because of lack of resources or limited knowledge, many patients and clinicians use a regular-sized adult cuff for BP measurement, regardless of the patient's arm circumference.2 Miscuffing (using an incorrectly sized BP cuff) is one of the most common causes of inaccurate BP measurement with automated oscillometric BP devices.2,3 Using too small of a BP (undercuffing) can result in a falsely higher systolic BP reading of up to 19.5 mm Hg,2 whereas using too large of a BP cuff (overcuffing) may result in a 1-6 mm Hg lower systolic BP reading.2
Proper selection of BP cuff size involves measuring the patient's mid upper arm circumference. To locate the mid portion of the upper arm, the length of the patient's arm between the acromion process (bony protuberance on the shoulder) and the olecranon process (bony protuberance at the elbow) should be measured and this this distance divided in half.3 The appropriate BP cuff size is determined by then wrapping a tape measure around the mid upper arm (measured in centimeters). A small adult cuff is used for circumferences of 22-26 cm, a regular-sized adult cuff for 27-34 cm, a large adult cuff for 35-44 cm, and an extra-large adult cuff for 45-52 cm.3 Many BP cuffs have the circumference ranges printed directly on them.
This patient case quiz is part of the larger Overcoming Challenges in Hypertension Management grant. Educational grant support is provided by Medtronic. To visit the Overcoming Challenges in Hypertension Management grant page and access additional educational activities on this topic, click here.
References
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APha/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71:e127-e248.
Ishigami J, Charleston J, Miller ER 3rd, Matsushita K, Appel LJ, Brady TM. Effects of cuff size on the accuracy of blood pressure readings: the Cuff(SZ) Randomized Crossover Trial. JAMA Intern Med 2023;183:1061-8.
Muntner P, Shimbo D, Carey RM, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. Hypertension 2019;73:e35-e66.
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