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Effects of Cuff Size on Accuracy of Blood Pressure Readings
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- Blood pressure (BP) readings obtained with a regular BP cuff instead of an appropriately sized cuff resulted in strikingly inaccurate BP measurements.
- Specifically, measurements obtained when the regular BP cuff was too large or too small resulted in clinically and statistically significant lower and higher BP readings, respectively.
- Accurate measurement of BP is crucial for reducing the prevalence of cardiovascular disease and these data suggest a need for renewed emphasis on individualized BP cuff selection, particularly in individuals with larger arm sizes.
Study Questions:
What is the effect of using a regular blood pressure (BP) cuff versus an appropriately sized BP cuff on automated BP readings?
Methods:
The investigators conducted a randomized crossover trial of community-dwelling adults with a wide range of mid-arm circumferences between March 16 and October 25, 2021, in Baltimore, MD. Participants were recruited via BP screening events at a public food market and a senior housing facility, targeted mailings to prior research participants, placement of study brochures in hypertension clinics at Johns Hopkins University, and referrals from physicians providing hypertension care to adults. Participants underwent 4 sets of triplicate BP measurements, with the initial 3 sets using an appropriate, too-small, or too-large BP cuff in random order; the fourth set of triplicate measurements was always completed with an appropriate BP cuff.
The primary outcome was the difference in mean BP when measured with a regular BP cuff compared with an appropriate BP cuff. The secondary outcome was the difference in BP when using too-small or too-large BP cuffs versus an appropriate BP cuff across all cuff sizes. Results were also stratified by systolic BP (≥130 mm Hg vs. <130 mm Hg) and body mass index (≥30 vs. <30 kg/2).
Results:
A total of 195 adults (mean [standard deviation] age, 54 [16] years; 67 [34%] male; 132 [68%] Black; 100 [51%] with hypertension) were randomized for inclusion. Among individuals requiring a small BP cuff, use of a regular BP cuff resulted in a statistically significant lower BP reading (mean systolic BP difference, −3.6 [95% CI, −5.6 to −1.7] mm Hg). In contrast, among individuals requiring a large or extra-large BP cuff, use of a regular BP cuff resulted in a statistically significant higher BP reading (mean systolic BP difference, 4.8 [95% CI, 3.0-6.6] mm Hg and 19.5 [95% CI, 16.1-22.9] mm Hg, respectively). For the secondary outcome, BP differences with overcuffing and undercuffing by 1 and 2 cuff sizes were greater among those requiring larger BP cuffs. The results were consistent in stratified analyses by systolic BP and body mass index.
Conclusions:
The authors report that miscuffing resulted in strikingly inaccurate BP measurements.
Perspective:
This randomized crossover trial of community-dwelling adults using an automated BP device reports that BP readings obtained with a regular BP cuff instead of an appropriately sized cuff resulted in strikingly inaccurate BP measurements. Specifically, measurements obtained when the regular BP cuff was too large or too small resulted in clinically and statistically significant lower and higher BP readings, respectively. Accurate measurement of BP is crucial for reducing the prevalence of cardiovascular disease and these data suggest a need for renewed emphasis on individualized BP cuff selection, particularly in individuals with larger arm sizes. These data further support the American Heart Association guidelines recommendation that arm circumference measurement be used for selecting a cuff with a corresponding bladder length and width.
Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Hypertension
Keywords: Blood Pressure, Blood Pressure Determination, Blood Pressure Monitors, Body Mass Index, Heart Disease Risk Factors, Homes for the Aged, Hypertension, Mass Screening, Primary Prevention, Risk Factors, Secondary Prevention, Systole
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