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‘Striking’ Differences in BP When Wrong Cuff Size Is Used
Strong new evidence on the need to use an appropriately sized cuff in blood pressure (BP) measurement has come from the cross-sectional randomized trial Cuff(SZ).
The study found that in people in whom a small adult cuff was appropriate, systolic BP readings were on average 3.6 mm Hg lower when a regular adult size cuff was used.
However, systolic readings were on average 4.8 mm Hg higher when a regular cuff was used in people who required a large adult cuff and 19.5 mm Hg higher in those needing an extra-large cuff based on their mid-arm circumference.
The diastolic readings followed a similar pattern (-1.3 mm Hg, 1.8 mm Hg, 7.4 mm Hg, respectively).
“We found that using the regular adult cuff in all individuals had striking differences in blood pressure,” lead author Tammy M. Brady, MD, PhD, Johns Hopkins University School of Medicine, Baltimore, Maryland, told theheart.org | Medscape Cardiology. “And that has a lot of clinical implications.”
She noted, for example, that people who required an extra-large cuff and were measured with a regular cuff had an average BP of 144/86.7 mm Hg, which is in the stage 2 hypertension range. But when the correct size cuff was used, the average BP was 124.5/79.3 mm Hg, or in the prehypertensive range.
Overall, the overestimation of BP due to using too small a cuff misclassified 39% of people as being hypertensive, while the underestimation of BP due to using a cuff that was too large missed 22% of people with hypertension.
“So I think clinicians really need to have a renewed emphasis on cuff size, especially in populations where obesity is highly prevalent and many of their patients require extra-large cuffs because those are the populations that are most impacted by mis-cuffing,” Brady said.
The findings were presented in an E-poster today at the Epidemiology and Prevention/Lifestyle and Cardiometabolic Health (EPI/Lifestyle) 2022 conference sponsored by the American Heart Association (AHA).
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The largest cuff size is called a THIGH CUFF, not “Extra large” or “Big Boy” – 50% of my CDL holders use the largest cuff size!
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