Abstract EP01: One Size Does Not Fit All: Impact Of Using A Regular Cuff For All Blood Pressure Measurements

Abstract

Background: Blood pressure (BP) guidelines recommend individualized cuff selection based on mid-arm circumference, but many clinics, especially in resource-constrained settings, use a regular adult cuff for all patients. Objective: Determine the effects of using a regular adult BP cuff compared to using a BP cuff that is appropriately sized for an individual’s mid-upper arm circumference. Methods: We conducted a randomized cross-over trial of 165 community-dwelling adults [mean age 55 yrs, 33% male (n=54), 68% Black (n=113)]. Participants had 2 sets of triplicate BP measurements (WelchAllyn ProB 2000) using a regular adult cuff and an appropriate cuff, in random order. Results: 30% (n=50) of the study participants had systolic BP (SBP) ≥130 mmHg, and 42% (n=69) had a BMI ≥ 30kg/m 2 . As shown in the Table , among persons who required a small adult cuff, a regular cuff resulted in significantly lower readings [SBP -3.8 (-6.3 to -1.3) and DBP -1.5 (-3.0 to -0.0) mmHg]. In contrast, among persons who required a large or extra-large adult cuff, a regular cuff was associated with significantly higher readings [SBP 4.8 (2.9 to 6.7) and 19.7 (16.3 to 23.2) mmHg, respectively]. The overestimation of BP due to undercuffing misclassified 39 % of participants with a hypertensive BP (≥130/80 mmHg) while the underestimation of BP due to overcuffing missed 22% of participants with a hypertensive BP. Conclusions: In this trial, using a regular adult cuff in all individuals resulted in striking differences in SBP and DBP. A renewed emphasis on cuff size is warranted, particularly in populations with high prevalence of obesity requiring large or extra large cuff sizes.