Blood pressure measurement: arm circumference and cuff size availability

Eugenia Velludo Veiga,Lyne Cloutier,Edna Aparecida Moura Arcuri,Jair Lício Ferreira Santos

doi:10.1590/s0104-11692009000400004

Abstract

To avoid inaccurate blood pressure (BP) readings, the American Heart Association (AHA) recommends cuff width (CW) encircling 40% of the arm circumference (AC) and cuff length at least 80-100%. This study aimed to identify inpatients AC, the corresponding cuff size and the cuff size availability. In total, 81 AC were measured in the right arm. The cuff sizes to fit them were calculated according to AHA AC/CW width 0.40 ratio. The AC varied from 17.5 to 40.5 cm and the corresponding cuff width from 6 to 16 cm. The standard cuff 12 by 23 cm, the only size available in the clinics, was appropriate for only 17.3% of the subjects, whose AC varied between 32.5 and 34.3 cm. The lack of availability of different cuff sizes continues being a challenging problem to be faced. The standard cuff available, 12 cm large, did not fit 82.7% of the identified AC, resulting in over or underestimated BP registers.

Highlights

It is emphasized in the literature that different factors may influence blood pressure (BP) measurement accuracy
The results are presented in the following order: patient distribution according to clinical specialty, and gender (Table 1); body mass index distribution to gender (Table 2); body mass index distribution to age (Table 3), and Table 4 presents patients‘ arm circumference and corresponding cuff width
Following a cohort of 530 subjects from the University of Sao Paulo[18] during the last 26 years, we have demonstrated that the use of the standard cuff (12 cm) in arms of 22-26 cm can result in hypertension misdiagnosis and mistreatment due to blood pressure underestimated readings

Summary

Introduction

It is emphasized in the literature that different factors may influence blood pressure (BP) measurement accuracy. There are several errors that can be made by the observer (person who measures blood pressure)(1) due to poor BP measurement knowledge or lack of attention[2,3,4]. The use of a wrong cuff size to arm circumference (AC) is the most discussed cause of imprecise measurement. To avoid over or under BP estimation, the ratio arm circumference/cuff width (AC/CW) must be around 0.40 and the cuff length must encircle AC from 80 to 100%(9-10) , as recommended by the American Heart Association[11]. The European Society of Hypertension Annual Meeting 2007 established guidelines[12] which recommended a standard bladder 12 -13 cm long, size appropriate to nearly 10-30 % of adults’ arm circumference. A bigger bladder for fat arms (35cm) and a smaller one for thin arms were recommended[12]

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Discussion

Conclusion