Abstract
Background: Masked hypertension has been associated with obese and overweight individuals; however, most studies do not mention the use of large cuffs for home BP measurements in patients with oversized arms. Our goal was to test the impact of cuff size on hypertension status in patients with oversized arms. Patients and Methods: 53 treated hypertensive patients (mean age 60 ± 13 y; mean BMI 36 ± 5 kg/m2 (range 25–48)) with an arm circumference >33 cm (range33–45 cms) have been included. After the office visit, they performed two cycles of home blood pressure measurements according to the French Society of Hypertension protocol with a standard cuff, and a large cuff, using the Microlife® BP A100 PLUS validated device. Home BP < 135/85 mmHg was the cut-off used to classify the patients in terms of BP control. Results: Mean office BP was 143 ± 17/85 ± 11 mmHg. Home BP measurements were 141 ± 14 / 84 ± 11 mmHg and 134 ± 13 / 80 ± 10 mmHg with the standard and the large cuff respectively (mean difference 6.9 / 4.0 mmHg for SBP/DBP p < 0.0001). The prevalence of white-coat and masked hypertension with the 2 different cuffs is summarized in the figure. The use of an appropriate large cuff for home BP evaluation led to a 3-fold decrease in masked hypertension and a 3-fold increase in white-coat hypertension. Conclusion: The use of inappropriate cuffs for home BP measurements has a significant and epidemiological impact by modifying substantially the prevalence of white-coat and masked hypertension. Large adult cuffs for home BP devices, commonly needed by hypertensive patients, are not always easily available for purchase, and charging extra for large adult cuffs is a potential hindrance to consumers purchasing the correct cuff size for accurate blood pressure measurement and should be eliminated. Future studies in the field of masked hypertension should specify the use of appropriate cuffs for home BP measurements in order to avoid any technical bias.
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