08 Aug When It Comes to Blood Pressure Cuffs, Size Matters
MedicalResearch.com Interview with:
Dr. McLoughlin Brady
Tammy M. Brady, MD, PhD (she/her/hers)
Vice Chair for Clinical Research, Dept of Pediatrics
Associate Director, Welch Center for Prevention, Epidemiology, and Clinical Research
Associate Professor of Pediatrics, Division of Pediatric Nephrology
Medical Director, Pediatric Hypertension Program
Johns Hopkins University
Baltimore, MD 21287
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Accurate BP measurement is key to identification and treatment of hypertension which serves ultimately to prevent cardiovascular disease. Our study describes substantial measurement error that can occur in a common office and home BP measurement scenario: use of a regular cuff size for all individuals regardless of arm size. Many office triage measurements occur without individualized cuff selection and most home BP devices come with one cuff size – and our study shows that using a regular cuff size for people who have larger arms – those who require a large adult cuff or an extra-large adult cuff – can lead to blood pressure readings that are almost 5 and 20 mmHg greater than their actual BP, respectively. Those require a small adult cuff can have BP readings that are almost 4 mmHg lower than their actual BP.
MedicalResearch.com: What should readers take away from your report?
Response: This degree of measurement error can lead to misclassification: with undercuffing, someone with elevated BP (previously termed “prehypertension”) could be labeled as having stage 1 or even stage 2 hypertension. Individuals with an incorrect hypertension diagnosis could experience undue stress, incur expense, undergo unnecessary testing, and receive overtreatment which could lead to side effects and adverse events. Conversely, when a loo-large cuff is used (overcuffing), hypertension could be missed leading to missed opportunity for treatment and prevention of CVD.
It is important not only for health care providers/staff (physicians, nurses, medical assistants) to understand the importance of cuff size on measurement, but it is important for patients to understand the importance as well. When pursuing home blood pressure measurements, in addition to making sure to choose a BP device that has been validated for accuracy (validatebp.org), patients should make sure the device they purchase comes with a cuff that fits their arm.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: Research regarding the availability of cuff sizes in clinical settings and in BP screening settings (health fairs, pharmacies) – ie, is more than one cuff size available? What range of arms sizes do the available cuff sizes fit? – and the degree of misclassification that occurs due to improper measurement technique would add another dimension to the clinical significance of miscuffing.
Additional trials to determine the potential measurement error that occurs when other BP measurement steps are not followed are important to inform future guidelines and help with efforts to streamline screening BP measurements in the clinic and community. Examples include determining the effect of arm position, ambient noise, phone use, feet and back support on BP measurement.
MedicalResearch.com: Is there anything else you would like to add? Any disclosures?
Response: I have no financial disclosures. However, I would like to share that I am co-chair of the American Medical Association’s Validated Device Listing Independent Review Committee (validatebp.org) and co-chair of the Association for the Advancement of Medical Instrumentation (AAMI) Sphygmomanometer Committee.
Citation:
Ishigami JCharleston JMiller ERMatsushita KAppel LJBrady TM. Effects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial. JAMA Intern Med. Published online August 07, 2023. doi:10.1001/jamainternmed.2023.3264
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