One size does not fit all: universal cuff overestimates oscillometric blood pressure in persons with large arm circumference

Abstract

Objective

Some brachial cuffs for oscillometric blood pressure (BP) measurement are claimed to cover a wide range of upper-arm circumferences; however, their validation is rarely conducted. Our aim was to compare oscillometric BP measurements obtained with a universal cuff with those obtained with an appropriately sized cuff.

Methods

We utilised the Microlife B6 Connect monitor, conducting oscillometric BP measurements in a random sequence with both a universal cuff (recommended for arm circumferences from 22 to 42 cm) and an appropriately sized cuff (medium for circumference 22–32 cm and large for 32–42 cm). We included 91 individuals with an arm circumference of 22–32 cm and 64 individuals with an arm circumference of 32–42 cm.

Results

For arm circumferences > 32 cm, systolic and diastolic BP measured with the universal cuff was higher than that measured with the large cuff (systolic 6.4 mmHg, 95% confidence interval [CI]). 3.9–8.8, diastolic 2.4 mmHg, 95%CI, 1.2–3.7, p < 0.001 for both). Overestimation of BP with the universal cuff was statistically significant after correcting for the sequence of measurements. No statistical difference was found between the universal cuff and medium cuff for circumferences in the 22–32 cm range. The bladder size in the universal cuff matched the dimensions of the medium-sized cuff; however, the cuff was larger.

Conclusion

Overestimation of BP measured with a universal cuff in persons with large arm circumferences is clinically important. It poses the risk of unnecessary initiation or intensification of antihypertensive medication in persons using the universal cuff.

PLAIN LANGUAGE SUMMARY

What is the context?

• Clinical guidelines recommend individualisation of the size of the cuff used for blood pressure measurement according to the circumference of the upper arm.

• Many blood pressure monitors are sold with a single “universal” cuff claimed to cover a wide range of upper arm sizes.

• We compared blood pressure obtained with the Microlife B6 Connect monitor and a “universal” cuff with the results obtained with individual sized cuffs (medium size for arm circumference between 22 and 32 cm and large size for arm circumference between 32 and 42 cm).

What is new?

• In persons with large upper arm circumference is the systolic blood pressure 6.4 mmHg higher and the diastolic blood pressure 2.4 mmHg higher with the universal cuff than with the individual-sized large cuff.

What is the impact?

• The universal cuff overestimates blood pressure in persons with large arm circumference.

Keywords:

• Cuff size
• bladder size
• blood pressure measurement
• oscillometry
• arm circumference

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Correction

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Clinic, Education and Research Community for Optimising Patient Pathways at Central Denmark Regional Hospitalat Central.