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Using one-sized blood pressure cuff can lead to inaccurate readings

A new study found using only one size of a blood pressure cuff for any and all patients could lead to highly inaccurate readings.
Using one-sized blood pressure cuff can lead to inaccurate readings
Posted at 5:36 PM, Aug 07, 2023

The blood pressure cuff typically used by your doctor could be giving you a wrong result, according to a new report.

The study published in JAMA Internal Medicine Monday found using a one-size-fits-all blood pressure cuff regardless of a patient's mid-upper arm circumference resulted in "strikingly inaccurate" measurements with an automated device, particularly in people who needed larger cuffs.

Though clinical practice guidelines recommend health care professionals select appropriately sized cuffs for each individual, the trial notes this step is often overlooked in blood pressure measurement due to time and resource restraints. This prompts health professionals to routinely use a regular adult cuff for all patients even though there are four sizes, small to extra-large. A regular cuff is also often the only size that comes in at-home blood pressure measurement devices.

The study also notes that statistics compiled by the National Health and Nutrition Examination Survey revealed a regular cuff was suitable for only 51% American adults, and 40% would require a large cuff. This is particularly important since the trial found those who required a larger cuff but were measured with the regular size, like many of those using at-home devices, would have an overestimated result.

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An accurate blood pressure reading is vital to diagnose and treat hypertension, which is the leading cause of heart disease. The only way to detect hypertension is through blood pressure measurement, as it's diagnosed if a person's blood pressure measures 140/90 mmHg or higher on two different days, according to the World Health Organization. The risk of hypertension is higher through genetics, older age, obesity and other markers.

The 195 adults involved in the newly published study had all different markers, including older age and health concerns like hypertension. 

All had their right arm measured using three different cuffs in random order: Too small, too large and an appropriate size. The regularly used cuff was always used, but it could've been too small, too large or appropriately sized depending on the person.

The results found those who needed a smaller cuff but were measured using a regular sized one had statistically significant lower readings, and those who needed a larger cuff had statistically significant higher readings.

"With misdiagnosis to this degree comes additional, likely unnecessary, clinical testing (laboratory and imaging) and treatment, leading to increased cost, psychosocial harm, and risk for adverse events," the study said.

These findings renew the emphasis on individualized cuff selection, both in and out of a clinical setting.

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