Contributor: Aaron Lessen MD

Educational Pearls:

Does the size of a blood pressure (BP) cuff matter?

A recent randomized crossover trial revealed that, indeed, cuff size can affect blood pressure readings

Design

• 195 adults with varying mid-upper arm circumferences were randomized to the order of BP cuff application:

• Appropriate

• Too small

• Too large

• Individuals had their mid-upper arm circumference measured to determine the appropriate cuff size

• Participants underwent 4 sets of triplicate blood pressure measurements, the last of which was always with the appropriately sized cuff

Results

• In individuals requiring a small cuff, the use of a regular cuff resulted in blood pressure readings 3.6 mm Hg lower than with the small cuff

• In individuals requiring large cuffs, the use of a regular cuff resulted in pressures 4.8 mm Hg higher than with the large cuffs

• In individuals requiring extra-large cuffs, the use of a regular cuff resulted in pressures 19.5 mm Hg higher than with extra-large cuffs

Conclusion

• Miscuffing results in significantly inaccurate blood pressure measurements

• It is important to emphasize individualized BP cuff selection

References

1. Ishigami J, Charleston J, Miller ER, Matsushita K, Appel LJ, Brady TM. Effects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial. JAMA Intern Med. 2023;183(10):1061-1068. doi:10.1001/jamainternmed.2023.3264

Summarized by Jorge Chalit, OMSII | Edited by Jorge Chalit