Blood pressure readings may be wrong for overweight patients
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7413.468-a (Published 28 August 2003) Cite this as: BMJ 2003;327:468
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Is it okay to use a large cuff on a small arm? Sometimes in
community settings, there are so many large-armed people coming thru the
line that it is easier to just keep the large cuff attached than keep
switching back and forth.
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No surprise the Mexicans are no better serviced by the mercury
sphygmomanometer than is the more developed world[1,2].
Often referred to by sentimentalists and hypertension experts as the
“gold standard” of blood pressure measurement, the mercury
sphygmomanometer acts both as a leaky reservoir of toxic mercury, and of
false reassurance for those doctors and nurses too mean to buy a full set
of arm cuffs. Using the embarrassingly small yet standard cuff, fat arms
are measured with a straight face.
Cachectic arms abound also, especially in hospitals, where starvation
is often therapy, and where presumably busy nurses often use too large yet
"standard" cuffs to arrive at falsely low readings.
Owners of conical short fat arms and their care givers are also
sartorially challenged. Using the correct cuff for these, one finds one
must literally stuff the cuff into the patients ripe arm pit.
Hospital is where doctors and nurses first practice of course, so
they take the bad habits learned there with them. So take with you, dear
reader, your own correct sized and properly laundered cuff, labelled with
your name, to all clinical settings.
1.Dobson R. Blood pressure readings may be wrong for overweight
patients. BMJ 2003;327:468 (30 August)
2.Fonseca-Reyes S, De Alba-Garcia JG, Parra-Carrillo JZ, Paczka-
Zapata JA. Effect of standard cuff on blood pressure readings in patients
with obese arms. How frequent are arms of a 'large circumference'? Blood
Press Monit. 2003 Jun;8(3):101-6.
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I have always remembered my clinical teacher's advice to use appropriate sized cuffs to get an accurate assessment of blood pressure, and this was more than 40 years ago! Have medical schools dropped training in the use of our basic tools?
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As a large person with big arm, I was stunned to find in a large teaching hospital/medical school in the main diabetic clinic large cuffs were not available. I was misdiagnosed with hypertension and put on lisinopril.After I began to feel a bit odd to say the least I insisted on a referral to hypertension nurse specialist who rest assured found my BP normal on many occasions.Amazing how it dropped from 160/110 mmHg to 120/80 mmHg. I took my objections to hospital management and now thankfully all clinics have the right cuffs and staff have been trained by hypertension nurse specialist when and how to use. I was though dismayed when recently attending clinic that a new member of staff attempted to use small cuff and assured me cuff was fine. I objected and was labelled as awkward but fortunately the consultant told the staff not to forget the large cuff again!
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Large cuff is better
Lawrence Kay, writing in the Journal of the American Board of Family
Practice, recommends considering always using a large cuff, as the impact
on measurement is negligible. (He sites Baker RH, Ende J, Confounders of
auscultatory blood pressure measurement, J Gen Intern Med 1995;10:223-31
to indicate that there is a 0-4mmHg underestimation of systolic BP and no
error for diastolic in using a "too-large" cuff.) It's a very nice
article, giving specific numbers for over- & underestimation for a
variety of mistakes in ways of measuring.
Kay, Lawrence E, Accuracy of blood pressure measurement in the family
practice center, J Am Board Fam Pract 11(4):252-258, 1998.
Also avaiable at Medscape:
http://www.medscape.com/viewarticle/417794_print
Competing interests:
None declared
Competing interests: No competing interests