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Study Reveals “One-Size-Fits-All” Blood Pressure Cuffs Highly Inaccurate

Improperly sized blood pressure cuffs can significantly distort blood pressure readings obtained from automated devices, as highlighted by a recent clinical trial. The study, published in JAMA Internal Medicine, revealed that using standard-sized cuffs instead of cuffs suited to a person’s arm circumference led to “strikingly inaccurate” readings, particularly for those requiring larger cuffs. Many clinics use a one-size-fits-all approach due to convenience, potentially leading to skewed readings that affect the monitoring and treatment of heart conditions. The research emphasized the importance of using correctly sized cuffs to ensure accurate blood pressure measurements, especially in settings with limited resources or at-home monitoring. The trial involved participants in Baltimore and found that using the wrong cuff size resulted in either artificially high or falsely low blood pressure readings, regardless of a person’s existing blood pressure or obesity status.

Dr. Georges Benjamin’s surprise arose when his pre-cataract surgery vitals revealed a sudden spike in his blood pressure. However, a subsequent recheck using the blood pressure machine and his own at-home measurement brought his levels back to an acceptable range. This disparity, it emerged, was unrelated to his heart health. The initial small-sized blood pressure cuff used at the hospital was only replaced upon his request. As a self-described “big guy” and the executive director of the American Public Health Association, Benjamin’s skewed readings were attributed to the undersized cuff.

A recent clinical trial sheds light on the significant impact of incorrectly sized blood pressure cuffs on automated blood pressure devices. Published in the JAMA Internal Medicine journal, the study revealed that utilizing standard-sized cuffs yielded “strikingly inaccurate” readings for patients requiring differently sized cuffs, particularly those needing larger ones. These automated blood pressure devices are widely employed for diagnosing hypertension, a major contributor to global heart disease.

Despite clinical guidelines advocating cuff sizes corresponding to a person’s arm circumference, the prevalence of employing only regular-sized cuffs is noticeable. Health care providers often hesitate to switch cuff sizes due to inconvenience, potentially leaving patients with inaccurate readings. The scarcity of appropriate-sized cuffs, malfunctioning equipment, and a lack of attention to detail contribute to this issue.

Even in community health centers and resource-limited clinics, only regular-sized cuffs may be available, and many at-home blood pressure monitors offer just one cuff size. This one-size-fits-all approach distorts blood pressure measurements, impeding accurate monitoring and treatment of heart conditions.

Dr. Tammy Brady, an associate professor of pediatrics at Johns Hopkins University and a study author, expressed concern about children referred for hypertension assessment, often measured with improperly sized cuffs. Her experience revealed significantly lower blood pressure measurements compared to referral values.

In the randomized trial involving 195 participants in Baltimore, appropriately-sized cuffs were selected based on arm measurements. After a brief period of walking, blood pressure readings were taken using three different cuff sizes: regular, fitted, and improperly sized. The study found that using a regular cuff on patients requiring smaller cuffs resulted in consistently low readings, while those needing larger cuffs received erroneously high readings, with larger errors than those needing smaller cuffs.

In essence, using a cuff smaller than recommended led to artificially high blood pressure readings, while larger cuffs yielded falsely low readings. These inaccuracies were consistent regardless of a person’s existing blood pressure or obesity status, according to the report.