Pitfalls of Cuff Size and Blood Pressure Measurement

To the Editor We read with great interest the article by Ishigami et al investigating the association of miscuffing with blood pressure (BP) measurement using automated BP devices. Although these findings are interesting and further contribute to the current knowledge on BP measurement, in the presented analysis the authors did not consider the troncoconical shape of the upper arm, which is frequently observed in the general population, especially in patients with overweight and obesity. The degree of troncoconicity can be mathematically described calculating the conicity index. Indeed, high conicity indices imply the existence of a large gap between the BP cuff and the surface of the distal arm, which may produce an irregular expansion of the cylindrical BP cuff during inflation. Consequently, in patients having a troncoconical shape of the upper arm, the use of cylindrical cuff during automated BP measurements may overestimate both systolic and diastolic BP ( ≥10 and 8 mm Hg, respectively), amplifying the BP measurement error. Therefore, as a general recommendation, troncoconical cuffs should be used for BP measurement in individuals with large and/or troncoconical arms.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research