Blood pressure measurement: Why one-size-fits-all approach can be bad

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High blood pressure, a major risk factor for heart disease, stroke, and kidney disease, is a leading cause of death in the United States.

Despite its significance, many with high blood pressure are unaware of their condition, making accurate blood pressure measurement vital for both diagnosis and treatment.

A recent study suggests that the conventional one-size-fits-all approach to blood pressure measurement could lead to significant inaccuracies.

The Study

Traditionally, clinical guidelines recommend selecting an appropriate cuff size based on the patient’s mid-arm circumference.

However, most research on cuff size and measurement accuracy has been conducted using mercury sphygmomanometers, which are manually inflated blood pressure monitors that determine blood pressure by listening for arterial sounds through a stethoscope.

In this study, researchers set out to analyze the impact of cuff size on blood pressure readings using automated blood pressure monitors, which are more commonly used today.

The team analyzed the blood pressure readings of 165 adults (average age of 55 years, one-third were male, and 68% were Black adults) using a regular adult-sized cuff and an appropriately sized cuff.


Researchers found that using a regular adult-sized cuff resulted in significantly lower blood pressure readings for those who required a small adult cuff.

Conversely, it resulted in much higher readings for those who required a large or extra-large cuff.

Individuals who needed an extra-large cuff and were measured using a regular cuff were misclassified as having stage 2 high blood pressure.

Similarly, those who needed a small adult cuff and were measured with a regular cuff were misclassified as not having high blood pressure.


These findings suggest that individuals who require a large or extra-large adult cuff size may be at the most risk for misclassification and potential over-treatment in the clinical setting.

The study underscores the importance of appropriate cuff size for accurate blood pressure measurement in office, kiosk, and home settings.

This is particularly significant for communities with a high prevalence of obesity, as accurate cuff sizing may be even more critical in these populations.


The study, conducted by Jeanne Charleston and her team, is a reminder of the need for personalized healthcare.

The one-size-fits-all approach to measuring blood pressure could potentially lead to misdiagnosis, over-treatment or under-treatment, emphasizing the importance of accuracy in blood pressure measurements.

As healthcare providers and patients continue to monitor blood pressure, the correct cuff size should be a critical consideration to ensure precise readings and effective treatment strategies.

If you care about high blood pressure, please read studies about how your eyes could help diagnose high blood pressure, and marijuana may strongly increase death risk in high blood pressure.

For more information about blood pressure, please see recent studies that early time-restricted eating could help improve blood pressure, and results showing plant-based foods could benefit people with high blood pressure.

The study was conducted by Jeanne Charleston et al.

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