A recent study has shown that using the wrong blood pressure cuff size can lead to major mistakes when diagnosing high blood pressure.
The findings were shared at the American Heart Association’s 2022 conference focused on heart health and disease prevention.
Dr. Tammy M. Brady from Johns Hopkins University led the study. She explained that accurate blood pressure readings depend on more than just using a machine.
The way a patient sits, how the measurement is taken, and most importantly, the size of the cuff, all make a big difference. Many clinics still use a one-size-fits-all cuff, which this study shows can lead to false readings.
High blood pressure is a serious issue. It raises the risk of heart disease, stroke, kidney problems, and even vision loss. In 2019 alone, over 500,000 deaths in the U.S. were linked to high blood pressure. Nearly half of all U.S. adults have it, but many don’t even know. That’s why checking blood pressure accurately is so important.
The study included 165 adults, average age 55, with about one-third being men and 68% being Black. Each person’s blood pressure was measured using both a regular cuff and a cuff specifically sized for their arm. Participants walked a short distance before sitting quietly for the tests, and three readings were taken with each cuff.
Here’s what the researchers found:
People who needed a small cuff but were measured with a regular cuff had their blood pressure measured too low—by about 3.8 mm Hg for the top number (systolic) and 1.5 mm Hg for the bottom number (diastolic).
People who needed a large or extra-large cuff but were measured with a regular one had readings that were much too high. For those needing an extra-large cuff, the systolic number was overestimated by nearly 20 mm Hg.
That difference can be the line between being told your blood pressure is normal or being diagnosed with stage 2 hypertension, which often leads to treatment with medication.
For example, people in the study who needed an extra-large cuff had blood pressure readings of 143.9/86.5 mm Hg with a regular cuff—high enough to be considered stage 2 hypertension. But when the correct cuff was used, their reading dropped to 124.2/79.1 mm Hg, which is in the normal range.
This means that using the wrong cuff could lead to incorrect treatment for high blood pressure or missing it entirely. In fact, the study showed that using a cuff that is too small could result in 39% of people being wrongly told they have high blood pressure, while a cuff that’s too big could cause 22% of cases to be missed.
Dr. Brady and her team warn that people with larger arms, especially those with obesity, are most at risk of getting wrong results from poorly sized cuffs. She emphasizes that everyone—doctors and patients—should understand the importance of using the right cuff size, whether at a clinic, a pharmacy kiosk, or at home.
Dr. Willie Lawrence of the American Heart Association says that this finding is crucial for community health efforts. Making sure blood pressure is measured correctly is a key part of new national efforts to improve heart health, especially in communities most affected by high blood pressure.
The researchers say that future studies should look at other groups, like children or high-risk adults, to better understand the full impact of cuff size errors.
If you care about blood pressure, please read studies that turmeric and vitamin D may boost blood pressure control in type 2 diabetes and scientists find link between blood pressure drugs and bowel diseases.
For more about blood pressure, please read studies about high blood pressure treatment: ARBs vs. ACE inhibitors and blood pressure response to exercise can predict future heart disease.
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