Hypertension “Epidemic” caused by Wrong Blood Pressure Cuff Size?

As a heavy person, I often find that places which measure blood pressure do not use the proper cuff size.  Using nurse taking blood pressuretoo small a cuff will show hypertension, where none exists.  Given the obesity epidemic, this can be a serious problem.  Many overweight people have hypotension, which may interfere with their exercise, it is important that they be measured carefully, especially when medication is involved.  And this is also very important during pregnancy when fluids can cause swelling but do not always raise blood pressure or cause pre-eclampsia.

Here is a piece written by a colleague who shall remain anonymous:

I can tell you that a frightening number of practitioners do not use protocol as stated.   It was something I was always a stickler about and required my staff to measure arm circumferences for both arms and determine the appropriate cuff size for each arm, and document such in the chart.  (My mother, for example, has one arm that is “normal size” and one arm that is considerably larger, and should require a larger cuff – she didn’t know, and this has been a source of much stress every time she goes for her appointments only to see her bp bouncing all over the place.  As a result, she has also developed white coat “hypertension” through sheer worry and conditioning of stress upon visits.)

I have to laugh that at least in Ohio, we have a department of weights and scales that goes about testing weights and scales used in businesses around every 6 months, but, to my knowledge, no such thing for the calibration and integrity of things such as blood pressure monitoring equipment.  If there is, indeed, an error margin of some 70 (+)% of all diagnosed with hypertension, imagine the market for the meds and ongoing, lifetime doctor visits to “manage hypertension.”

Hypertension is most certainly a serious condition that requires diagnosis an proper management, lest it create lethal organ disease or strokes.  However, I think we have a much bigger epidemic that needs to be revealed for what it is.  I do challenge the idea that all people who gain weight, or qualify as overweight or obese, are walking time bombs with issues such as hypertension, when, in fact, it is more likely that the proper cuff size is not used with size or weight gain, and during weight loss, it may be the arm circumference in relationship to the smaller cuff size, not a measure of improvement in the so-called weight associated “condition.”  The same could be said for those working out to enhance muscle mass in the upper arm, where steroid use or muscle enhancement agents may be blamed.

I have always been very muscular in the upper arms, and, of course, with weight gain also, the circumference has increased with years.  This blood pressure to cuff ratio has been an ongoing issue since I was in my early 20’s, even when I was 100 lbs dripping wet.  God KNOWS my arms are bigger now!!

If you are a practitioner make sure that you have the proper cuff size for your patients and that your blood pressure meter even comes with the correct sizes. Train your staff to check arm size before selecting the cuff. If you are heavy or have very muscular arms, make sure that the doctor or his staff uses the proper size, especially if you have been diagnosed with hypertension or give hypertension medications.

  • For arm circumference of 22 to 26 cm, the cuff should be “small adult” size: 12X22 cm
  • For arm circumference of 27 to 34 cm, the cuff should be “adult” size: 16X30 cm
  • For arm circumference of 35 to 44 cm, the cuff should be “large adult” size: 16X36 cm
  • For arm circumference of 45 to 52 cm, the cuff should be “adult thigh” size: 16X42 cm

And the patient should be sitting, with the arm supported at heart level, with a supported back, without crossing their legs or engaging in conversation.    For standards on blood pressure readings, see govenment standards.
Also see http://articles.mercola.com/sites/articles/archive/2003/09/20/overweight-patients.aspx?

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