Impact of cuff positioning on blood pressure measurement accuracy: may a specially designed cuff make a difference?
Open accessAbstract
During blood pressure (BP) measurement, the recommended positioning of the cuff bladder center is directly above the brachial artery. We investigated the relevance of incorrect cuff positioning during (1) auscultatory measurement with an appropriate or improperly small cuff and (2) oscillometric measurement with a wide-range cuff designed to guarantee accurate measurements regardless of position. In subjects with wide BP and arm circumference ranges, (1) auscultatory BP was repeatedly measured with a properly positioned cuff (reference) and, simultaneously, with an identical cuff placed on the other arm in either a correct or an incorrect position (test). The measurements were performed with a properly sized (N=57) or an improperly small cuff (N=33). (2) Auscultatory measurements obtained with a properly positioned and sized cuff were compared with oscillometric measurements obtained with a specially designed wide-range cuff (Omron IntelliWrap) placed on the contralateral arm either in a correct or an incorrect position. Auscultatory BP measures were unaffected by incorrect positioning of a properly sized cuff, whereas with undercuffing, BP was overestimated with the cuff displaced by 90° laterally (systolic/diastolic BP differences: 4.9±4.6/4.0±4.6 mm Hg, P<0.01) or by 180° (3.9±5.4/4.2±5.1 mm Hg, P<0.01) in relation to the correct position. Incorrect placement of the oscillometric cuff had no significant effect on the accuracy of the measurements (difference with correct position <1.5 mm Hg). Incorrect cuff positioning introduces a systematic overestimation of auscultatory BP when the cuff is too small in relation to arm circumference but not when it is correctly sized. No systematic error was observed with oscillometric measurements obtained with a specially designed wide-range cuff.
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The clinical application and accuracy of HBPM may be limited by conditions related to the individual, the procedure, the oscillometric technique, or cuff-related issues.
“the clinical application and the accuracy of HBPM may be limited by certain conditions related either to the individual [63–66], to the procedure itself [4,67], to the oscillometric technique for BP measurement or to cuff-related issues [4,65,68–74].”
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Background
- Authors
- Bilo, G., Sala, O., Perego, C., Faini, A., Gao, L., Głuszewska, A., Ochoa, J. E., Pellegrini, D., Lonati, L. M., & Parati, G.
- Affiliations
- IRCCS Istituto Auxologico Italiano (IT)
- Peking University First Hospital (CN)
- Jagiellonian University (PL)
- Corresponding author
- Parati, Gianfranco
- ORCID
- Venue
- Hypertension Research
- Published
- 2017-01-12
- Volume
- 40
- Issue
- 6
- Pages
- 573-580
- ISSN
- 0916-9636 (ISSN-L)
- 1348-4214
- PMC
- PMC5506235
- OpenAlex
- W2575424177
- Cited by
- 43
- References
- 35
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 9 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 6 · 2019: 6 · 2018: 1 · 2017: 3
- FWCI
- 3.39
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Hypertension Research (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion, cc-by-nc-sa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- blood pressure measurement, cuff size, auscultatory blood pressure, oscillometric blood pressure, brachial artery, arm circumference, measurement accuracy
- MeSH terms
- Adult, Aged, Blood Pressure Determination, Female, Humans, Male, Middle Aged, Sphygmomanometers, Young Adult
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