To obtain a reliable blood pressure (BP) measurement, several methodological requirements have to be satisfied. Conditions for optimal BP measurement include [1]:(1) Full explanation of the procedure and proper patient’s education. (2) Correct attitude of patient and observer. (3) Correct posture of the patient. (4) Arm support. (5) Arm position at heart level. (6) Proper arm selection. (7) Selection of cuff and bladder of adequate size. Among these requirements, choice of an appropriate cuff and bladder size is an essential prerequisite for accurate BP assessment. In fact, use of cuffs containing bladders of inappropriate dimension is the source of substantial measurement errors, which may lead to misclassification of patients’ BP levels in clinical practice (Table 1) [2]. Undercuffing is responsible for a spurious overestimation of BP in patients with large arms leading to overdiagnosis of hypertension, whereas overcuffing (that is, use of relatively large cuffs with small arms), may be responsible for an opposite problem, leading to erroneous underestimation of BP levels. Thus, the inflatable rubber bladder should be long enough to match the arm circumference and should be contained within an inelastic cloth, the full length of which should extend beyond the end of the inflatable bladder [1,2]. Most guidelines recommend a bladder width and length of 40 and 80% of arm circumference, respectively [3–5]. These recommendations are often neglected by healthcare professionals because they imply availability of cuffs of different size and require measurement of arm circumference to be routinely implemented in clinical practice [1,5]. To overcome these problems, several procedures and a few technical solutions have been proposed [1,5], but for reasons of cost and practicality none have become popular.Among them, correction formulae have been suggested to adjust for measurement errors, a procedure which has the disadvantage of further complicating the measurement of BP in a clinical setting.
Palatini, P., Parati, G. (2011). Blood pressure measurement in very obese patients: a challenging problem. JOURNAL OF HYPERTENSION, 29(3), 425-429 [10.1097/HJH.0b013e3283435b65].
Blood pressure measurement in very obese patients: a challenging problem
PARATI, GIANFRANCO
2011
Abstract
To obtain a reliable blood pressure (BP) measurement, several methodological requirements have to be satisfied. Conditions for optimal BP measurement include [1]:(1) Full explanation of the procedure and proper patient’s education. (2) Correct attitude of patient and observer. (3) Correct posture of the patient. (4) Arm support. (5) Arm position at heart level. (6) Proper arm selection. (7) Selection of cuff and bladder of adequate size. Among these requirements, choice of an appropriate cuff and bladder size is an essential prerequisite for accurate BP assessment. In fact, use of cuffs containing bladders of inappropriate dimension is the source of substantial measurement errors, which may lead to misclassification of patients’ BP levels in clinical practice (Table 1) [2]. Undercuffing is responsible for a spurious overestimation of BP in patients with large arms leading to overdiagnosis of hypertension, whereas overcuffing (that is, use of relatively large cuffs with small arms), may be responsible for an opposite problem, leading to erroneous underestimation of BP levels. Thus, the inflatable rubber bladder should be long enough to match the arm circumference and should be contained within an inelastic cloth, the full length of which should extend beyond the end of the inflatable bladder [1,2]. Most guidelines recommend a bladder width and length of 40 and 80% of arm circumference, respectively [3–5]. These recommendations are often neglected by healthcare professionals because they imply availability of cuffs of different size and require measurement of arm circumference to be routinely implemented in clinical practice [1,5]. To overcome these problems, several procedures and a few technical solutions have been proposed [1,5], but for reasons of cost and practicality none have become popular.Among them, correction formulae have been suggested to adjust for measurement errors, a procedure which has the disadvantage of further complicating the measurement of BP in a clinical setting.
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