The effect of varying cuff position on recording ankle systolic blood pressure

OBJECTIVE: Ankle brachial pressure index (ABPI) aids the diagnosis of leg ulcer aetiology, although there is potential for patient anxiety or discomfort when the cuff is placed over an ulcerated ankle. This study aimed to ascertain any differences in systolic pressure if the cuff is positioned proximal to the ankle and to determine the feasibility of varying the cuff position to avoid ulcerated areas. METHOD: The systolic blood pressure in the lower limbs of healthy volunteers (n = 60) was measured with the cuff at two discrete sites on the lower limb. RESULTS: There was a statistical difference in systolic blood pressure readings between the two sites (0-4 mmHg; p = 0.02) and a statistically significant ABPI difference (-0.08 to 0.05; p < 0.002). CONCLUSION: Blood pressure recording is subject to considerable variation in clinical practice and the ABPI has to vary by more than 0.15 to be clinically significant. Therefore, the differences in systolic pressure between sites and the ABPI calculations are not clinically significant in this study. An additional finding was that some subjects found the upper cuff position uncomfortable during the procedure.