Key result
Extra-large BP cuffs are required by ~7% of hypertensive adults but cost significantly more than standard devices.
Why the study?
The prevalence and cost implications of extra-large blood pressure cuff need among US adults with hypertension were unknown.
Cross-Sectional
Yes
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This disparity in sizing is particularly concerning given the already high and increasing prevalence of high blood pressure among Black adults. To increase equity, manufacturers should prioritize the development and affordable sale of blood pressure measuring devices that accommodate arm circumferences greater than 42 centimeters, and health care professionals should measure patients' arm circumferences to help them select an appropriate cuff size when purchasing a home blood pressure device.”
“When we buy clothing, we can find sizes medium, large, and extra-large easily. The same could be an option for blood pressure monitor purchases.”
“Many people think measuring blood pressure is simple, but actually, there are many steps that need to be taken to get an accurate reading. One issue is finding the right cuff size for an individual's arm size. If the cuff is too small, it will overestimate a person's blood pressure reading. If it is too large, it will underestimate their blood pressure reading.”
Over 7 million US adults with hypertension require extra-large blood pressure cuffs, which are less available and significantly more expensive, representing a barrier to accurate home blood pressure monitoring.
BACKGROUND: Accurate home blood pressure (BP) monitoring depends on appropriate cuff sizing, but the prevalence and cost implications of extra-large cuff need among US adults with hypertension are unknown. METHODS: Using pooled data from 2017-2023 National Health and Nutrition Examination Survey (NHANES) with survey weighting, we estimated the prevalence of having a mid-arm circumference >43cm among US adults with hypertension, overall and by race/ethnicity. We also categorized home BP monitors listed on the US Validated Device Listing as standard (accommodating arm circumferences from 22-43cm) or extra-large cuff compatible (accommodating arm circumferences >43cm). RESULTS: Approximately 6.6% of US adults with hypertension (∼ 7.2 million individuals) had an arm circumference >43cm. Prevalence was highest among Non-Hispanic (NH) Black adults (11.4%) followed by Other Race/Multiracial (8.2%), NH White (6.2%), Hispanic (5.3%) and NH Asian adults (0.9%). Of the 51 validated devices, only 22 (43.1%) accommodated arm circumferences >43cm. The mean total cost of an extra-large cuff compatible system was 32.7% higher ($99.06 versus $74.70 for standard devices). CONCLUSIONS: More than 7 million US adults with hypertension require an extra-large BP cuff; the substantially higher cost of extra-large cuff-compatible devices represents an important and underrecognized barrier to accurate home BP monitoring.
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Sahoo et al. (2026) conducted a cross-sectional in Hypertension. Mid-arm circumference >43cm vs. Mid-arm circumference 22-43cm was evaluated on Prevalence of mid-arm circumference >43cm. Approximately 6.6% of US adults with hypertension require an extra-large blood pressure cuff, which costs on average 32.7% more ($99.06 vs $74.70) than standard devices.
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