Arm circumference in adults in Poland as an important factor influencing the accuracy of blood pressure readings

AIMS: The aim of this study was to assess the distribution of right arm circumference (RAC) in adults in Poland and to establish how often other than standard cuffs should be used in everyday practice. We also wanted to examine whether large cuffs are available in the market in Poland and whether the cuffs comply with WHO and JNC VII recommendations. MATERIAL AND METHODS: In 2002, we conducted a cross-sectional representative survey NATPOL PLUS to examine prevalence and control of cardiovascular risk factors in Poland. The survey included a questionnaire interview, blood pressure (BP) and anthropometric measurements, as well as laboratory tests. The examined representative sample of adults in Poland consisted of 3051 men and women aged 18-94 years. The measurements of RAC were performed in all respondents. Arterial hypertension (AH) diagnosis was based on three separate visits (BP > or =140/90 mmHg or treatment). Subjects with body mass index (BMI) > or =25 kg/m were included to overweight/obese group. RESULTS: The prevalence of AH was 29% and of overweight or obesity, 52%. In 24% of all adults RAC was > or = 32 cm, and in 6% was < 24 cm. In hypertensives, the respective figures were 36 and 3%; and in overweight/obese subjects 40 and 0.6%. Mean RAC was 29.2+/-3.8 cm (males 30.2+/-3.5 cm; females 28.3+/-3.9 cm, P<0.001). Mean RAC was significantly greater (P<0.01) in patients with AH (30.4+/-3.9 cm; males 30.7+/-3.5 cm; females 30.2+/-3.8 cm) than in normotensive subjects (28.4+/-3.7 cm; males 29.9+/-3.4 cm; females 27.3+/-3.5 cm). However, these differences were not statistically significant when the results were adjusted for age and BMI. Additional analysis of sphygmomanometers available in Poland showed that parameters of standard cuffs fulfilled recommendations of JNC VII and WHO/ISH guidelines. However, the sets with large cuffs were usually much more expensive and only one manufacturer made them available as a special order. CONCLUSIONS: One-third of adults in Poland have an arm circumference, which requires use of a 'non-standard' sized cuff. Moreover, in patients with AH or overweight/obese subjects, wider or narrower cuffs should be used in approximately 40% of subjects.