What does this research mean for the field?

Mid-arm circumference in the US population varies significantly by demographic factors, BMI, and blood pressure status, resulting in a substantial proportion of adolescents and adults requiring large or extra-large blood pressure cuffs for accurate measurement. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 4, 2018Open Access

Mean mid-arm circumference and blood pressure cuff sizes for US children, adolescents and adults

YOYechiam OstchegaPreventive Cardiology JHJeffery P. HughesNational Center for Health Statistics TNTatiana NwankwoCenters for Disease Control and Prevention

Structured PICO

Population

US population aged more than 3 years from the 2011-2016 National Health and Nutrition Examination Survey (n=24,723)

Outcome

Mean mid-arm circumference (mid-AC) and frequency distribution of mid-AC cuffed by Baum and Welch Allyn cuff systems

A significant proportion of the US population requires large or extra-large blood pressure cuffs, highlighting the critical need for appropriate cuff sizing to avoid inaccurate blood pressure measurements.

Abstract

BACKGROUND: Measuring blood pressure (BP) requires an appropriate BP cuff size given measured mid-arm circumference (mid-AC). OBJECTIVE: To provide mid-AC means and percentiles for US population aged more than 3 years and examine the frequency distribution of mid-AC cuffed by Baum and Welch Allyn cuff systems. PATIENTS AND METHODS: The 2011-2016 National Health and Nutrition Examination Survey, a cross-sectional survey, was used to estimate mean mid-AC (n=24 723). RESULTS: Mean mid-AC did not differ from 2011 to 2016 (31.0 vs. 31.3 cm, P>0.05). During 2011-2016, mean mid-AC was greater for males than females (32.0 vs. 30.4 cm, P<0.001) and was largest among adults 40-49 years (34.0 cm). Non-Hispanic Black persons had the largest mean mid-AC (32.0 cm) and non-Hispanic Asian persons the smallest (28.4 cm). Increased BMI was associated with increased mean mid-AC for those 3-19 years (normal, 22.0 cm and obese, 31.5 cm, P<0.001) and more than 20 years (normal, 28.2 cm and obese, 37.8 cm, P<0.001). Among those aged 8-17 years, high BP status was associated with a larger mean mid-AC (normotensive 26.1 cm vs. high BP 28.2 cm, P=0.001). Among adults aged 18 years and older, hypertension status was associated with a larger mean mid-AC (normotensive 32.4 cm vs. hypertensive 34.2 cm, P<0.001). Among those aged 12-19 years, 13.0% required a Baum large cuff (35-46.9 cm mid-AC) and 21.7% required a Welch Allyn large cuff (32-39.9 cm mid-AC). Among those aged more than 20 years, 33.2% required a Baum large cuff, 48.2% required a Welch Allyn large cuff, 1.3% required a Baum extra-large cuff (44-66 cm mid-AC), and 9.5% required a Welch Allyn extra-large cuff (40-55 cm mid-AC). CONCLUSION: Currently, BP is obtained in clinic, pharmacy, home, and ambulatory setting using single or multiple cuffs. National Health and Nutrition Examination Survey mid-AC data should be considered for accurate cuffing avoiding cuff hypertension or hypotension.

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