title: The changing distribution of arm circumferences in NHANES III and NHANES 2000 and its impact on the utility of the 'standard adult' blood pressure cuff.
abstract: BACKGROUND
  Accurate blood pressure measurement is dependent on using a blood pressure cuff that is appropriate to the patient's arm circumference.
  
  
  OBJECTIVE
  This study identifies the change in distribution of arm circumferences in the United States and its impact on usage of the 'standard adult' cuff.
  
  
  METHODS
  The most current National Health and Nutritional Examination Survey (NHANES) data, available on the website (http://www.cdc.gov/nchswww/nchshome.htm), covers NHANES III (Cycle 1, 1988-1991; 8381 subjects and Cycle 2, 1991-1994; 8566 subjects) and NHANES 2000 (1999-2000; 4,444 subjects). The weighted change in arm circumference between NHANES III as a whole and NHANES 2000 was calculated. Correlates for increased arm circumference were obtained via multivariate analysis. The predicted change in blood pressure cuff usage based on the changing prevalence of arm circumferences was calculated.
  
  
  RESULTS
  The mean arm circumference for the whole population increased significantly from NHANES III to NHANES 2000 (31.83 +/- 0.08 cm versus 32.86 +/- 0.15 cm, p < 0.001) and in the hypertension population without reaching statistical significance (33.07 +/- 0.16 to 33.61 +/- 0.30 cm, p = 0.11). When adjusted regressions were performed, the increases in arm circumference were due to increasing weight in both the whole population and the hypertensives. The numbers of Americans predicted to require the 'standard adult' cuff to accurately measure blood pressure decreased from 76.2% to 66.3% while the number of Americans increased from 42.2% to 45%.
  
  
  CONCLUSIONS
  The increasing prevalence of overweight and obese Americans found in NHANES III and NHANES 2000 has led to larger mean arm circumferences in hypertensives and the total population. This increased frequency of larger arm circumferences predicts that the 'large adult' cuff will be increasingly required in clinician's offices for accurate blood pressure measurement.
authors.affiliation: Division of Hypertension, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. graves.john@mayo.edu
authors.forename: John W
authors.initials: JW
authors.lastname: Graves
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.forename: Sheldon G
authors.initials: SG
authors.lastname: Sheps
mesh_terms: D000328:Adult; D001132:Arm / Q000033:anatomy & histology*; D001795:Blood Pressure Determination / Q000379:methods* / Q000639:trends; D006306:Health Surveys; D006801:Humans; D009316:National Institutes of Health (U.S.); D014481:United States