title: Impact of miscuffing during home blood pressure measurement on the prevalence of masked hypertension.
abstract: BACKGROUND
  Masked hypertension has been associated with obesity. However, because most studies do not mention the specific cuff size used for home measurements, masked hypertension prevalence may have been overestimated in obese patients because of undersized cuffs. In this prospective, observational study, the effect of miscuffing on hypertension status was evaluated in patients with large arms.
  
  
  METHODS
  Fifty-three patients with an upper-arm circumference >33cm, undergoing treatment for mild-to-moderate hypertension, took 2 sets of home blood pressure (BP) measurements (standard vs. large cuff) using the validated Microlife BP A100 Plus automated device.
  
  
  RESULTS
  Mean BP was 143/85mm Hg at the office using a large cuff, 141/84mm Hg at home using a standard cuff, and 134/80mm Hg at home using a large cuff. Standard vs. large cuff home BP mean differences were 6.9mm Hg (95% confidence interval (CI) = 4.7-9.2; P < 0.0001) for systolic BP and 4.0mm Hg (95% CI = 2.4-5.5; P < 0.0001) for diastolic BP. Hypertension status differed significantly between standard vs. large cuffs: sustained hypertension (56.6% vs. 41.5%, respectively; P = 0.002), controlled hypertension (20.8% vs. 28.3%, respectively; P = 0.04), white coat hypertension (7.5% vs. 22.6%, respectively; P = 0.002), masked hypertension (15.1% vs. 7.5%, respectively; P = 0.04).
  
  
  CONCLUSIONS
  In patients with large arms, use of an appropriately sized large cuff for home BP measurements led to a 2-fold reduction in masked hypertension. Regarding clinical and epidemiological implications, future studies investigating masked hypertension should specify cuff size for home BP measurements. The low market availability and increased cost of large cuffs should also be addressed.
authors.affiliation: Excellence Center for Hypertension, CHU Avicenne, AP-HP, Bobigny, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Mourad
authors.forename: Marilucy
authors.initials: M
authors.lastname: Lopez-Sublet
authors.forename: Sola
authors.initials: S
authors.lastname: Aoun-Bahous
authors.forename: Frédéric
authors.initials: F
authors.lastname: Villeneuve
authors.forename: Olivier
authors.initials: O
authors.lastname: Jaboureck
authors.forename: Caroline
authors.initials: C
authors.lastname: Dourmap-Collas
authors.forename: Thierry
authors.initials: T
authors.lastname: Denolle
authors.forename: Jacques
authors.initials: J
authors.lastname: Fourcade
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Baguet
mesh_terms: D000368:Aged; D001132:Arm / Q000033:anatomy & histology; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D059468:Masked Hypertension / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D059466:White Coat Hypertension / Q000175:diagnosis
keywords: blood pressure; blood pressure determination; cuff size; diagnostic errors; hypertension; isolated clinic hypertension; masked hypertension; obesity; white coat hypertension.