Effect of Cuff Design on Auscultatory and Oscillometric Blood Pressure Measurements.
Two-piece blood pressure (BP) cuffs are the historical cuff standard. Use of 1-piece cuffs is increasing. Substituting 1-piece for 2-piece cuffs has an unknown effect on measurement accuracy. We compared these cuff types in a 2-phase study using auscultatory and oscillometric techniques.



Consenting subjects (aged ≥18 years) with BP levels between 80 and 220mm Hg/50 and 120mm Hg and arm circumferences between 25 and 43cm were studied using the International Standards Organization (ISO) 2013 protocol (modified). A Baum 2-piece cuff was used as the reference standard. A 1-piece Welch Allyn cuff was the comparator. In phase 1 (2-observer auscultation with a mercury sphygmomanometer), 88 subjects were required to obtain 255 paired BP determinations. In phase 2 (oscillometric measurement with a Spacelabs 90207 device), 85 subjects were studied. Each phase was analyzed separately using paired t-tests.



Phase 1 mean age was 54.2±20.5 years, mean arm circumference was 29.9±3.7cm, 60% were female, and 32% had hypertension. One-piece cuff mean BPs were lower than the 2-piece cuff means (115.5±15.5/66.4±9.3 vs. 117.8±15.2/67.9±9.2; difference of -2.4±3.6/-1.5±2.4; P values <0.0001 for systolic and diastolic comparisons). Phase 2 mean age was 52.8±20.8 years, mean arm circumference was 29.4±3.9cm, 67% were female, and 38% had hypertension. Mean BPs were lower for the 1-piece compared to the 2-piece cuff (116.5±12.8/67.1±8.1 vs. 120.8±13.5/70.4±8.5; difference of -4.4±3.6/-3.3±2.7; P values <0.0001 for both).



Mean BP is lower with 1-piece cuffs vs. 2-piece cuffs. Differences are greater with oscillometry. When performing validation studies and measurements for clinical purposes, cuff type should be taken into account.
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada;
Jennifer S
JS
Ringrose
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada;
Donna
D
McLean
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada;
Peter
P
Ao
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada;
Farahnaz
F
Yousefi
College of Pharmacy, Qatar University, Doha, Qatar;
Sowndramalingam
S
Sankaralingam
AccurateBloodPressure.com , Beaverton, Oregon, USA;
Jack
J
Millay
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada. rpadwal@ualberta.ca.
Raj
R
Padwal
D000328:Adult; D000368:Aged; D001314:Auscultation; D001795:Blood Pressure Determination / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009991:Oscillometry; D019722:Sphygmomanometers; D055815:Young Adult
auscultatory; blood pressure measurement; cuff design; cuff type; hypertension; oscillometric.