title: Impact of cuff positioning on blood pressure measurement accuracy: may a specially designed cuff make a difference?
abstract: During blood pressure (BP) measurement, the recommended positioning of the cuff bladder center is directly above the brachial artery. We investigated the relevance of incorrect cuff positioning during (1) auscultatory measurement with an appropriate or improperly small cuff and (2) oscillometric measurement with a wide-range cuff designed to guarantee accurate measurements regardless of position. In subjects with wide BP and arm circumference ranges, (1) auscultatory BP was repeatedly measured with a properly positioned cuff (reference) and, simultaneously, with an identical cuff placed on the other arm in either a correct or an incorrect position (test). The measurements were performed with a properly sized (N=57) or an improperly small cuff (N=33). (2) Auscultatory measurements obtained with a properly positioned and sized cuff were compared with oscillometric measurements obtained with a specially designed wide-range cuff (Omron IntelliWrap) placed on the contralateral arm either in a correct or an incorrect position. Auscultatory BP measures were unaffected by incorrect positioning of a properly sized cuff, whereas with undercuffing, BP was overestimated with the cuff displaced by 90° laterally (systolic/diastolic BP differences: 4.9±4.6/4.0±4.6 mm Hg, P<0.01) or by 180° (3.9±5.4/4.2±5.1 mm Hg, P<0.01) in relation to the correct position. Incorrect placement of the oscillometric cuff had no significant effect on the accuracy of the measurements (difference with correct position <1.5 mm Hg). Incorrect cuff positioning introduces a systematic overestimation of auscultatory BP when the cuff is too small in relation to arm circumference but not when it is correctly sized. No systematic error was observed with oscillometric measurements obtained with a specially designed wide-range cuff.
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.|Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Bilo
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.|Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Oscar
authors.initials: O
authors.lastname: Sala
authors.affiliation: Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Perego
authors.affiliation: Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Faini
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.|Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.|Department of Cardiology, Peking University First Hospital, Beijing, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.|Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Kraków, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Głuszewska
authors.affiliation: Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Juan Eugenio
authors.initials: JE
authors.lastname: Ochoa
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.|Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Pellegrini
authors.affiliation: Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Laura Maria
authors.initials: LM
authors.lastname: Lonati
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.|Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
mesh_terms: D000328:Adult; D000368:Aged; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019722:Sphygmomanometers; D055815:Young Adult