Please Help, Blood Pressure measurements and arm size

[Rivet]

I went to get my blood pressure taken by my new Doctor and it came out pretty high. What I'm wondering is does arm size affect the reading? Do most MD's just use a standard cuff for Hmm 7-13inch arms? Or are they one size fits all. I'm asking this because I was worried and bought my own automatic machine (I know not as good as the real thing). I had to pay extra to get a cuff to fit my arm (size large). I tried out the small cuff but it has measurements all around it and says "use size large" when I have it wrapped around. When I use it it gives me pretty close to the same reading as I got at the Drs. Now when I used the large arm cuff the readings are 30-40pts lower. Before this I have never had my BP tested. Is it supposed to hurt a little bit when having it done? Cuz it hurt a bit when the Dr did it and when I use my small cuff.

I tried asking this over the phone with a nurse over at my dr's office and she basically treated me like i was full of s**t

 

[jas123]

I've seen two at my doc's. One is the 9-13 and one goes up to 16. Still doesn't seem big enough. I've measured mine the machines at a pharmacy before with the 9-13 ones, and it always read really high and felt dangerously tight for a while.

 

[prld2gr8ns]

Yeah it could... the whole point of the cuff routine is to cut off full circulation to the lower portion of the arm i.e giving it a certain amount of pumps to achieve correct tightness and adequate blockage, followed by a slow pressure release(and thus blood release) in which the point at of the thud and thump can be heard(systolic and dystolic). If your arm is big and your cuff is small using the same pressure system could give higher readings based on it's mechanism of action, causing more pressure to build up.

 

[Rivet]

Well after reading google groups for quite a while, It does seem that arm size does play a major role in the readings. Saw a lot of posts on people who have larger then avg(12-13'') arms and getting high readings until they requested a large size arm cuff and then getting healthy readings. There was even one post about a guy who was put on meds and they made him Ill, he gave up on them went back in and requested a large arm band only to find out he had healthy BP. Now how do I request a larger large cuff size (usually only used on obese people) , they treated me like **** when I mentioned this over the phone. Just watch I request a size large cuff which insults the Dr then I have to defend my point only to have my BP go up with this right before getting a reading...

 

[Rivet]

I found my solution. I printed out this article written by 3 Doctors (with plenty of references) that talks about the problem I had with my BP reading. Highlighted all the import stuff. I bet he will still be insulted...


Miscuffing: inappropriate blood pressure cuff application -- Manning et al. 68 (4): 763 -- Circulation



I suggest almost everyone here who has been diagnosed with high BP using a "standard" sized cuff get checked out with a size large (or bigger)

 

[machine528]

I have white coat hypertension the way it is. I have very high blood pressure when they do not use the right cuff. Even when they do use the larger cuff my blood pressure is still in the low range of high blood pressure.

 

[Rivet]

I have white coat hypertension the way it is. I have very high blood pressure when they do not use the right cuff. Even when they do use the larger cuff my blood pressure is still in the low range of high blood pressure.

The nurse pretty much told me over the phone that my home Blood Pressure machine wasn't accurate at all. She would not listen to me at all on the Arm size issue. No matter what I do with the Standard cuff it comes out almost always the same number. Now when I use the properly fitting cuff I can have a cup of coffee then go out for a quick sprint then take my BP and still have it MUCH lower then what the Dr's standard sized cuff and what my size "medium" cuff says. I'm really hoping he doesn't want to start a debate even after I show him the article because I'm just going to walk out...

On another note this all started because I needed a physical for work reasons. I need to be withing a certain amount of good health for something. Now I find out most of the readings written down on this physical are wrong. I didn't check until after I had sent out my physical sheets.


Ok they got my weight right at 198

But then the use a standard cuff and get my BP almost 30-40pts higher then it should.

THEN I find out my height was done in inches so I didnt pay much attention to it. Only to convert it to feet later on to find out I'm written down as 5' 7 (I'm 6').

So to the officer getting this physical I'm short, fat and hypertensive....:blink:

 

[machine528]

LOL dont worry about it to much. Like i said my bp was very high.. there were alot of variables though. Biggest one was that my doctors appointments were always late in the day. So i was always stressed out, i always had worked out prior to going, always had tons of caffeine in me and they always used the wrong sized cuff. I went for my physical to get into my police department and they took me in first thing in the morning on an empty stomach. They used the right sized cuff and my blood pressure was almost to low !! I was amazed

 

[sdmf45]

same problem here. i went to the doctor and my bp was 192/110. the velcro on the cuff tore off and the cuff opened and she tightend it again and i said do you have a bigger cuff and she said ya but its for heavy ppl, i said ok but my arm is too big for this one so she put the other cuff on and it was for a 17 in arm and did the same thing.

so then the doc tells me i should go on blood pressure medication by reading what she wrote down. i said i won't take it cause i know my blood pressure is fine, you just need a bigger cuff and finally he agreed. so they use the leg cuff on my arm now.

 

[Rivet]

ya but its for heavy ppl, i said ok but my arm is too big for this one so she put the other cuff on and it was for a 17 in arm and did the same thing.

All the studies, articles and reports I have seen on "miscuffing" are usually for obese people. I don't get the "for heavier people" thing a large arm is a large arm...

 

[Trauma1]

Yeah it could... the whole point of the cuff routine is to cut off full circulation to the lower portion of the arm i.e giving it a certain amount of pumps to achieve correct tightness and adequate blockage, followed by a slow pressure release(and thus blood release) in which the point at of the thud and thump can be heard(systolic and dystolic). If your arm is big and your cuff is small using the same pressure system could give higher readings based on it's mechanism of action, causing more pressure to build up.

yeah your pretty much right on here....a cuff that is too big will give a person a false low b/p reading, and a cuff that is too small will give a person a false high b/p reading. In all actuality, nothing is substitute for a manual b/p done with the correct size cuff taken by a qualified professional. You would not believe how inaccurate automatic b/p machines truly are......i see this evinced in my job everyday.

 

[Rivet]

yeah your pretty much right on here....a cuff that is too big will give a person a false low b/p reading, and a cuff that is too small will give a person a false high b/p reading. In all actuality, nothing is substitute for a manual b/p done with the correct size cuff taken by a qualified professional. You would not believe how inaccurate automatic b/p machines truly are......i see this evinced in my job everyday.

Now all I need is to get my Dr to use the right sized cuff. When you say inaccurate do you mean its no where near the same or just 10pts off or so ?

 

[Trauma1]

Now all I need is to get my Dr to use the right sized cuff. When you say inaccurate do you mean its no where near the same or just 10pts off or so ?

If the right sized cuff is used on a "quality" purchased automatic b/p machine it can get within 10mmhg(systolic/diastolic)of a properly taken manual b/p. I can't tell you how many times i've had people come through the er complaining that their b/p was high because their archaic machine at home said so....only to find out it couldn't have been more normal.

 

[Rivet]

If the right sized cuff is used on a "quality" purchased automatic b/p machine it can get within 10mmhg(systolic/diastolic)of a properly taken manual b/p. I can't tell you how many times i've had people come through the er complaining that their b/p was high because their archaic machine at home said so....only to find out it couldn't have been more normal.

I'm going to bring mine in with me and if it doesn't put my Dr in a bad mood I'm going to ask him to let me use mine then verify with his (with the right sized cuff)