[Oversized patient arms: a problem with blood pressure measurements]

The increase in the worldwide prevalence of obesity systematically leads to a higher number of individuals who may be wrongly diagnosed as hypertensive because their arms are too large for standard blood pressure cuffs, which are ordinarily appropriate in patients with normal sized arms. The aim was to gain real data of upper arm and wrist circumferences in 327 elected subjects with larger arms (upper arm circumference >32.5 cm) from two Bavarian general practices. We found that 93.9% of all patients had an upper arm circumference of a maximum of 41.0 cm and a wrist circumference of at most 20.5 cm. These data were then compared with the approved size ranges of six wrist blood pressure measurement devices, one special three-in-one cuff for different sizes and the two large adult cuffs recommended by the German Hypertension Society. Availability of one large cuff and one wrist blood measurement device (either used at the upper arm or at the wrist depending on patient dimensions) seems to be sufficient. This should allow for true blood pressure readings to be obtained in at least 96% of all patients with arms of more than normal circumference.