Extra-Large Blood Pressure Cuff Need and Cost Burden in United States Adults with Hypertension

Accurate home blood pressure (BP) monitoring depends on appropriate cuff sizing, but the prevalence and cost implications of extra-large cuff need among US adults with hypertension are unknown.

Using pooled data from 2017-2023 National Health and Nutrition Examination Survey (NHANES) with survey weighting, we estimated the prevalence of having a mid-arm circumference >43cm among US adults with hypertension, overall and by race/ethnicity. We also categorized home BP monitors listed on the US Validated Device Listing as standard (accommodating arm circumferences from 22-43cm) or extra-large cuff compatible (accommodating arm circumferences >43cm).

Approximately 6.6% of US adults with hypertension (∼ 7.2 million individuals) had an arm circumference >43cm. Prevalence was highest among Non-Hispanic (NH) Black adults (11.4%) followed by Other Race/Multiracial (8.2%), NH White (6.2%), Hispanic (5.3%) and NH Asian adults (0.9%). Of the 51 validated devices, only 22 (43.1%) accommodated arm circumferences >43cm. The mean total cost of an extra-large cuff compatible system was 32.7% higher ($99.06 versus $74.70 for standard devices).

More than 7 million US adults with hypertension require an extra-large BP cuff; the substantially higher cost of extra-large cuff-compatible devices represents an important and underrecognized barrier to accurate home BP monitoring.