Arm Circumference, Shape, and Length: How Interplaying Variables Affect Blood Pressure Measurement in Obese Persons

Halm, Margo A.

doi:10.4037/ajcc2014364

Cited by 15 publications

(7 citation statements)

References 21 publications

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“…Accurate BP measurement can be challenging in individuals with obesity. 23,211,212 Elevated BMI in children and adolescents is associated with an increase in the midarm circumference, 96 requiring the use of a larger cuff to obtain accurate BP measurements. 83 During NHANES 2007-2010, among children 9 to 11 years of age with obesity, one-third of boys and one-quarter of girls required an adult BP cuff, and a fraction required a large adult cuff or an adult thigh cuff for an accurate measurement of BP.…”

Section: Measurement In Children With Obesitymentioning

confidence: 99%

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

et al. 2017

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These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.

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Section: Measurement In Children With Obesitymentioning

confidence: 99%

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

et al. 2017

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“…This observation is relevant given that high BP variability and, most of all, elevated prevalence of white-coat hypertension and masked hypertension among obese patients make HBPM a fundamental tool to appropriately define the BP profile in such patients [ 192 , 193 ]. One of the main issues in the management of patients with large arm circumference is the limited availability of properly sized cuffs, which can end up in an overestimation of BP whilst using a standard size cuff [ 194 , 195 ]. Other issues, which may affect accuracy of HBPM include the conical shape of large arms and the combination of large arm circumference with short humerus length [ 196 ] (see also session on cuff size and shape).…”

Section: Special Conditionsmentioning

confidence: 99%

Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension

Parati

Stergiou

Bilo

et al. 2021

Journal of Hypertension

100

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The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.

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“…While the limited range of cuffs according to the MAC has been recognized, the role of arm shape, or conicity, has only recently been addressed in measurement recommendations of the AHA , and it is not incorporated into validation protocols . However, it is increasingly appreciated as a significant problem in clinical practice . The AHA recommendations now support the use of tronco‐conical cuffs in people with cone‐shaped arms .…”

Section: Discussionmentioning

confidence: 99%

Arm Dimensions of Patients with Obesity and Their Experiences with Blood Pressure Measurement: An Observational Study

Ceglowski

Lehane

Chow

et al. 2020

Obesity

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Objective In patients with obesity, it was determined what proportion had an arm slant angle (SA) < 83° and which measure best predicted arm conicity. Patient experience with noninvasive blood pressure measurement was evaluated. Methods Arm SA was calculated from arm measurements. Linear regression determined whether BMI, weight, or right midarm circumference (MAC) best predicted conicity. Patient experiences were evaluated by survey and conventional content analysis of free‐text comments. Results One hundred participants had a median (interquartile range; range) BMI of 44.1 (39.1‐53.1; 31.1‐80.8). Thirty‐three (33%) had a right arm SA < 83°. Seven (7%) had a right MAC outside the recommended range. BMI, weight, and the right MAC showed low correlation with and explained little of the variation (with age and sex adjustment) in right arm SA (r = −0.29, −0.27, −0.31; P = 0.003, 0.007, 0.002; R2 = 0.09, 0.08, 0.10). Forty‐two (42%) reported noninvasive blood pressure measurement caused severe pain, and 30 (30%) reported skin damage. Themes identified in free‐text responses were “problems with equipment,” “feelings and experiences,” and “concerns about accuracy.” Conclusions Current equipment is inadequate for patients with obesity based on MAC and conicity. Pain and skin damage contributed to negative experiences of these patients.

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Arm Circumference, Shape, and Length: How Interplaying Variables Affect Blood Pressure Measurement in Obese Persons

Cited by 15 publications

References 21 publications

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension

Arm Dimensions of Patients with Obesity and Their Experiences with Blood Pressure Measurement: An Observational Study

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