Popular Home Blood Pressure Monitors May Not Fit Millions of Americans

New research presented at the American Heart Association's Hypertension Scientific Sessions 2024 suggests that millions of Americans may be using ill-fitting blood pressure cuffs at home, potentially compromising the accuracy of their readings. The study, simultaneously published in the journal Hypertension, estimates that standard cuffs on popular home blood pressure monitors may not properly fit up to 18 million U.S. adults – nearly 7% of the adult population.

Researchers analyzed 10 of the most popular blood pressure monitoring devices sold through a major online retailer. They found that nine out of ten devices offered a cuff-size range of 22 to 42 centimeters (8.7 to 16.5 inches) in circumference. By comparing this range to data from the National Health and Nutrition Examination Survey (NHANES) and extrapolating to U.S. Census data, the team concluded that 6.7% of U.S. adults could not use these devices due to arm circumferences falling outside the standard range.

The study revealed a concerning disparity in cuff fit among different ethnic groups. Black adults were found to be the most affected, with 11.8% potentially unable to use standard cuffs, compared to 6.6% of white adults, 5.2% of Hispanic adults, and 1.8% of Asian adults. This disparity is particularly alarming given the already high prevalence of hypertension among Black adults.

Dr. Kunihiro Matsushita, senior study author and professor at Johns Hopkins University, emphasized the importance of addressing this issue: "To increase equity, manufacturers should prioritize the development and affordable sale of blood pressure measuring devices that accommodate arm circumferences greater than 42 centimeters, and health care professionals should measure patients' arm circumferences to help them select an appropriate cuff size when purchasing a home blood pressure device."

The implications of this study are significant, as nearly half of U.S. adults have been diagnosed with high blood pressure, according to the American Heart Association's 2024 Statistical Update. Accurate home monitoring is crucial for managing hypertension and preventing complications such as heart attack, stroke, and heart failure.

The 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults recommends that all individuals with high blood pressure monitor their blood pressure at home between office visits. However, this new research highlights the need for manufacturers and retailers to improve access to diverse blood pressure cuff sizes for consumers.

Dr. Paul K. Whelton, chair of the American Heart Association's 2017 Hypertension Practice Guidelines, commented on the study's findings: "This research found that the number of U.S. adults expected to have an arm size larger than routinely covered by the cuff size provided by the manufacturer (16.5 million) was much larger than the number expected to have an arm size smaller than that routinely covered by the manufacturer (0.8 million). Thus, the use of a routinely sized cuff is far more likely to result in overestimation of hypertension rather than underestimation of hypertension."

As the study highlights the potential for inaccurate blood pressure measurements due to improper cuff sizing, it underscores the need for increased awareness among both consumers and healthcare providers. Ensuring that individuals have access to appropriately sized blood pressure cuffs is crucial for accurate diagnosis and management of hypertension, ultimately contributing to better cardiovascular health outcomes for all Americans.