A recent study presented at the American Heart Association’s Hypertension Scientific Sessions 2024 has uncovered a significant problem with home blood pressure monitoring devices that could affect millions of Americans. Researchers found that the standard cuffs provided with 10 of the most popular home blood pressure monitors may not properly fit up to 18 million U.S. adults, or nearly 7% of the adult population.
The study, simultaneously published in the journal Hypertension, raises concerns about the accuracy of blood pressure readings for a substantial portion of the population. This issue is particularly alarming given that nearly half of U.S. adults have been diagnosed with high blood pressure, according to the American Heart Association’s 2024 Statistical Update.
Lead researcher Dr. Kunihiro Matsushita, a professor at Johns Hopkins University, stated, ‘We estimate that these one-size cuffs would not properly fit approximately 18 million U.S. adults potentially providing inaccurate blood pressure measures.’ The study found that most of the devices tested had cuffs designed to fit arms with a circumference between 8.7 and 16.5 inches (22 to 42 centimeters).
The research team analyzed data from the National Health and Nutrition Examination Survey (NHANES 2015-2020) and extrapolated their findings to the U.S. Census data. They discovered that 6.7% of U.S. adults, or about 17.3 million people based on the 2023 U.S. Census, have arm circumferences that fall outside the range covered by standard cuffs.
Perhaps most concerning is the disparity in cuff fit among different racial groups. The study found that 11.8% of Black adults would not be able to use these devices properly, compared to 6.6% of white adults, 5.2% of Hispanic adults, and 1.8% of Asian adults. This disparity is particularly troubling given the already high prevalence of hypertension among Black adults.
Dr. Matsushita emphasized the importance of addressing this issue, stating, ‘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 accurate blood pressure monitoring is crucial for managing hypertension and preventing serious health complications such as heart attacks, strokes, and heart failure. The 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults recommends that all people with high blood pressure monitor their blood pressure at home between office visits to help healthcare professionals assess treatment effectiveness.
Paul K. Whelton, M.B., M.D., M.Sc., FAHA, president of the World Hypertension League and chair of the American Heart Association’s 2017 Hypertension Practice Guidelines, commented on the study’s findings. He noted that using an incorrectly sized cuff is more likely to result in overestimation of hypertension rather than underestimation. Dr. Whelton suggested that ‘the best solution is to have cuffs of different sizes available, so a cuff that is of correct size for the patient can be chosen.’
As the medical community and device manufacturers grapple with these findings, it is clear that more attention must be paid to the diversity of body types when designing and marketing home blood pressure monitors. Addressing this issue could lead to more accurate diagnoses and better management of hypertension across all segments of the population, ultimately improving cardiovascular health outcomes for millions of Americans.
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