Quantifying variation in blood pressure measurement through different arm cuffs and estimating its impact on diagnosis of hypertension at community level

Aims: The aim of this study was to analyze does the difference in blood pressure (BP) measured by different arm cuffs has a clinical/diagnostic implication? Settings and Design: This study was a cross-sectional evaluation of sample rural population from Central India. Materials and Methods: Three different adult arm cuffs were used on a selected 394 rural population from 35 to 65 years age group to estimate BP. Their BP was taken on three different times of the day on three different occasions/days. Statistical Analysis: Basic sociodemographic profiles were expressed in frequency and percentages; relationships of hypertension (HTN) with sociodemographic and other risk factors were calculated by Chi-square test; variability in BP by different arm cuffs was expressed by mean, standard deviations, and ANOVA; and prevalence difference of HTN by different arm cuffs was expressed by frequency, percentage, paired t- test, and Chi-square test. Results and Conclusions: The routinely used small adult cuff was found appropriate in only 3.8% of cases studied, thereby highlighting the prevalence of under cuffing at 96.2%. The mean variation in systolic and diastolic BP recorded by using small adult arm cuff vs. medium arm cuff and small arm cuff vs. large arm cuffs were 5.9mm Hg/4.4mm Hg and 9mmHg/7.2mmHg respectively. These observations were both clinically and statistically significant. Our study reported an overestimation of 4.8% systolic and 15% diastolic HTN by the exclusive use of small adult arm cuff. The prevalence of systolic, diastolic, and both systolic and diastolic HTN in selected age group using the correct arm cuff was found to be 20.8%, 29.6%, and 37.5%, respectively. Thus, arm cuff mismatch was a prevalent cause in misdiagnosis of primary HTN in our study population.