blood pressure cuffs

[Dave Fritz]

I've had to throw out two Omicron blood pressure cuffs as they were not accurate when compared to a manual cuff taken at the clinic. They said that about one third of the cuffs they check are not accurate. Direct wired are better than battery but manual analog is best. I'm wondering if anyone else has a similar experience?

[Patty Hann]

How far off were your Omrons from the monitor/cuff at the clinic?
You know about "white coat" syndrome, right? And how that can skew your readings.

I have a AND (A&D) plug in monitor/cuff. (It was about 25% cheaper than a similar Omron)
It has the battery option but I immediately bought an adapter for plugging it in because those things just consume batteries like there's no tomorrow.
I've read that "home monitors" are only good for a few years.... I've had mine 7 or 8 years and it's still pretty accurate.
I monitor my BP at least once a day. And whenever I go food shopping I will check my BP the pharmacy (Walmart/ Kroger/ Safeway/ CVS etc ) it's usually pretty close to my A&D reading so I think it's safe to assume that my monitor is still accurate.

Also, I was reading a lot on BP measurements...not once in any MD's office has my BP been taken the way it's supposed to be.
Not once, ever, in any office. You are supposed to sit quietly for 10 minutes prior to them taking it.
I've never been in an office where the Aide or PA or NP waits 10 minutes.
And if you are answering questions while they take it that can raise the reading 5-10 points.

And you have to be sitting up straight, feet flat on the floor and you upper arm (where the cuff is) even with your heart.
Raising or lowering it even a little can change the reading 5-10 points... lowering your arm raises the reading, raising your arm, lowers the reading.

Crossing your feet at the ankles will change it. If you are dehydrated or have drunk too much water it will be off...and if you have full bladder, that will affect it.
All these things result in inaccurate readings.

[Alan Rutherford]

How big were the differences? Do your two Omicron cuffs agree with each other? Were the comparisons done within minutes of each other? Blood pressure can change minute to minute. Taking it manually requires some interpretation and not every medical person will agree either. I also find that of the 10 or so things you're supposed to do while taking blood pressure (sit straight, feet on the floor, etc. etc.) most doctors' offices ignore half of them. Unless you've made several comparisons and gotten consistent differences of more than 10 mm in the systolic pressure (first number) or 5 mm in the other, I wouldn't worry about it.

Just my opinion. I'm not a doctor.

[Edward Weber]

I use an Omron (arm type not wrist) that can test it the same as they do at the hospital, three separate readings.
It automatically takes first reading, pause for 1 minute, second and so on. It then reports the average reading, which is a more accurate reflection of what going on.
I have never found the wrist cuffs to be accurate at all.

[Patty Hann]

I had to monitor my BP for a month, taking three readings (spread out) during the day. I decided to take three readings on each arm (so 6 reading per day).
My machine does the averaging thing but I read that between readings on the same arm you should wait 10 minutes (and take the cuff off).
So I don't have a lot of confidence in the 3 readings a minute apart (even tho' my machine does it that way too).
I would take a reading on one arm, take the cuff off and move it to the other arm and take a reading, and record both readings (date and time)
I did that two more times maybe 6 hours apart.
Kept all the info on spreadsheet. Took it to my GP a month later. She just stared at it. I asked her what was wrong.
She said "Nothing. I've just never had any of my "senior" patients record their readings on a spreadsheet... they usually just scribble them down. This is so easy to read and spot any anomalies."

[Stan Calow]

My doc asked me to bring my meter in so they could test it in their office under the same conditions. Turned out to be pretty close.

[Lee Schierer]

My doc asked me to bring my meter in so they could test it in their office under the same conditions. Turned out to be pretty close.

The same with the one that I have. One thing I noticed is you have to be really careful to have a bare arm and get the pumping tube located directly centered on the inside of your elbow joint, preferably directly over a vein.

[Edward Weber]

I had to monitor my BP for a month, taking three readings (spread out) during the day. I decided to take three readings on each arm (so 6 reading per day).
My machine does the averaging thing but I read that between readings on the same arm you should wait 10 minutes (and take the cuff off).
So I don't have a lot of confidence in the 3 readings a minute apart (even tho' my machine does it that way too).
I would take a reading on one arm, take the cuff off and move it to the other arm and take a reading, and record both readings (date and time)
I did that two more times maybe 6 hours apart.
Kept all the info on spreadsheet. Took it to my GP a month later. She just stared at it. I asked her what was wrong.
She said "Nothing. I've just never had any of my "senior" patients record their readings on a spreadsheet... they usually just scribble them down. This is so easy to read and spot any anomalies."

All I can say is that's the way they did it when I was tested.
Not sure where you read waiting 10 minutes in between, I've not heard that before.
I test the same way they test so we are all on the same page.

[Patty Hann]

All I can say is that's the way they did it when I was tested.
Not sure where you read waiting 10 minutes in between, I've not heard that before.
I test the same way they test so we are all on the same page.

If I switch arms I don't wait (no need to).... but I recall reading only recently that even a 3 minute wait between readings on the same arms is not long enough.
5 minutes was said to be the absolute minimum and 10 was preferable. Something about giving the vascular system time to "relax", which cannot be done in a minute.
Also the cuff has to be totally loosened, else the arm is still under some pressure.
In other words, if one is going to take 3 "immediate" readings, the conditions (controls) for those readings have to be the same.
If the first reading is taken with the arm initially under no pressure (no cuff on the arm to start with), and the person was sitting quietly for the recommended 10 minutes, then all subsequent readings (to get an average) need to be made under the same conditions: arm not under pressure, vascular system typically relaxed.

[John Ziebron]

For reasons I won't get into I have been doing a lot of research lately on BP monitors. I have an Omron that is about 25 years old. I agree with Patty and my research shows that many people including health care professionals do not take readings correctly including my doctor's office. In addition to what Patty mentioned your arm should be bare in the area where the cuff is and most doctors say you should be sitting in a chair with a back.

I believe that some of my inconsistancies are with the cuff which needs to be not too tight or too loose. A lot of the information I found indicates that it is best to have a second person install the flexible cuff which is nice if you have someone available. I have just discovered that for the last few years some companies sell a preformed cuff which is easier for one person to apply and is supposed to be more consistant. So that's what I'm looking at now to replace my old unit.

BTW Patty, I've been giving my PCP color coded spreadsheets since Excel was released. I'm sure there are many more of us out there.:D

[Patty Hann]

.....
BTW Patty, I've been giving my PCP color coded spreadsheets since Excel was released. I'm sure there are many more of us out there.:D

Color coded???? Oh my... I'll have to start doing that :rolleyes: ;).

[Edward Weber]

I ask this of both of you,
Who or where is instructing you to wait 5-10 minutes in between tests?
I have never heard this and everything I've read indicates only a minute or two.
Places like the American Heart Association, CDC and the NIH
I'm certainly not looking for medical advice from this forum, just curious as to your sources.

[Jim Allen]

I gave my cardiologist my bp on a spreadsheet, he asked me if I was an engineer, yes I was, kinda upset my wife who isn't an engineer but much better at Excel than I am at Quattro Pro.

[Patty Hann]

I ask this of both of you,
Who or where is instructing you to wait 5-10 minutes in between tests?
I have never heard this and everything I've read indicates only a minute or two.
Places like the American Heart Association, CDC and the NIH
I'm certainly not looking for medical advice from this forum, just curious as to your sources.

An article or abstract here and there....give me some time to find them.
It's not like an overwhelming consensus....
But there's the thing: try and tell a doctor's office that is "get 'em in, get 'em out" that they need to take 3 times longer to take BP. They won't do it. Period.
That is why (I think) you don't see/hear much about it. Staff will not take the time to do it.
If Omron (and like companies) made a BP machine that took average of 3 reading that were 3 minutes apart... it would never be able to sell the machine. "Too slow".
Anyway, give me some time to find the postings on it.


Edit: found a couple... https://www.ama-assn.org/delivering-care/hypertension/4-big-ways-bp-measurement-goes-wrong-and-how-tackle-them

https://journals.lww.com/jhypertension/Fulltext/2019/09000/Optimizing_observer_performance_of_clinic_blood.2. aspx

2nd Edit: Actually there IS pretty much a consensus that clinical personnel aren't doing it correctly

[Jim Becker]

The electronic one I bought for our daughter recently off Amazon was a bust...it read way high. The electronic one I bought to replace it at a locally owned pharmacy/healthcare products store is pretty darn close. About a twenty buck difference in cost.

[Patty Hann]

The electronic one I bought for our daughter recently off Amazon was a bust...it read way high. The electronic one I bought to replace it at a locally owned pharmacy/healthcare products store is pretty darn close. About a twenty buck difference in cost.

My A&D was made in Vietnam I think...A&D is a Japanese company
Bought mine on Amazon, but that was 2016 or 2017.

[Patty Hann]

FYI to folks who aren't on BP meds but would still like to lower their BP a few points:
Pumpkin seed are known to lower BP by at least 5 points, sometime a few more points.
This isn't one of those: "Well, it appears to have some positive affect on BP but there is nothing conclusive."
They know it lowers BP... but it may take several weeks before you see anything.
Also you have to eat the seeds everyday...but it doesn't take much...maybe 20gm (shelled)
I put them out in dish in the morning and just eat them over the course of the day.
(I'm not big on "seeds" of any kind ... I lean more towards Oreos, dunked in milk whenever possible :) )

[Alan Rutherford]

.. I have just discovered that for the last few years some companies sell a preformed cuff which is easier for one person to apply and is supposed to be more consistant. So that's what I'm looking at now to replace my old unit....

I have one of those and don't really like it. Nuthin' really wrong with it but I don't see any advantage either. We also have a couple of the original style. It's bulkier to store and awkward to handle. Not a big deal. On a scale of 10, I like it one point less. Can't see why readings would be any different.



...Pumpkin seed are known to lower BP by at least 5 points, sometime a few more points...
(I'm not big on "seeds" of any kind ... I lean more towards Oreos, dunked in milk whenever possible :) )

So how many pumpkin seeds do you need to eat per Oreo?

[Bruce Wrenn]

First my BP is usually 120/68, or lower. Last week at cardiologist, BP taken in left arm was ten points higher than right. Cardiologist used to use an analog cuff, with a large gauge, which would show my BP to be around 100/60. Go to GP's office on the other side of same wall, and BP would be normal. Those drug store machines always show my BP to be dangerously elevated. My brother who is way over weight, has a normal BP of 100/60. When he has someone new take his BP, first they do it twice, then get another cuff to take it again. He tells them to look at his chart.

[Patty Hann]

So how many pumpkin seeds do you need to eat per Oreo?

I might eat up to 6 Oreos a day (but sometimes none).
I haven't counted out how many individual seeds are in 20 gm (give me time...I'll eventually do it) but for 6 Oreos it's 3.33 grams of seeds per Oreo.
Of course if I eat fewer than 6 Oreos, it would be more "seed grams" per cookie.
But whether it's 6 or zero Oreos it's always 20mg of pumpkin seeds per day
(I'm assuming your tongue was firmly imbedded in your cheek when you inquired about this...;))

[Patty Hann]

First my BP is usually 120/68, or lower. Last week at cardiologist, BP taken in left arm was ten points higher than right. Cardiologist used to use an analog cuff, with a large gauge, which would show my BP to be around 100/60. Go to GP's office on the other side of same wall, and BP would be normal. Those drug store machines always show my BP to be dangerously elevated. My brother who is way over weight, has a normal BP of 100/60. When he has someone new take his BP, first they do it twice, then get another cuff to take it again. He tells them to look at his chart.

I'm always affected by "White coat syndrome" at my GP's but nowhere else....always reads about 10 points higher than normal, both numbers.
Otherwise, at a MD specialist/dentist, my machine (anytime of day), and all pharmacy machines all read well below 120/80 (+/- 5 points)

[Alan Lightstone]

I'm really hesitant to get in this discussion, but I am a professional blood pressure taker (clinical anesthesiologist). I'll just make a few points.

1.) All the blood pressures taken by cuff are by definition not the true blood pressure. I've put thousands of arterial catheters in peoples wrists, axillary arteries, femoral arteries, and, of course aortic blood pressures. Those are the real blood pressures, and they vary from site to site in ways we understand.

2.) I remember (not fondly) taking manual blood pressures during my first year of my residency. 38 years ago. And, not ever since. This is because automated blood pressure machines (the good ones we used in the ORs, PACUs, and ICUs) were demonstrably more accurate. Yes, these are not the ones you get at home for $30.

3.) Pretty well every doctors office I go to as a patient has someone (a nurse, PA) taking my blood pressure with a manual cuff. I shake my head every time I see this. So basically, I'm relying on their hearing, lack of ambient background noise, speed of letting out pressure from the cuff vs heart rate, proper placement of the stethoscope (another archaic device - invented in 1851. The Littman one everyone uses was patented in 1960. On a weird side note, I invented the electronic stethoscope in 1986 - 37 years ago)) to get a proper reading. I can assure you, the readings they get taking manual blood pressures are not accurate. So assuming the BP that your doctor sees in the office is accurate is also just not true. Certainly, it is likely the diastolic reading is too high, as the practitioner stops hearing it too high. And I can assure you, I have no white coat syndrome as I am one.

4.) I personally use an Omron at home. For kicks I brought it in to compare it to a professional machine when I had a cardiac cath at Mass General Hospital. It was bang on.

Anyway, my $0.02. If you have hypertension, take meds to treat it. Your body will appreciate it. Better living through chemistry.

[Dave Fritz]

I've taken them to my cardiologist's office and his nurse took it first, then had me take it on the same arm with my machine (which she plugged in). One machine was twenty points high and the other was forty points high. They find one third of the machines are not accurate so that means two thirds are. Some of you are lucky enough to have good ones. When I had a pre-op the check in person (I'm not sure what level of training she had) took it with an automatic machine which also measured blood oxygen. BP was high. I think the machines are made for less trained people to operate really, push a button and fill in the blanks on the computer. She said she'd be back to take it again, but she left and never saw her again. The cardiologists nurse has me sit and if it's high, she comes back after I've been sitting alone in the room and takes it again. It's been lower. I have to think the cardiologist office has to know what they're doing. Orthopedics, not so much.

[Edward Weber]

Thank you Alan

[Jim Becker]

Thank you, Alan...I've always suspected that there are a "yuge" number of variables involved with manually measuring BP...including all those "human" factors you mentioned.

[Alan Lightstone]

I have to think the cardiologist office has to know what they're doing. Orthopedics, not so much.
ROTF.
As we used to say about orthopedists - "Strong as an ox. Similar IQ"

[Patty Hann]

I

3.) Pretty well every doctors office I go to as a patient has someone (a nurse, PA) taking my blood pressure with a manual cuff. I shake my head every time I see this. So basically, I'm relying on their hearing, lack of ambient background noise, speed of letting out pressure from the cuff vs heart rate, proper placement of the stethoscope (another archaic device - invented in 1851. The Littman one everyone uses was patented in 1960. On a weird side note, I invented the electronic stethoscope in 1986 - 37 years ago)) to get a proper reading. I can assure you, the readings they get taking manual blood pressures are not accurate. So assuming the BP that your doctor sees in the office is accurate is also just not true. Certainly, it is likely the diastolic reading is too high, as the practitioner stops hearing it too high. And I can assure you, I have no white coat syndrome as I am one.

4.) I personally use an Omron at home. For kicks I brought it in to compare it to a professional machine when I had a cardiac cath at Mass General Hospital. It was bang on.

....

SO if i read your answer correctly
(1) no way to tell if BP readings taken in the doctor's office are accurate (so comparing your machine the PCP's machine is useless)
(2) One can only check out the "home machine" by comparing it to a professional machine in a hospital...meaning one is SOL unless you can convince a hospital staff to let you come in off the street with your machine to check it out.

Ergo...no way for a lot of folks to determine/monitor what their BP is.

If I've misunderstood your reply, or come to an erroneous conclusion, please correct me.
I'd like to be able to accurately monitor my BP. Thanks

[Alan Rutherford]

Or, as I believe I read in an article in JAMA (Journal of the American Medical Association) not long ago, a single BP reading just isn't always all that useful.

[Michael Weber]

My sole experience with white coat syndrome was with an extremely appealing nurse. She was aware of the situation as when I mentioned that the reading seemed higher than normal for me, she matter of factory replied “It’s me.” She must have moved on because I never saw her at my PCP’s clinic again.

[Michael Weber]

Or, as I believe I read in an article in JAMA (Journal of the American Medical Association) not long ago, a single BP reading just isn't always all that useful. That’s what I’ve always been told. Its more about watching trends over time I think. I assume that doesn’t include extremely high or low results.

[Alan Lightstone]

SO if i read your answer correctly
(1) no way to tell if BP readings taken in the doctor's office are accurate (so comparing your machine the PCP's machine is useless)
(2) One can only check out the "home machine" by comparing it to a professional machine in a hospital...meaning one is SOL unless you can convince a hospital staff to let you come in off the street with your machine to check it out.

Ergo...no way for a lot of folks to determine/monitor what their BP is.

If I've misunderstood your reply, or come to an erroneous conclusion, please correct me.
I'd like to be able to accurately monitor my BP. Thanks
Basically, what you said is true. But it is what it is. The machines or that human being measured BP may be perfectly accurate. Or not. But that's what we all get. There's no profit motive for doctor's offices to buy expensive BP machines, so most don't.

I would look at a trend of your BPs, taken at different times, in different locations perhaps and use that to judge what your blood pressure is. It doesn't have to be totally accurate, because it won't be. It's not like they're going to put an arterial line in your radial artery every time you go to the doctor's office to get an accurate reading (and there is artifact with the gold standard, too).

As I said, I'm content with my home Omron machine. I take my BPs lying in bed, watching TV. Don't watch the Red Sox or Rays losing. That would raise my BP. I look at trends. That's, at least to me, a reasonable approach.

[Patty Hann]

Basically, what you said is true. But it is what it is. The machines or that human being measured BP may be perfectly accurate. Or not. But that's what we all get. There's no profit motive for doctor's offices to buy expensive BP machines, so most don't.

I would look at a trend of your BPs, taken at different times, in different locations perhaps and use that to judge what your blood pressure is. It doesn't have to be totally accurate, because it won't be. It's not like they're going to put an arterial line in your radial artery every time you go to the doctor's office to get an accurate reading (and there is artifact with the gold standard, too).

As I said, I'm content with my home Omron machine. I take my BPs lying in bed, watching TV. Don't watch the Red Sox or Rays losing. That would raise my BP. I look at trends. That's, at least to me, a reasonable approach.

OK..."trends" works for me....fortunately my trends are fairly consistent, and (even better) low.
Thanks

[Alan Lightstone]

OK..."trends" works for me....fortunately my trends are fairly consistent, and (even better) low.
Thanks
What I used to say to people is if your BP is low, and you're not passing out.... Awesome!!

[Jim Becker]

"Trend" is what I keep trying to emphasize with our daughter...she's a bit, um...impatient.

[Lee DeRaud]

Also, I was reading a lot on BP measurements...not once in any MD's office has my BP been taken the way it's supposed to be.
Not once, ever, in any office. You are supposed to sit quietly for 10 minutes prior to them taking it.
I've never been in an office where the Aide or PA or NP waits 10 minutes.
And if you are answering questions while they take it that can raise the reading 5-10 points.
Yup. Their normal procedure is weighing me, commenting that I'm up/down a kilo or so from last time, and taking the BP measurement 30 seconds later while asking how much I typically eat/drink/exercise. Then when it's too high, they immediately take it again with me standing up. Seriously? Why do they even bother?

Mine was "white-coat" high at my last visit. They asked if I had a widget at home, and gave me pre-printed instructions on how to take it and report back. It was a sequence of (1) put on the cuff, (2) remain still for five minutes, (3) take three readings one minute apart, and (4) report the average. I'm not really sure what they do with the "self-report" numbers, but I suspect they'll never find their way into the official record.

[Patty Hann]

...They asked if I had a widget at home, and gave me pre-printed instructions on how to take it and report back. It was a sequence of (1) put on the cuff, (2) remain still for five minutes, (3) take three readings one minute apart, and (4) report the average. I'm not really sure what they do with the "self-report" numbers, but I suspect they'll never find their way into the official record.

My PCP (really a PA) had my spreadsheet scanned and put in my file. She's pretty thorough. I like having her as my "doc".
I see my real MD (sports med) when musculo-skeletal problems come up.

[Patty Hann]

ROTF.
As we used to say about orthopedists - "Strong as an ox. Similar IQ"

Oh, come now... that is hardly fair.
I know people who have had orthopedic guys work on their spines and necks.
That is some pretty scary work, to have someone messing around your spinal cord who (you say?) isn't very bright.
Now, for the record I have had work done on my spine and neck, (lumbar and cervical fusions) and I opted to go with a neurosurgeon precisely because that is what neurosurgeons do, they work near/on "nerve stuff".
They don't do shoulders or hips or knees or hands or feets.
But when I need one of those joints worked on (and I will need thumb surgery soon) it will be one those "oxen" that works on it.

[Dave Fritz]

When I originally posted my lack of faith in the ortho clinics BP readings I was referring to the people that checked me in. I'm not sure what level of training they have, I know they're not RN's. All they do is check your meds., put the cuff on your arm and push a button, then record the readings. Almost secretaries. Again, she said she'd be back to recheck BP but never showed up. I think a couple of things are at play. Over worked hospital systems, short staffed and in my case not the best pay. The physician's assistances and surgeons are top notch.

[glenn bradley]

My doc asked me to bring my meter in so they could test it in their office under the same conditions. Turned out to be pretty close.

Ding, ding, ding. You can get different readings in sequence by altering arm position, support, talking, breathing faster or slower . . . 9 out of 10 times the person taking my BP at the doctor's office does a poor job method-wise. At home we are testing for generalities, not the precision of continuous monitoring like when you are wired up in a controlled environment.

[Patty Hann]

When I originally posted my lack of faith in the ortho clinics BP readings I was referring to the people that checked me in. I'm not sure what level of training they have, I know they're not RN's. All they do is check your meds., put the cuff on your arm and push a button, then record the readings. Almost secretaries. Again, she said she'd be back to recheck BP but never showed up. I think a couple of things are at play. Over worked hospital systems, short staffed and in my case not the best pay. The physician's assistances and surgeons are top notch.

I know you and Alan were just joshin'...;)

[Jeff Clode]

This has been a meandering thread and a tiny bit worrisome to me - good control of hypertension is probably one of the most important and easily accomplished things that can be done in modern medicine- the payback is HUGE. If your BP is questionable , get a validated cuff ( look the choices up online under that name ) and use it per easily available online instructions. The readings in a doctors office are fraught with multiple sources of errors in terms of absolute numbers but if you take your cuff in for a check and it’s within about 10 points of the office reading (done by a reasonably competent practitioner) your cuff is probably good to go. Wrist cuffs are fine (if validated and used according to strict guidelines/instructions)- they are easier to screw up than arm cuffs because of arm position issues. The point is know your BP and make sure it’s treated appropriately if it’s elevated…monitor it yourself with a validated cuff
Jeff

[Scott Winners]

27 year RN checking in. I agree with Alan this is a slippery slope. Yes you should uncross your ankles. Yes you should "relax" for 5-10 minutes. I use the hospital calibrated automated cuffs for almost all of my BP measurements- so my colleagues can use the same gear and have comparable numbers to whatever I get when I use the same machines on you.

I use a $320 Littman CORE to assess your lung, heart and intestine sounds around my hearing aids and I can sure as the Lord made little green apples measure your blood pressure too, but the main thing is trends. Using the same equipment as my colleagues we can look at your trends over days and have useful data.

If I were to hook two hospital calibrated auto cuffs to your arms, one each right and left, and push the 'start' buttons simultaneously, I would record two different BPs. You are not a Small block Chevrolet with factory oil galleries, a blueprinted oil pump and Hohenzollern lifters. You are an organism. Your "blood pressure" varies not just all over your body but moment to moment as well.

Wrist cuffs suck. If that is all you can afford that is fine, but you MUST lay flat on your back with your arms crossed over your chest and hold the heck still while the cuff is up to get useful data. The auto cuffs that measure on your upper arms are much more repeatable and you absolutely should take your auto cuff with you to the doctors office, every time, to check your home cuff against the pro cuff. In my experience home cuffs are fairly consistent, but they might read +/- 10mmHg compared to calibrated cuffs. Consistently wrong, but consistent.

Finally, if your BP is so consistently borderline that you want to critique my OTJ performance with an auto cuff so you can stay off meds, there are a couple things you should know. 1. You are probably overweight. 2. You probably have too much fat and sugar in your diet. 3. You are probably getting sub optimal physical activity.

Eat your greens. Drink your water. Do your steps. Stay off my floor.
Scott RN

[Roger Feeley]

So here’s a question. Can I calibrate my cuff this way:
1 take my manual cuff to my doctors office,
2 partially inflate it and wrap my doctors cuff around it.
3 Inflate my doctors cuff to some value
4 compare the two readings

[Lee Schierer]

So here’s a question. Can I calibrate my cuff this way:
1 take my manual cuff to my doctors office,
2 partially inflate it and wrap my doctors cuff around it.
3 Inflate my doctors cuff to some value
4 compare the two readings

Not likely. The cuff then inflates until it fits tightly around your arm, cutting off your blood flow, and then the valve opens to deflate it. As the cuff reaches your systolic pressure, blood begins to flow around your artery. This creates a vibration that's detected by the meter, which records your systolic pressure.

The cuff on top probably would detect the pulse through the inner cuff.

[Alan Lightstone]

And, of course, there’s this:
https://www.cnn.com/2023/08/07/health/blood-pressure-cuff-size-wellness/index.html

[Alan Lightstone]

good control of hypertension is probably one of the most important and easily accomplished things that can be done in modern medicine- the payback is HUGE.
Jeff

+1000 and then some.

[Patty Hann]

I read the article Alan linked to.

Wow. Clinic personnel may find it "too inconvenient" to ensure the proper size cuff is used. Just...Wow.

[Jim Becker]

And, of course, there’s this:
https://www.cnn.com/2023/08/07/health/blood-pressure-cuff-size-wellness/index.html
Hah! I was just going to post this. We've had this struggle with our older daughter who is a "big woman" and I remain concerned that the XL cuff on her machine she has to use every day may still not be large enough.

[Dave Fritz]

My take aways - BP is a moving target. Get a physician you trust and do what they say. As the author, August Derleth once told me, "Not everyone with a reverse collar will get you into heaven and not every doctor will save your life."

[Alan Lightstone]

I just wrote a very long post that somehow got deleted. Aaargh!!!!!

I'm straying from the original post, but let me add some additional information from someone who has taken hundreds of thousands of BP readings from patients. In surgery, we typically take patient's blood pressures every 5 minutes on expensive, accurate BP machines with usually a choice of 3-4 different cuff sizes for adults, and more for kids. We are attuned to artifacts/bad readings and adjust as necessary.

When I need more accurate BP readings for more invasive surgery (like open heart surgery, lung surgery, major vascular surgery, trauma) I put an arterial line in the patient (think of a plastic IV catheter placed usually in a patient's radial artery in their wrist, but sometimes in their axillary artery, femoral artery, or even the aorta). This gives me far more accurate BP readings and second-by-second real-time readings, as well as makes it easy to take blood samples. We often have the BP cuff running concurrently (though less frequently) and the readings differ. It's comparing apples to oranges. Why don't we do this on everyone? It's invasive, painful (unless it's well anesthetized), and difficult to do unless you are well trained in it. I'm extremely good at it after decades of work, and ultrasound has made it far easier and quicker to do. What used to take sometimes minutes and minutes of work, I can usually now do in seconds. But enough patting myself on the back.

The point of this tome is that you need to think of BP readings as an estimate of what is going on in your body. Trends are the most helpful to look at (we can make you run, down tons of caffeine and make your BP high, but it's meaningless). If your physician thinks you have hypertension and should treat it, there is voluminous evidence in the medical literature as to how that is beneficial to your health.

I feel for large patients, who too small cuffs are placed on them and they get painful, inaccurate readings. It's a problem for sure.

[Patty Hann]

...

I feel for large patients, who too small cuffs are placed on them and they get painful, inaccurate readings. It's a problem for sure.

(There, Alan, I just deleted your post again ;)..well, most of it. But I digress...)

The "painful" part of using a too small cuff is, I would think, a minor problem compared to getting an inaccurate reading , which can have major consequences and ramifications.
So now the patient with "consistently high" BP readings is put on BP meds, when the real problem is the GP's staff "consistently used" too small of a cuff for Mr Linebacker.
What does taking BP meds do to a person with normal BP?
(I myself don't know, not being on BP meds, but I can't imagine any good comes of it.)

[Bill Howatt]

Item on some newscast a couple of days ago saying that a too large a cuff will tend to incorrect readings of low and a too small cuff will tend to incorrect readings of high. Apparently, the experts were surprised at the large magnitude of the errors so a correct cuff size is very important according to the study.

[Alan Lightstone]

...(snip)
What does taking BP meds do to a person with normal BP?
(I myself don't know, not being on BP meds, but I can't imagine any good comes of it.)
In most cases nothing bad, though it does cost money. In MOST cases. In some cases, bad things can happen. Obviously you only want to be on medicine if you need it and it makes things better, or prevents bad things from happening.

[Bill Howatt]

It probably depends on exactly what the medication is altering, but I lost some weight and my BP dropped (top number about 105) such that I was getting dizzy so the dose was cut back. I think some meds relax arteries and some others reduce the water in the body - the so-called pee-pill.

[Jeff Clode]

"Not everyone with a reverse collar will get you into heaven and not every doctor will save your life."
I love that!
I will make a plea that folks not get overwhelmed by the potential problems of measuring BP and miss the opportunity for appropriate treatment of hypertension. The issues with cuff size have been known since I was in medical school in the 70s - (nothing new here tho it does seem we have to “rediscover” stuff every so often for some reason). People with huge arms are often well served by using a validated wrist cuff - one which is from the validated lists and one which has been checked by their provider and is used in strict accordance with instructions.
The issue of BP variability is huge - it changes moment to moment. This is why home monitoring is so important - the more numbers you have the more accurate the averages are. The purpose of checking the cuff in the provider’s office is to see that you are getting a number congruent with the office cuff values. The absolute value at that moment is way less important than the fact that the should be within 5-10 points of each other. Then keep it simple- follow the instructions readily available on line - rest 5 minutes, no food or drink, no full bladder, no fights with SO, yada yada….check it once or twice at most, record it….rinse and repeat couple times per day until you see that the trend Alan is talking about is established. Don’t need to do both arms every time as long as they are similar when the diagnosis is made unless it floats your boat to do so…..
please don’t get frustrated - just measure and treat if appropriate. Your brain, heart, and kidneys will thank you

[Alex Zeller]

I asked the nurse at my doctor's office why she went so fast when doing things like weight and BP. She said they are just general numbers to see if there's a meaningful trend over the time between the last time it was taken. As long as it's close they are happy. Only if the BP is high will they do it a second time trying to be more accurate after having the patent try to relax. At work we have the same sort of sit on machine drug stores have but it's a little bit of a walk to get to it. I've never used it because I don't know how accurate it is without taking plenty of time after walking 10 minutes to it.

[Allan Dozier]

Question for Alan: For a thin patient with no hypertrophic muscles or obesity issues, given that the intra-arterial pressures differ from the external cuff pressures, are the external cuff measured ones consistently lower? Or all over the board? Again, for a thin armed individual.
The reason i ask is that the level of pressure that is considered harmful has been defined or determined over many years (and occasionally adjusted). I assume almost all of those readings were made with the cuff so if the measurements are consistent, isn't that the measurement that should be looked at? Do anesthesiologists use a different range of normal for intra-arterial pressures vs. the cuff measure? I would assume you couldn't extrapolate one to the other.

[Alan Lightstone]

Question for Alan: For a thin patient with no hypertrophic muscles or obesity issues, given that the intra-arterial pressures differ from the external cuff pressures, are the external cuff measured ones consistently lower? Or all over the board? Again, for a thin armed individual. The reason I ask is that the level of pressure that is considered harmful has been defined or determined over many years (and occasionally adjusted).
Some very interesting questions, there. I would say that the external cuff pressures are all over the board, but would likely be more accurate and precise for a thin armed individual, when measured by a quality automated machine or a skilled person with good hearing and good technique. The good technique part is important. Let's take the example of a patient either on a beta blocker, or natively bradycardic (slow heart rate). Lets arbitrarily use a HR of 55. So less than one heart beat every second. Now the person taking the BP is letting the pressure out of the BP cuff a little too quickly, as the patient is saying that it hurts them (pretty common scenario). If the operator is lowering the pressure more than 10mm a second, they could easily miss a heart beat and measure an artifactually high diastolic blood pressure. Easy to do this, and get an inaccurate reading. You can see why I'm more than a little partial to accurate automatic machines to do this. During my residency at Mass General (God, I'm getting old), they were just adopting automatic BP machines in the OR (the old Dynamaps). When we were on call at night, the first thing I would do is steal one of them from one of the operating rooms and take it with me wherever I had an operation that night. They were easier and more accurate to use.

I assume almost all of those readings were made with the cuff so if the measurements are consistent, isn't that the measurement that should be looked at?
Yes, I would assume (a safe assumption) that all of the recommended BP levels have been determined by measuring huge numbers of individuals with cuffs.

Do anesthesiologists use a different range of normal for intra-arterial pressures vs. the cuff measure? I would assume you couldn't extrapolate one to the other.
That is a very complicated question to answer. The simple answer to the above question is that we assume, if there is no or little artifact, that the arterial pressure is the correct reading.

But it is far, far more complicated. Let's take the example of a patient under general anesthesia, so unconscious. Usually the patients blood pressure drops during GA (general anesthesia). We often intervene to increase the blood pressure with vasopressors (constrict blood vessels) when the BP drops more than 20%. Tighter ranges are used for patients with known or suspected carotid or cardiovascular disease. If the patient doesn't have sufficient blocking of the pain response to parts of an operation, their blood pressure can rise. During parts of the procedure when nothing much is happening, the patient's blood pressure can drop. We strive for what we call "railroad tracks" - straight lines of BP readings that don't change from intended levels. It's by no means universally obtainable.

Now when doing many operations, often with orthopedic surgeons (see above quote about ox and IQ) https://gomerblog.com/2014/09/bones/?fbclid=IwAR24-A4NOXec-XeyN4xID5LVwUXUK4gKl4qAIdpZ_7w61llLepfcQ61VyxE,
(An orthopedists view of the body - What's the purpose of the heart - it pumps Ancef (an antibiotic) to the bones. What's the purpose of the lungs - they provide oxygen so the heart can pump Ancef to the bones. What's the purpose of the brain - it tells the heart and lungs to pump Ancef to the bones. What's the purpose of the kidneys - they have no purpose. They excrete Ancef. But I digress... :D)

Anyway, back to the question. The orthopedists want us to intentionally lower the patient's blood pressure with medications to reduce blood loss, and improve their surgical view. (Intentional hypotension). This drives us crazy, as we are worried about the patient's brain and heart. They are focused on the surgical site (knee, hip, etc...) There are operations like cerebral aneurysm clipping that we also have to tightly control the BP, to avoid devastating consequences. Yeah, we are working hard not just sitting and reading a book while people are undergoing surgery. And I could write a book about cardiovascular surgery and BP control - many elements where the BP is intentionally raised or lowered, and long pump runs on a heart lung machine clearly do harm, necessitating sometimes heroic efforts at maintaining homeostasis.

[Jim Becker]

Professor Dr. SWMBO's close undergrad friend Selina is in your trade, Alan, coincidentally in the Boston area where you trained. (a contractor these days) She tells some interesting stories like that, too, relative to the surgeon's expectations vs reality.

[alan weinberg]

whenever the machine reading is strange we (yes, I’m a doctor, specifically urologist) use a stethoscope and manual sphygmomanometer, so if concerned, just buy those. Two minutes of training and you can be an expert even taking one’s own BP. Accurately.