I don’t think anybody would dispute the familiar association between obesity and blood pressure 1. An obese arm possesses the potential to cause complications with BP measurement. Those issues may exaggerate hypertension more 2. So what steps should be followed for obese arms and blood pressure?
The following steps must be followed with an obese arm for blood pressure measurement:
- Use a cuff size large enough for the obese arm.
- Make sure the arm is not a conical shape. If so, use another location.
- Do not wrap the cuff too tight.
- Have a physician compare the upper arm to the forearm and wrist measurements. Use the more accurate location for measurements.
The steps are not limited to an obese arm. Any large arm, like a very muscular one, may be troublesome. This article will expand on the 4 steps above and explain how to perform them properly. In addition, I’ll inform you how inaccurate the measurements may be on an obese arm.
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It’s very common for a cuff to be too small when measuring the blood pressure on an obese arm 3. Most blood pressure monitors come with different size cuffs. Many times the person buying the machine may buy it without checking for the correct size. For someone with a very large arm, it may be harder to find the correct size.
These people often use one that’s too small because they would rather measure their blood pressure than not check it at all. This may result in falsely high readings making the person think their blood pressure is higher than what it really is. The following steps should be followed to achieve the correct cuff size.
Measure the Upper Arm
It’s just a guessing game buying a monitor or cuff without knowing your upper arm circumference. To find out your arm size, use a cloth measuring tape. Wrap it securely around your upper arm, midway between your elbow and shoulder. Make sure the tape is level all the way around and not pulled too tight. Write down the measurement along with your blood pressure records.
Check the Arm Size Range on the Cuff
Every home blood pressure cuff is made for a particular size range. The home monitor I use, came with a range of 8.75″ to 16.5″. All you have to do is check the size of the cuff to your arm circumference prior to ordering.
If you’re looking for a new, affordable machine that’s high quality, you can read about it in my blog post, Home Blood Pressure Monitors. It has cuff options up to 21.25″. If the monitor doesn’t come with the correct size cuff for you, try these options:
- Find out if the cuff can be changed.
- Shop for an appropriate size for your arm that will attach to your monitor. Here are some extra large size cuffs you can check out.
- Find a monitor with the correct size for you. Here are some monitors with extra large cuffs.
- Consider using a wrist cuff monitor instead. Here’s the wrist monitor I recommend.
Check Your Arm For a Conical Shape
If you examine your upper arm, you’ll see it’s not perfectly round like a cylinder. It’s typically wider on the back and more narrow towards the front. This makes the arm more of a cone shape than round. Even though, round blood pressure cuffs and bladders are used for measuring blood pressure.
When someone is obese, the cone shape may be more pronounced compared to others. Some may have a larger circumference more towards the elbow than the top. This can cause the cuff not to wrap around the arm evenly. In this situation, when the cuff is inflated, it may not compress the artery as efficiently. This may result in a higher blood pressure reading.
In a study of 220 people, BP was measured with typical round shaped cuffs and tronco-conical shaped ones. The results indicated the round ones measured blood pressure as great as 9.7 mmHg more than the coned shaped 4.
If your arm is more cone shaped because of obesity, it may be more beneficial to measure blood pressure on the wrist or forearm. Using the forearm would be a technique used by a physician. A smaller cuff would be wrapped around your forearm, and the stethoscope would be used to listen to the radial artery running down your forearm.
At home, you can purchase a wrist blood pressure monitor. They also have different size cuffs. Just like the upper arm, measure your wrist and compare it to the size of the cuff. Many people knock wrist monitors for being inaccurate, but many of those inconsistencies are to blame on the user. I wrote a whole post on wrist monitors and how to use them which you can read right here, Are Wrist Blood Pressure Monitors Accurate?
If you have no other choice, a wrist monitor will be fine. Cuff height and consistency are the key important factors. If the readings are a little off and you use it the same way every time, you’ll be comparing your pressure under similar circumstances as your other measurements. This will inform you if your pressure is staying the same, lower or higher.
It’s common to wrap a cuff around an obese arm too tightly. If your cuff is too small for your arm, it may be the only way to enclose the end of the cuff. When a cuff is too tight, it can cause an uncomfortable feeling and may elevate your pressure 3.
In addition, it’s possible to wrap an appropriately sized cuff around an obese arm and have it tight. The cuff should be snug enough where you can barely slip 2 fingers under the edge. If you can’t wrap it around without it being tight, you’ll need to purchase a larger size.
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Have a Physician Compare Your Measurements
Whether you have an obese arm or not, you should routinely take your blood pressure monitor to your physician. Typically, once a year is recommended to check it for accuracy. While you have it there, ask your physician to check your cuff’s size and fit to your arm. In addition, make sure the physician’s cuff is large enough for you. You’d be surprised how many medical facilities can’t accommodate a large size arm.
If your arm is too big, it may be unpossible for them to have the correct size cuff. As the fat in the upper arm increases, the length of the arm from the shoulder to elbow remains the same. Blood pressure cuffs must meet the requirements of the 80-40 rule. The length must not be less than 80% of your arm circumference and the width must not be less than 40%. Because of this, the bladder width can’t be manufactured any wider as it would take up too much of your arm length.
Your doctor may determine an accurate measurement is possible at the upper arm after comparing it to the forearm and wrist. In this situation, you can continue measuring your upper arm. If the doctor determines your upper arm is inaccurate, you’ll have to purchase a home wrist monitor if you want to continue home monitoring.
The medical experts recommend using a wrist monitor at home if you are unable to use an upper arm cuff because of an obese arm. In addition to obesity or a conical shape, it may be useful in elderly people with whom the upper arm is sometimes unpractical. With others, there may be mobility issues. Check out the wrist monitor I recommend here in my blog post, Wrist Monitor.
If you found this Blood Pressure topic interesting check out these related blood pressure articles also found in this same website:
- How Often You Should Replace Your Blood Pressure Monitor
- Causes Of False Blood Pressure Readings
- Effect Of Arm Position On Blood Pressure
- National Center for Biotechnology Information: Obesity and hypertension[↩]
- Journal Hypertension: Blood pressure measurement in very obese patients: a challenging problem[↩]
- Harvard Health: Avoid these common blood pressure measuring mistakes[↩][↩]
- National Center for Biotechnology Information: Rectangular Cuffs May Overestimate Blood Pressure in Individuals With Large Conical Arms[↩]