From the Guidelines
The recommended cuff size for checking blood pressure in adults should be based on the arm circumference, with the cuff width being approximately 40% of the arm circumference and the bladder length encircling 80-100% of the arm. To determine the appropriate cuff size, the following guidelines can be used:
- For arm circumference of 22–26 cm, a small adult cuff is recommended 1
- For arm circumference of 27–34 cm, an adult cuff is recommended 1
- For arm circumference of 35–44 cm, a large adult cuff is recommended 1
- For arm circumference of 45–52 cm, an adult thigh cuff is recommended 1 Using an inappropriately sized cuff can lead to significant measurement errors, with a cuff that's too small falsely elevating blood pressure readings, and one that's too large potentially underestimating the true blood pressure 1. The most recent and highest quality study, published in 2019, supports these guidelines and emphasizes the importance of proper cuff sizing for accurate blood pressure measurement 1. Proper cuff sizing is essential for accurate blood pressure measurement, as incorrect readings could lead to inappropriate diagnosis and treatment of hypertension. The cuff should be placed at heart level with the bottom edge about 1 inch above the antecubital fossa (elbow crease). Some key points to consider when selecting a cuff size include:
- The cuff width should be at least 40% of the arm circumference
- The bladder length should encircle 80-100% of the arm
- The cuff should be labeled with the ranges of arm circumferences to which it can be correctly applied
- In patients with morbid obesity, alternative methods such as measuring blood pressure from a cuff placed on the forearm or using a validated wrist blood pressure monitor may be necessary 1.
From the Research
Recommended Cuff Size for Checking Blood Pressure in Adults
The American Heart Association (AHA) recommends a cuff width that encircles 40% of the arm circumference and a cuff length of at least 80-100% 2.
- The standard cuff size of 12 cm was found to be appropriate for only 17.3% of subjects in a study, highlighting the need for a range of cuff sizes to ensure accurate blood pressure readings 2.
- A study on the Visomat Comfort 20/40 device found that it could be accurate in a wide range of arm sizes (23-43 cm) using a single cuff 3.
- The mean mid-arm circumference for US adults was found to be 31.0-31.3 cm, with 33.2% requiring a large cuff and 1.3% requiring an extra-large cuff 4.
- A study analyzing data from the National Health and Nutrition Examination Survey 2015-2020 found that 51% of US adults required an adult-sized cuff, 40% required a large adult cuff, and 3% required an extra-large adult cuff 5.
- Research suggests that using a large cuff in overweight hypertensives can help avoid overestimation of blood pressure, and that large cuffs should be used exclusively in this population 6.
Cuff Size Categories
Based on mid-arm circumference, the recommended cuff size categories for adults are:
- Small adult: ≤26 cm
- Adult: >26 to ≤34 cm
- Large adult: >34 to ≤44 cm
- Extra-large adult: >44 cm 5