From the Guidelines
Wrapping a blood pressure cuff around a sweatshirt sleeve can significantly affect blood pressure readings, typically resulting in falsely elevated measurements, and therefore, the cuff should always be placed directly on bare skin. For accurate blood pressure readings, it is essential to remove all clothing that covers the location of cuff placement, as stated in the guidelines by the American Heart Association Council on High Blood Pressure Research 1. The patient should be asked to remove all clothing that covers the location of cuff placement, and the individual should be comfortably seated, with the legs uncrossed, and the back and arm supported, such that the middle of the cuff on the upper arm is at the level of the right atrium (the mid-point of the sternum) 1.
Some key points to consider when taking blood pressure readings include:
- The patient should be at rest for at least 5 minutes before taking readings, and all thick and extraneous clothing should be removed from the site of measurement 1
- The bladder of the cuff should cover at least 80% of the arm circumference snugly, and upper arm measurements are optimal 1
- An average of 3 to 5 readings taken 1 to 2 minutes apart is ideal because BP can fluctuate 1
- Patients should regularly take their BP monitoring device to the clinic to make sure that it is measuring the BP adequately 1
By following these guidelines and ensuring that the blood pressure cuff is placed directly on bare skin, individuals can obtain accurate blood pressure readings, which is crucial for proper diagnosis and treatment of hypertension. Inaccurate readings can lead to misdiagnosis or improper medication adjustments, which can have significant consequences on morbidity, mortality, and quality of life. Therefore, it is essential to prioritize accurate blood pressure measurements by following the recommended guidelines.
From the Research
Effect of Wrapping a Blood Pressure Cuff Around a Sweatshirt Sleeve
- The study 2 found that there was no significant effect of sleeved arms on the accuracy of blood pressure measurement by using an electronic oscillometric sphygmomanometer equipped with a conventional cuff.
- Another study 3 also found that measuring blood pressure with the cuff over the person's sleeve does not significantly affect the result, with no statistically significant difference in blood pressure measurements between bare, clothing, and standard sleeve conditions.
- However, a study 4 found significant differences in blood pressure between measurements taken on a bare arm and over a cardigan sleeve, as well as over a rolled-up cardigan sleeve, suggesting that blood pressure should be measured on bare arms whenever feasible.
- The American Heart Association recommends that cuff width should encircle 40% of the arm circumference and cuff length should be at least 80-100% 5.
- A study 6 found that single width blood pressure cuffs can result in inaccuracies, and that cuff width should be proportional to arm circumference to avoid 'cuff hypertension' and 'cuff hypotension'.
Key Findings
- Measuring blood pressure over clothing may not significantly affect the result in some cases 2, 3.
- However, significant differences in blood pressure can occur when measuring over certain types of clothing, such as a cardigan sleeve 4.
- Cuff size and arm circumference are important factors in accurate blood pressure measurement 5, 6.