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Advice from the BP Measurement Experts

What is a "Long" Blood Pressure Cuff?

Long size BP cuffAs a manufacturer of blood pressure (BP) cuffs, we are often asked: “What is the difference between an Adult BP cuff (or “standard” cuff) and an Adult Long BP cuff?”

Simply put, a “long” cuff has the same range indicators and bladder size as a “standard” cuff, but the actual length is longer than that of a “standard” cuff.  Therefore, a “long” cuff is able to fit on a larger patient population than a “standard”  cuff.

You are probably asking yourself, “If the range and the bladder size is the same on both a “standard cuff” and a “long cuff”, do they both give accurate readings?”


To answer this question, you need to understand the “80/40” rule.  The “80/40” rule states that in order to obtain an accurate blood pressure measurement, the cuff bladder length should be approximately 80% of the circumference of the upper arm and the cuff bladder width should be optimally 40% of the circumference of the upper arm.  The basic reasoning behind this rule is that the cuff bladder must be able to occlude the brachial artery (obstruct the flow of blood through the artery) when the bladder is inflated.  If the brachial artery is not completely occluded before you start to deflate the bladder, then you will hear the Korotkoff sounds earlier which will result in false high readings.  On the other hand, if the bladder size is too big for the arm, then it will take longer to hear the Korotkoff sounds which will result in false low readings.

So if a “long cuff’ is used on a patient with an arm circumference that fits in the intended range of the cuff, then an accurate blood pressure measurement can be expected.  However, if a “long cuff” is used on a patient with an arm circumference outside the intended range of the cuff, even if the cuff fits the arm of the patient, you risk obtaining inaccurate blood pressure measurements.

While we have kept customer demand in mind by making the long sized cuff available, we recommend always using best practices for obtaining an accurate blood pressure reading.  You can read “10 Steps to Accurate Manual BP Measurement” for a detailed guide for obtaining a high quality reading.  In addition, we highly recommend the following video tutorial for proper cuff sizing.

 

 

If you have experiences using "long" versions of blood pressure cuffs, we invite you to share your thoughts with us.

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Video: Consumer Reports Tests Home BP monitors

Home BP Consumer ReportThis news video reports on a clinical evaluation of select Home BP monitors recently completed by Consumer Reports. We were not surprised to see, among their findings, that the wrist monitors evaluated were not as accurate as upper arm monitors. We were encouraged that the video seems to indicate the evaluation was administered by two observers taking auscultatory readings with a stethoscope and mercury column where those results would serve as the basis to compare the automated monitors' results. This is truly the best method for performing clinical evaluations of automated, non-invasive BP monitoring technologies.

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Let's Bring in the New Year in Moderation

BP and alcoholAlthough some people like to “indulge” in alcoholic beverages to help bring in the New Year, you may want to take it easy if you have high blood pressure.  While it is common knowledge that high blood pressure increases your risk of cardiovascular diseases and that excessive drinking is not beneficial to your body; the combination of the two may be double trouble.

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Man Protests Outside Drug Store Over Faulty BP Monitor

Man ProtestingWe recently came across an article reporting on a man in Grand Forks, North Dakota, who is so upset about the erroneously high readings from his new BP monitor that he spent three days protesting outside the store he purchased it from*.

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The Psychology vs the Science of Blood Pressure

guessHave you ever been to a "Guess your age" booth at an amusement park?  If you are able to fool the person guessing the age of passers-by within a couple of years you win a stuffed animal or toy. Well believe it or not, clinicians occasionally do this to their patients.  Not for age, but for blood pressure.  Glenn Nyback, an EMT teacher, recounts a personal experience from one of his classes:

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Watching Your Favorite Sports May Be Bad for Your Blood Pressure

sports fan blood pressure riseHave you ever caught yourself yelling at the television when your favorite team drops a touchdown pass in the end zone or makes a fielding error late in the game?  We’re all guilty of it.  However, I feel obligated to share some bad news.  First, the coaches and players cannot hear you from the confines of your living room, and second, research shows that there is a direct link between spectator sports and an increased risk of cardiovascular (CV) events.  Dr. Franklin Zimmerman, from Phelps Memorial Hospital Center, recently published an article in the Journal of Clinical Hypertension investigating the blood pressure (BP) and heart rate (HR) response of baseball and football fans both before and during games.

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Clinician Beware of Smartphone Health Apps

iStethoscopeDo you have a smartphone? Have you downloaded any apps that help you track or measure your own vital signs information—like blood pressure, heart rate, or glucose level? If you’re a health care professional, maybe you’ve downloaded apps that help you measure and stay informed about your patients’ vitals.  Either way, mobile healthcare-related apps are creating significant buzz within the mobile computing industry. Figures vary for the size of the home health and telehealth markets, but nobody questions that the number is in the billions of dollars, and such sweet numbers inevitably attract lots of bees.

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10 Things to Look for When Purchasing Reusable Cuffs

Blood Pressure Cuff Check ListIn a recent blog post, we took a look at the various types of blood pressure cuffs available on the market. One of four main types of blood pressure cuffs is the reusable cuff. Given that there are many different manufacturers of reusable blood pressure cuffs with many different options, the selection process can be difficult.  So what do you look for when purchasing a reusable cuff?  Below, we have listed the top 10 features to look for when purchasing a reusable cuff:


  1. Durability: Reusable cuffs must be made with a durable material that will be able to withstand multiple inflations, multiples times per day, on multiple patients and used in a variety of applications (i.e. hemodialysis, EMS, primary care offices, hospitals, etc).
  2. Patient Comfort: Even though reusable cuffs need to be durable; they must also be comfortable to the patient.  If the cuff is uncomfortable, patients will probably let you know and resultant patient movement during a reading may lead to multiple re-inflates or error codes.
  3. Cleaning and Disinfecting: Since reusable cuffs are used on multiple patients, it is extremely important that these cuffs are washed on a regular basis (preferably after every patient).  This is especially true today since several studies have identified blood pressure cuffs as potential vehicles for transmission of nosocomial infections (i.e. MRSA, C-diff, etc).
  4. Range of Cuff Sizes: It is extremely important to make sure that a manufacturer makes a full range of cuff sizes.  There is a big difference in upper arm circumference between a child, a middle-aged man, and an elderly woman, so a medical facility should have the proper size cuffs to use on each patient.
  5. Color-Coding: Most cuff manufacturers color-code their cuffs to help medical professional quickly chose the right size cuff for a patient.  Most manufacturers follow the same color coding schemes for each size cuff, which is shown in the table below:
    Cuff Size Color
    Infant Orange
    Child/ Child Long Green
    Small Adult / Small Adult Long Light Blue
    Adult / Adult Long Navy Blue
    Large Adult / Large Adult Long Burgundy
    Thigh Brown
  6. Range Markings: A cuff must have range markers on the inside or outside, (or preferably both), of the cuff to indicate if the correct size is being used on a patient.  Using an incorrectly sized cuff often results in inaccurate blood pressure measurements.
  7. Latex Free & PVC Free: To minimize risk of adverse reactions to latex and to promote patient safety, reusable cuffs should be free of latex and PVC.
  8. Reliable Performance:  The last thing you want to happen when you purchase a blood pressure cuff is to have it leak.  Therefore, look for a cuff manufacturer that leak tests their cuffs on a regular basis.
  9. Regulatory Requirements: All blood pressure cuffs should be designed and validated to the AHA (American Heart Association) and the AAMI (Association for the Advancement of Medical Instrumentation) standards.  These standards provide recommendations for cuff sizing, life cycle of the cuff, maximum inflation, etc.
  10. Warranty:  Most cuff manufacturers have a 2 or 3 three year warranty on their reusable cuffs.  Of course, this doesn’t mean they will replace cuffs with normal wear and tear.  If the cuff leaks, rips, or tears, then you should be able to return the cuff under warranty with no hassle.

Whether you are a distributor, physician, nurse, or in materials management and responsible for purchasing blood pressure cuffs, it is good to know the features and benefits of reusable cuffs so you can make an informed decision on which brand of cuff you would like to purchase and use at your facility.  If you have any additional features you would like to add to the list, please leave us a comment below.

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Does Your New Physician Make Your Blood Pressure Rise

High Blood Pressure MeasurementA recent article in the Journal of Clinical Hypertension does a colorful yet effective job of describing the transient effects of White Coat Hypertension (WCH) when meeting  a new physician.  Studies show that patients who are not hypertensive but show high BP readings when visiting a new doctor for their first time can continue to present with these elevated BP readings for three to six visits.  Although treatment for hypertension based on these measurements is not recommended, the gold standard diagnostic test for WCH, a 24-hour study with an ambulatory blood pressure (ABP) monitor, can more effectively determine whether treatment is, in fact, needed.

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Implantable blood pressure monitors: Science fiction or reality?

blue waveformAt SunTech Medical, we’re always thinking about blood pressure (BP) and how current measurement tools and techniques might be improved. In many ways, “routine” blood pressure measurement hasn’t changed much over the last 100 years. But innovative tools like ambulatory blood pressure monitoring (ABPM) have helped us learn about the importance of masked hypertension, overnight dipping, and blood pressure variability, their impact on clinical outcomes, and the subsequent guidance of hypertension treatment.

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The Different Types of Blood Pressure Cuffs on the Market

Specialty CuffMost people think of a blood pressure (BP) cuff as simply, “just a cuff.” However, there are actually a number of BP cuffs that have been developed to meet the varying needs of patients and medical facilities. In an effort to shed more light on the different cuffs available for use, here is some detailed information on each type, how they are used and the typical environment in which each are used.

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SunTech Partner's Remote Patient Monitor Featured in the Economist

RDT logoWe love to highlight our partners’ achievements.  While some of these have been highly technical BP measurement endeavours in the pursuit of expanding scientific understanding such as experiments on the International Space Station or Mount Everest, the Economist trumpets one which may help anyone who travels by plane. Congratulations to our colleagues at RDT!

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Masked Hypertension: What You Don't Know Could Kill You!

Masked hypertensionWhite-coat hypertension is a familiar term to most clinicians.  Patients with white-coat typically have elevated blood pressure measurements in the clinician’s office, but display normal BP measurements in their everyday environment.  The prevalence of white-coat hypertension varies from 15% to 20% of patients.  Conversely, there is another group of individuals whose hypertension often goes unnoticed by traditional methods of BP measurement.  These patients have normal in-office BP but elevated out-of-office BP.  This phenomenon is referred to as “masked hypertension” and is defined as having in-office BP < 140/90 mm Hg but daytime ambulatory or home BP ≥ 135/85 mmHg.

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Automated BP vs Manual BP Measurement: Which is Better? (Part 2 of 2)

Doctor, nurse, and patientIn my last post, I discussed the importance of informed debate in helping determine effective clinical practice. Specifically, I mentioned two recent journal articles about automated oscillometric blood pressure devices that arrived at two different conclusions. In that post I also provided some comments from the SunTech perspective. Today, I’ll share the perspectives of an experienced, practicing physician on the subject of automated BP devices versus manual sphygmomanometers.

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Automated BP vs Manual BP Measurement: Which is Better? (Part 1 of 2)

Automated or manual BP debateWhat’s a clinician to do? Debates about clinical trials, patient populations, and statistical analyses can seem hollow and distant when looking at an anxious patient in an exam room. At that moment, all that matters is what’s best for your patient. Yet clinically relevant data, and more importantly, rigorous discussion of that data, is the means to the end. Professional clinicians quite often need the former in order to effectively deliver the latter. To wit, two similar journal articles were recently published that arrived at two very different conclusions. Let’s take a look:

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Correctly Diagnosing High BP In Children: Help Needed!

Child Having His Blood Pressure Measured

(Update 6/10/15: The video referenced in this article is no longer available)

We recently came across a video report that originally appeared shortly after an article on the underdiagnosis of hypertension in children and adolescents was published in the August 2008 issue of the Journal of the American Medical Association (JAMA). The focal point of the report was the fact that 3 out of every 4 children who have high blood pressure have not been correctly diagnosed with the condition. This certainly would prompt the question “Why not?”

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Top 5 reasons your automated BP monitor gave an error code

The real problem is not whether machines think but whether men do.”  ~B.F. Skinner, Contingencies of Reinforcement, 1969

Sometimes, the more technology aims to help us, the more burden we take on to ensure it works. These days, automated blood pressure monitors are rapidly displacing mercury and aneroid sphygmomanometers in physician’s offices. As we move farther away from the 100 year old standard of listening for Korotkoff sounds to obtain a BP measurement, and towards the simple press of a button, there are a new set of usage factors that clinicians must remember when encountering problems.

Below is a list of the Top 5 reasons a clinician would encounter an error code when attempting to take an automated BP.

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Canadian Blood Pressure Study of Obese Children Yields Unexpected Results

Child on scaleA recent Canadian blood pressure study discovered that high blood pressure does not directly correlate with the rising obesity rate in pediatric patient populations.  Contrary to expected research outcomes, while most pediatric patients (ages 6-19) with high blood pressure were obese, not all overweight adolescents (a mere 3%) suffer from high blood pressure.

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Guidelines for Ambulatory Blood Pressure Monitoring in Children

Child patientHaving covered the recently rising awareness of childhood hypertension, we thought it appropriate to highlight the guidelines of using ambulatory blood pressure monitoring (ABPM) in children. The American Heart Association has published comprehensive recommendations on this topic...


 

...Which can be found here.  Additionally, separate commentary by Dr. Bruce Alpert, one of the contributing authors, can be found on the SunTech White Papers section.

In some ways, the guidelines for its use on children is not so different than for adults.  However, you should be aware of the following nuances:

  • Check the monitor’s qualification: While clinical validation to the US standard (AAMI) and to the British standard (BHS) are mandatory before a product is allowed on the market, an ABPM specifically needs to be validated for use on children and adolescents.  Make sure to inquire with the manufacturer or representative that the ABPM has been tested to and passed the validation with children as subjects.
  • Use equipment tuned for children: The ABPM should be lightweight, small, quiet, and well-protected when it is worn by the child.  More importantly, an appropriately-sized cuff must be used.
  • Use ABPM software that analyzes children’s BP readings according to the previously discussed thresholds based on age, gender, and height.

The AHA statement goes into significantly more detail.  However, the three guidelines above are the most important to successfully using ABPM on children in a medical practice.

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Instrument Calibration Adds Error Potential in Manual BP Measurement

Blood pressure instrumentsIn previous posts, we have reviewed the 10 Steps to Accurate Manual Blood Pressure Measurement and 10 Factors That Can Affect Blood Pressure Readings.  As important as these details are, accurate measurement also requires two things:

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