Hi Shannon!
My name is Crystal - I am a Nurse Manager at UC Davis Health who currently provides direct patient care and education to patients with Stage II HTN enrolled in our Remote Patient Monitoring Program.
I am afraid what we have found is the "appropriate size blood pressure cuff" is relevant to the specifications of the cuff manufacturer. For example, we started our RPM program using iHealth blood pressure cuffs, but when we switched to a Welch-Allyn cuff, we noticed we needed to teach our support staff the specifications and new names of the sizes - each manufacturer had different measurements for the same size name.
To make matters even more complicated, we could not pull "cuff size" historical data from the EMR (because we could not confirm that all of our primary care clinic staff were inputting correct size data), so, we have to ask each patient at the time of enrollment to measure their preferred arm around the bicep at the widest point.
Here are the differences in the two cuff manufacturer specifications:
Welch-Allyn:
Small Size: 5.75" to 9.5" (15cm to 24 cm)
Standard Size: 8.75" to 16.5" (22cm to 42 cm)
XL Size: 15.75" to 21.25" (40cm to 54cm)
iHealth:
Standard: 8.66" to 14.17" (22cm to 42cm)
Large Size: 11.8" to 16.5" (29cm to 42 cm)
XL Size: 16.5" to 18.9" (42cm to 48cm)
We do not have a policy that outlines steps in determining the appropriate size cuff; however, I would encourage you to write your policy with the cuff manufacturer piece in mind. What is so important is the use of a cuff that is too small can result in an elevated SBP reading that may read between 4.8 mmHg - 19.5mmHg higher than an accurate measurement with an appropriately sized cuff (Ishigami et al., 2023)!
I hope this bit of insight helps you in developing your policy!
References
Ishigami, J., Charleston, J., Miller, E.R. 3rd, Matsushita, K., Appel, L.J. & Brady, T.M. (2023) Effects of cuff size on the accuracy of blood pressure readings: The cuff(SZ) randomized crossover trial. JAMA Internal Medicine,183(10):1061-1068. https://doi.org/10.1001/jamainternmed.2023.3264
Crystal Hapgood, MSN, BSN, BA, RN
Nurse Manager, Connected Care Center
UC Davis Health
chapgood@health.ucdavis.edu
916.946.1228
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Crystal Hapgood BSN RN
Nurse Manager
UC Davis Health
Stockton CA
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Original Message:
Sent: 07-23-2025 16:28
From: Shannon Roosma-Goldstein
Subject: Blood pressure cuff sizing
Greetings!
There is ample evidence in the literature to indicate that using the correct sized blood pressure cuff is an important component in obtaining an accurate reading. I am finding that policies and evidence-based skill references such as Dynamic Health typically state to "use the appropriate size blood pressure cuff", but do not further identify how this is done in practice.
I am interested in learning what organizations are doing to ensure that correct blood pressure cuff sizes are used. Does anyone have a policy that outlines the steps in determining the correct size BP cuff to use? Does anyone have a policy that specifies the range of BP cuff sizes (appropriate for their population) that should be available in places where blood pressures are obtained? Thoughts about training and accountability related to this? On a related note, does anyone include conical (cone-shaped) BP cuffs as a part of their regular equipment?
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Shannon Roosma-Goldstein MPH, BSN, RN, NPD-BC
Nursing Education & Practice Specialist
Kaiser Permanente Washington
Seattle WA
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