How to take blood pressure on obese patients
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Q: What is the best way to measure blood pressure in obese patients? If the cuff does not fit around the patient’s arm, should I use a larger cuff or just use the standard cuff on the patient’s forearm? Which method is the most accurate? Show
A: Jennifer McFarlane, RN, MSN, CCRN, CNRN, CBN, replies: Measuring blood pressure in patients with obesity presents a number of challenges centered on the selection of the right size cuff. Multiple techniques for blood pressure measurement in patients with morbid obesity have been described; however, no evidence is available to support a preference for one method over another, and expert consensus varies. The most common site for measurement of blood pressure is on the upper arm of the patient. The upper arm is defined as the part of the upper extremity extending from the shoulder to the elbow. Standards have been established by the American... We have detected that you are using an Ad Blocker. We have sent a message to the email address you have provided, . If this email is not correct, please update your settings with your correct address. The email address you provided during registration, , does not appear to be valid. Please update your settings with a valid address before to continue using PracticeUpdate. Editorial aDepartment of Clinical and Experimental Medicine, University of Padova, Padua, Italy bDepartment of Clinical Medicine and Prevention, University of Milano-Bicocca, Italy cDepartment of Cardiology, San
Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy Correspondence to Gianfranco Parati, MD, FESC, Department of Cardiology, San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Piazza Brescia 20, 20149 Milan, Italy Tel: +39 02 619112890; fax: +39 02 619112956; e-mail:
[email protected] doi: 10.1097/HJH.0b013e3283435b65
Devices and Technology aNursing Department, Izmir Bakircay University, Health Sciences Faculty, İzmir bNursing Department, Erciyes University, Health Sciences Faculty, Kayseri cAnesthesia Department, İzmir Bakircay Universitesi Cigli Training and Research Hospital, İzmir dDialysis Department, Cappadocia University, Nevşehir, Turkey Received 3 May 2021 Accepted 15 July 2021 Correspondence to Seda Şahan, RN, PhD, Nursing Department, Izmir Bakircay University, 35100 Menemen, İzmir, Turkey, Tel: +90232 493 1241; fax: +90232 8447122; e-mail [email protected] doi: 10.1097/MBP.0000000000000565
AbstractBackground: Blood pressure measurement in severe obesity may be technically challenging as the cuff of the device may not fit adequately around the upper arm. The aim of the study was to assess the agreement between intra-arterial blood pressure values (gold standard) compared with forearm blood pressure measurements in severely obese patients in different arm positions. Methods: Thirty-three severely obese patients and 21 controls participated in the study. Pairs of intra-arterial blood pressures were compared with simultaneous forearm blood pressure measurement using an oscillometric device in 4 positions: (i) supine, (ii) semi-fowler with the forearm resting at heart level, (iii) semi-fowler with the arm downward, and (iv) semi-fowler with the arm raised overhead. Degree of agreement between measurements was assessed. Results: Overall, correlations of systolic and diastolic blood pressure measurements between the gold standard and forearm blood pressure were 0.95 (n = 722; P < 0.001) and 0.89 (n = 482; P < 0.001), respectively. Systolic blood pressure measured using the forearm approach in the supine and the semi-fowler positions with arm downward showed the best agreement when compared with the gold standard (-4 ± 11 (P < 0.001) and 2 ± 14 mm Hg (P = 0.19), respectively). In the control group, better agreement was found between the supine and semi-fowler positions with the arm resting at heart level (1 ± 9 mm Hg (P = 0.29) and -3 ± 10 mm Hg (P = 0.01), respectively). Conclusions: Forearm systolic blood pressure consistently agreed with the gold standard in the supine position. This method can be of use in clinical settings when upper-arm measurement is challenging in severe obesity. How do obese people check their blood pressure?Extra-large cuffs like conical-shaped cuffs or thigh cuffs can be used for BP measurement in severely obese patients in upper arm. Conical cuffs better fit the natural contour of the upper arm in severely obese patients who have often have a pronounced conical upper arm shape.
How do you take blood pressure with big arms?This expert statement provides recommendations on blood pressure measurement in large arms for clinical use and research purposes. Tronco-conically shaped cuffs should be used in people with large arms, especially with arm circumferences greater than 42 cm as they better fit on the conical arm shape.
Do fat arms affect blood pressure readings?Overweight and Obese Patients
The elbow-facing end of the cuff often remains loose, expanding irregularly over the lower part of the arm. This can cause providers to overestimate the patient's blood pressure; in some cases, there may be a systolic blood pressure difference of 10 mm Hg.
How does obesity affect the blood pressure of the client?Obesity might lead to hypertension and cardiovascular disease by activating the renin–angiotensin–aldosterone system, by increasing sympathetic activity, by promoting insulin resistance and leptin resistance, by increased procoagulatory activity and by endothelial dysfunction.
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