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jen's avatar

This cuff size thing is such a peeve… I was an EMT and a CNA for a few years in the 1990’s and cuff size was drilled into our heads. Also everywhere I worked always had a range of cuffs, including XL/thigh cuffs. I don’t know WHAT happened, but in the mid 00’s I stopped seeing these larger cuffs and as a patient, I’m looked at like I have 4 heads when I ask for the largest cuff, because they don’t have one any more. What happened??? What changed?? I don’t get it.

I hate that I’m constantly told I have “pre-hypertension” or “we should talk about medication” because they’re taking my BP with too small of a cuff (while asking me questions and not wanting to be quiet as the cuff inflates and deflates) after arguing about not getting weighed. Of COURSE it’s gonna be high.

I wonder how many fat folks with low BP also don’t get proper diagnosis because of incorrect cuffs too. Providers are shocked it’s not high but what would they do if they learned their fat patients were actually dangerously low?

I’ve tried a couple wrist cuffs and I haven’t found one that seems really consistent. I think there are some high end ones that look really reliable but wow they’re costly. (Hopefully they’ll come down in price.) I’ve still got a manual cuff from my EMT days (which fits large arms!) so I’ll compare that to the auto cuffs on my partner, and even the wrist cuff is only off by 10-15 points, which is still more accurate than what happens in a doctors office between the stress and a bad cuff.

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Debra deLuis's avatar

Absolutely a nightmare! Even when I had lower weight, I have large upper arms. This is a 50 year battle for me, a fat elder. A cardiologist in Hawaii told me exactly what you described: for accurate blood pressure the patient should have time to sit and relax prior to the reading, good back support, legs uncrossed, the proper cuff size, arm supported at heart level, and no chitchat during the reading. That has only happened at that doc's office.

I've been asked to hold the cuff on, told a too-small cuff was fine when the person wanted to use tape to keep it shut, been tsk-tsk'd at because my bp was "sky high" while my arm and the cuff were wedged tightly between a gurney's rail and my body (apparently doesn't make a difference?!), and told that having my bp taken manually was "not possible." Given proper circumstances, healthy bp so the Good Doc suggested I buy a properly sized unit with XL arm cuff and track my bp myself so I'd have good data. May do that one day...after my enormous lottery win.

Thanks for making it clear this is lunacy. I'm so disappointed it persists! Nobody should have to seriously consider whether the benefit of seeking medical care is worth the stress of doing so....

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