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.
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....
This exact issue led to my most recent traumatic health care experience. The next appointment I had after that, I had to bring my best friend with me tas an advocate because I had a panic attack when I thought about returning to the facility. Which sounds extreme, but I'm autistic and often struggle to be heard by strangers and end up crying out of frustration/anger rather than being able to get results.
I had a nurse take my blood pressure last year on the forearm, after I mentioned that the blood pressure cuff always hurts my upper arm. She was the first person (in my mid thirties!) to inform me that a forearm reading was an option. Every time I had a reading taken after that, I told the provider that an upper arm reading hurts and that I would like a forearm reading. Every. Single. Time. I was told something dismissive like 'let's just try' or 'sorry, but that won't give an accurate reading' or 'oh, well, this cuff won't fit that way' and they pushed forward with the upper arm anyway.
Fast forward to earlier this year, when my blood pressure check before a urology procedure read as high. It was rechecked after the procedure and still read as high, so the woman taking it scheduled me for a standalone appointment in the future, just to check again--she told me that if my BP was still high then, it would mean I had hypertension, and they would probably put me on medication. I was kind of baffled by this since nobody had found an issue with my BP before, but she was very insistent about how lots of patients were 'getting away' with cancelling their blood pressure checks during the pandemic, and they 'had' to force follow-ups.
So I arrived for a standalone blood pressure check appointment, which I scheduled right before an appointment to get a foot injury looked at. I was ushered into an alcove with a BP machine rather than an actual room, where I explained to the tech that I had an appt soon after and hoped it wouldn't take long. She told me, much to my surprise, that I could have just gotten my blood pressure taken at that appt instead, but proceeded to check my BP. The reading was high, so she told me to 'relax' and left me sitting there for ten minutes. Rather than relaxing, I was growing more anxious at the idea that I might have to have more readings and miss my appointment.
After a similar second reading, reading number three came back fine, though by then I was deeply irritated at being nearly late for my foot appt. The tech noted that while my BP was fine, my heart rate was high, and left me sitting yet again to consult with the ER doctor on call. She came back many minutes later to say that I would be needing an EKG, and when I reminded her of my foot appt and protested, she said they 'could not let me leave with my heart rate that high' and that the doctor would look at my foot instead.
It took a while longer for the EKG tech to arrive with equipment, and until she did I sat there crying, just wanting to go home. The EKG reading went smoothly--the tech was nice, I knew it wasn't her fault I was stuck there--and then the ER doctor came in to read the results. He referred to me 'requesting' the EKG because of how my heart felt, and I corrected him, explaining that my heart rate read as high (no wonder) but I had no heart issues I was aware of and hadn't wanted an EKG at all.
He assured me that my results were fine, as though I had thought otherwise, and literally used a hand to push me back down against the table where I was laying whenever I tried to sit up a little to talk to him without him looming over me. Kept telling me to 'just relax' when he was the one causing me upset. I reminded him that I'd been told a doctor would look at my foot, since I had been forced to miss my appt, and he didn't even remove my shoe to do so--just told me to get it x-rayed and then follow up with my regular doctor.
Doing so meant waiting until the following week, so no one ever looked at it while it was at its most damaged. The EKG was ultimately a waste of time and medical resources, since it showed no problems. It was only initiated because my heart rate was high, and my heart rate was high after three separate painful BP readings on my upper arm while I watched the clock and worried about being late. And it turns out I never needed that separate special blood pressure check in the first place!
The next day, at home, I realized I had a bunch of small bruises on that upper arm area where the cuff had been. I brought my best friend with me to my 'follow up' the next week with my doctor, and was so glad I did--once again, the nurse tried to ignore me when I asked for a forearm reading, and having 'backup' helped when I insisted that they would either have to do so or use my other arm, because of the bruising.
I've honestly always found BP checks painful, and had no idea the problem could be a too-small cuff because of my size. But two weeks after I was told I probably had hypertension and one week after the hellish experience that skyrocketed my heart rate, I insisted on a forearm reading...and my BP was perfectly normal. (My doctor in THAT appointment was also literally the first person to ever mention that my feet should be flat on the floor during. And my best friend, who had just been diagnosed hypertensive, had never been told that either.)
Sorry for the long-winded rant, but thank you so much for writing specifically about blood pressure cuffs/dismissal of fat patients' needs during readings. It seems like such a small thing compared to other areas of discrimination, but it almost stopped me from being able to return and seek care that I sorely needed, because I no longer felt like I would be safe or listened to even around the most basic elements.
Just a note about wrist cuff accuracy: wrist cuffs *should not* cover the wrist bone. This is the most common mistake made and will give wildly inaccurate BP readings. I use my forefinger to measure one finger width away from my wrist bone as I put the cuff around my arm. I have instructed medical personnel about the improper placement over my wrist bone and they altered the placement when I pointed out that the wrist cuff covered my wrist bone.
I often do have to tell medical personnel how to properly apply the wrist cuff and to not talk to me while taking my blood pressure. To be fair to most medical assistants - I believe they are not receiving full and proper training on taking blood pressure.
The American Heart Association had in 2018-2019 an excellent colorful chart with instructions and practice tests especially for medical providers on the proper way to take blood pressure for accurate readings — but I cannot locate it online now.
The colorful chart I was looking for was easier to show to people, but this free journal article could be useful just for the illustrations that are included. If you are in need of more detailed information on Hypertension Practice Guidelines, this journal article covers those as well.
Thank you for this. I have so many stories about "just try" including one where I was put on blood pressure medication after a false high reading and a single dose dropped my already low/normal pressure so low I nearly had to be hospitalised. I could feel the blood whooshing through my heart and I nearly passed out. Now I have a wrist cuff machine at home and thankfully my GP accepts it and some of the hospital readings I've had.
My experience with wrist cuffs is that they are wildly inaccurate -- I would get readings differing by as much as 30 points within 5 minutes of one another. I tried several models of wrist cuffs but could never find one that was at all consistent or reliable.
Soooooo...question. Is taking blood pressure supposed to be painful? I've always found it very painful (and I'm generally high pain threshold/tolerance, stuff like piercings I don't even feel).
Ms. Chastain, how great and humbling to learn and read, thanks. It doesn't take long on the internet to see that yes, readings on those too-small blood pressure cuffs can be biased upward, as can the folks who take the readings. Me? I am a high school teacher who's intent on teaching a lot to our juniors and seniors about how our food environment has brought new diseases to school during my lifetime. I will remember your lesson!
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.
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....
This exact issue led to my most recent traumatic health care experience. The next appointment I had after that, I had to bring my best friend with me tas an advocate because I had a panic attack when I thought about returning to the facility. Which sounds extreme, but I'm autistic and often struggle to be heard by strangers and end up crying out of frustration/anger rather than being able to get results.
I had a nurse take my blood pressure last year on the forearm, after I mentioned that the blood pressure cuff always hurts my upper arm. She was the first person (in my mid thirties!) to inform me that a forearm reading was an option. Every time I had a reading taken after that, I told the provider that an upper arm reading hurts and that I would like a forearm reading. Every. Single. Time. I was told something dismissive like 'let's just try' or 'sorry, but that won't give an accurate reading' or 'oh, well, this cuff won't fit that way' and they pushed forward with the upper arm anyway.
Fast forward to earlier this year, when my blood pressure check before a urology procedure read as high. It was rechecked after the procedure and still read as high, so the woman taking it scheduled me for a standalone appointment in the future, just to check again--she told me that if my BP was still high then, it would mean I had hypertension, and they would probably put me on medication. I was kind of baffled by this since nobody had found an issue with my BP before, but she was very insistent about how lots of patients were 'getting away' with cancelling their blood pressure checks during the pandemic, and they 'had' to force follow-ups.
So I arrived for a standalone blood pressure check appointment, which I scheduled right before an appointment to get a foot injury looked at. I was ushered into an alcove with a BP machine rather than an actual room, where I explained to the tech that I had an appt soon after and hoped it wouldn't take long. She told me, much to my surprise, that I could have just gotten my blood pressure taken at that appt instead, but proceeded to check my BP. The reading was high, so she told me to 'relax' and left me sitting there for ten minutes. Rather than relaxing, I was growing more anxious at the idea that I might have to have more readings and miss my appointment.
After a similar second reading, reading number three came back fine, though by then I was deeply irritated at being nearly late for my foot appt. The tech noted that while my BP was fine, my heart rate was high, and left me sitting yet again to consult with the ER doctor on call. She came back many minutes later to say that I would be needing an EKG, and when I reminded her of my foot appt and protested, she said they 'could not let me leave with my heart rate that high' and that the doctor would look at my foot instead.
It took a while longer for the EKG tech to arrive with equipment, and until she did I sat there crying, just wanting to go home. The EKG reading went smoothly--the tech was nice, I knew it wasn't her fault I was stuck there--and then the ER doctor came in to read the results. He referred to me 'requesting' the EKG because of how my heart felt, and I corrected him, explaining that my heart rate read as high (no wonder) but I had no heart issues I was aware of and hadn't wanted an EKG at all.
He assured me that my results were fine, as though I had thought otherwise, and literally used a hand to push me back down against the table where I was laying whenever I tried to sit up a little to talk to him without him looming over me. Kept telling me to 'just relax' when he was the one causing me upset. I reminded him that I'd been told a doctor would look at my foot, since I had been forced to miss my appt, and he didn't even remove my shoe to do so--just told me to get it x-rayed and then follow up with my regular doctor.
Doing so meant waiting until the following week, so no one ever looked at it while it was at its most damaged. The EKG was ultimately a waste of time and medical resources, since it showed no problems. It was only initiated because my heart rate was high, and my heart rate was high after three separate painful BP readings on my upper arm while I watched the clock and worried about being late. And it turns out I never needed that separate special blood pressure check in the first place!
The next day, at home, I realized I had a bunch of small bruises on that upper arm area where the cuff had been. I brought my best friend with me to my 'follow up' the next week with my doctor, and was so glad I did--once again, the nurse tried to ignore me when I asked for a forearm reading, and having 'backup' helped when I insisted that they would either have to do so or use my other arm, because of the bruising.
I've honestly always found BP checks painful, and had no idea the problem could be a too-small cuff because of my size. But two weeks after I was told I probably had hypertension and one week after the hellish experience that skyrocketed my heart rate, I insisted on a forearm reading...and my BP was perfectly normal. (My doctor in THAT appointment was also literally the first person to ever mention that my feet should be flat on the floor during. And my best friend, who had just been diagnosed hypertensive, had never been told that either.)
Sorry for the long-winded rant, but thank you so much for writing specifically about blood pressure cuffs/dismissal of fat patients' needs during readings. It seems like such a small thing compared to other areas of discrimination, but it almost stopped me from being able to return and seek care that I sorely needed, because I no longer felt like I would be safe or listened to even around the most basic elements.
Just a note about wrist cuff accuracy: wrist cuffs *should not* cover the wrist bone. This is the most common mistake made and will give wildly inaccurate BP readings. I use my forefinger to measure one finger width away from my wrist bone as I put the cuff around my arm. I have instructed medical personnel about the improper placement over my wrist bone and they altered the placement when I pointed out that the wrist cuff covered my wrist bone.
I often do have to tell medical personnel how to properly apply the wrist cuff and to not talk to me while taking my blood pressure. To be fair to most medical assistants - I believe they are not receiving full and proper training on taking blood pressure.
The American Heart Association had in 2018-2019 an excellent colorful chart with instructions and practice tests especially for medical providers on the proper way to take blood pressure for accurate readings — but I cannot locate it online now.
I did find this journal article with similar instructions and illustrations: “2020 International Society of Hypertension Global Hypertension Practice Guidelines” found at https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA.120.15026.
The colorful chart I was looking for was easier to show to people, but this free journal article could be useful just for the illustrations that are included. If you are in need of more detailed information on Hypertension Practice Guidelines, this journal article covers those as well.
Thank you for this. I have so many stories about "just try" including one where I was put on blood pressure medication after a false high reading and a single dose dropped my already low/normal pressure so low I nearly had to be hospitalised. I could feel the blood whooshing through my heart and I nearly passed out. Now I have a wrist cuff machine at home and thankfully my GP accepts it and some of the hospital readings I've had.
My experience with wrist cuffs is that they are wildly inaccurate -- I would get readings differing by as much as 30 points within 5 minutes of one another. I tried several models of wrist cuffs but could never find one that was at all consistent or reliable.
Soooooo...question. Is taking blood pressure supposed to be painful? I've always found it very painful (and I'm generally high pain threshold/tolerance, stuff like piercings I don't even feel).
Does this mean that any 'too tight' blood pressure test will give a false reading no matter how big or small your arm is?
Ms. Chastain, how great and humbling to learn and read, thanks. It doesn't take long on the internet to see that yes, readings on those too-small blood pressure cuffs can be biased upward, as can the folks who take the readings. Me? I am a high school teacher who's intent on teaching a lot to our juniors and seniors about how our food environment has brought new diseases to school during my lifetime. I will remember your lesson!