Thank you for this breakdown!! I had no idea. I went through both EMT and CNA training in the mid-1990’s, and the effects of BP on cuff size were heavily stressed (it was even part of my CNA exam), but a troncoconical cuff was NEVER mentioned.
And now today in 2024, with fat conical arms, I am just now learning about it. Amazing.
I wonder how many fat people have been treated inappropriately for HPB because of improper cuffs, and improper cuffs combined with the stress of anti-fatness in medical settings. And how many more had negative reactions to the BP meds they didn’t need.
THANK YOU!!!!! Immediately going to request these for our hospital. It drives me nuts taking blood pressures on wrists and ankles for people with peripheral vascular disease and other conditions that affect circulation. The little arrows on the cuff need to be over the brachial artery (and that's where you put the stethoscope if you do it manually, which is more accurate); the longer cuffs may fit the larger part of the upper arm, but there's usually a huge gap around the bottom edge of the cuff WHICH IS THE MOST IMPORTANT PLACE TO GET A GOOD FIT. And if you try to make a conical shape by just slanting the rectangular cuff, it's not accurate and usually just busts through the velcro. In the ICU, we do so many interventions based on blood pressure, and we owe it to our larger patients to be as accurate and diligent as possible.
Thanks for this Ragen! It enrages me that there are so many factors that make blood pressure reading falsely high in fat people, the main one being the cuff. I have bought a larger one to replace the tiny one that came with the home machine but the shape of it is just so wrong I can’t manage to get any reading. Do you know if there’s a way to buy a conical cuff as an individual? A search only lands research results but I can’t find any website in North America that sells those.
This is the Medline one from Ragen's column-- it looks like it would fit into the Medline automatic BP machines on the site, but you'd have to confirm w/the supplier. Also, it says you need a prescription unless you're a provider, so that's an additional step you have to take. But five cuffs for $33, and a monitor for $25-40.
Oh that’s a good one, I’m in Canada so if it requires a prescription I wouldn’t be able to buy it but it’s the best link I’ve seen so far. It’s a bit ridiculous they require a prescription when anyone can buy the other cuffs 🤷♀️
We re-use them with the same patient in the hospital either for their length of stay or until they get all sweaty and gross. Anecdotally, they seem to maintain their accuracy.
thanks for the information. I have never about or seen a cuff like this before. i was recently at the docotors and they used a cuff that was hard/rigid on the outside w/ an inflatable inside. it was sort of hinged with multiple joints that fold around the arm and then fasten w/ velcro. do up have any idea about what i'm describing and if so, is it any good at measuring. thanks
thanks for the info. I kind of do as well. Maybe in part since they are always pushing weighing in the office so i don't trust them for being sensitive/aware of the issues of people in bigger bodies at all
First, thanks for all you do for us fats! You have provided such great resources and info! My question is about (and please forgive my privilege here) getting a cuff for not only home use but to take with me to my doctors' offices. I have found one online that seems to have a fairly universal connector. What are your thoughts on not only bringing my one (since I have that economic ability) but also finding one to use at home. I currently have a wrist cuff. Thanks!
Glad to be of a little help. I think taking it to the doctor is a great idea and if the one you found doesn't work, you could return it and then you could ask what company they use and then ask them/purchase one from that company. Unfortunately I don't know of an at-home option, I'll keep looking!
I realize I am a week late on joining in on this discussion but I am SO GLAD I realized I missed this and went back to read it! The blood pressure machines that most medical offices like to use do not seem to work for me. Not that they don't work well - they don't - but in many cases, they don't work at all. My arm will fit in the (larger sized cylindrical) cuff but the machine will try to get my reading like four times before erroring out. I had to have a spinal block last spring for an ongoing back issue and when they did my pressure at intake before I went into the surgical suite for my injections, my readings were so high the nurse on duty went "well, you aren't stroking out right now so that's clearly not right." And she basically ignored it and just moved on.
I have told and told and told people "the machines don't work on me" and I've had exactly ONE provider able to do it manually. Most either try and fail, shrug and move on; or try, get a completely absurd reading, note it down in the chart or whatever, and still shrug and move on. It's absolutely ludicrous! At least now I know what to ask for and if I need to get my own to take with me to appointments, so freaking be it.
Thank you SO MUCH for sharing this! Its insane to me how many things should AND COULD be done differently or better for people in larger bodies and just......aren't. Despite the fact that as a people, we are only getting bigger, not smaller. So bananas.
....I'm supposed to be checking my blood pressure at home, and I did buy a larger cuff. And while my upper arm is only 41 cm, and that is in the range for the cuff, I wonder if this is why the cuff always slides down to my elbow.
Also have never seen a conical cuff at any doctor's office. Heck half the time they have to go searching for the larger cuffs.
Do you know what the relative accuracy of a rectangular cuff used on the forearm instead of the upper arm is? That's what they always do at my doctor's office but now I'm wondering. They've got me on meds for HBP.
I can't get a clear answer on this (and a content warning that the studies I'm about to mentioned are absolutely drenched in weight stigma. There seem to be small studies with disagreeing conclusions. For example:
A study in 2004 (Blood pressure measurement in ob*se patients: comparison between upper arm and forearm measurements) found that "forearm blood pressure measurement overestimates the values of arm blood pressure measurement" but a 2018 study (Blood Pressure Measurement in S*v*r*ly Ob*se Patients: Validation of the Forearm Approach in Different Arm
Positions) found "Forearm systolic blood pressure consistently agreed with the gold standard in the supine position"
Thank you for this breakdown!! I had no idea. I went through both EMT and CNA training in the mid-1990’s, and the effects of BP on cuff size were heavily stressed (it was even part of my CNA exam), but a troncoconical cuff was NEVER mentioned.
And now today in 2024, with fat conical arms, I am just now learning about it. Amazing.
I wonder how many fat people have been treated inappropriately for HPB because of improper cuffs, and improper cuffs combined with the stress of anti-fatness in medical settings. And how many more had negative reactions to the BP meds they didn’t need.
Me. My whole life. I have only learned of this today, despite a long history of Bariatric medical “care.”
THANK YOU!!!!! Immediately going to request these for our hospital. It drives me nuts taking blood pressures on wrists and ankles for people with peripheral vascular disease and other conditions that affect circulation. The little arrows on the cuff need to be over the brachial artery (and that's where you put the stethoscope if you do it manually, which is more accurate); the longer cuffs may fit the larger part of the upper arm, but there's usually a huge gap around the bottom edge of the cuff WHICH IS THE MOST IMPORTANT PLACE TO GET A GOOD FIT. And if you try to make a conical shape by just slanting the rectangular cuff, it's not accurate and usually just busts through the velcro. In the ICU, we do so many interventions based on blood pressure, and we owe it to our larger patients to be as accurate and diligent as possible.
And it hurts when done repeatedly!!
Thanks for this Ragen! It enrages me that there are so many factors that make blood pressure reading falsely high in fat people, the main one being the cuff. I have bought a larger one to replace the tiny one that came with the home machine but the shape of it is just so wrong I can’t manage to get any reading. Do you know if there’s a way to buy a conical cuff as an individual? A search only lands research results but I can’t find any website in North America that sells those.
Try searching "contour" blood pressure cuff. I'm getting more hits with that.
This is the Medline one from Ragen's column-- it looks like it would fit into the Medline automatic BP machines on the site, but you'd have to confirm w/the supplier. Also, it says you need a prescription unless you're a provider, so that's an additional step you have to take. But five cuffs for $33, and a monitor for $25-40.
https://www.bettymills.com/medline-bariatric-contour-blood-pressure-cuffs-5-each-per-bag-mds9914bc-medmds9914bc
Oh that’s a good one, I’m in Canada so if it requires a prescription I wouldn’t be able to buy it but it’s the best link I’ve seen so far. It’s a bit ridiculous they require a prescription when anyone can buy the other cuffs 🤷♀️
This one also appears to be a "disposable" cuff - not sure how many times they can be re-used, if at all?
We re-use them with the same patient in the hospital either for their length of stay or until they get all sweaty and gross. Anecdotally, they seem to maintain their accuracy.
Good to know!!
From Walgreens:
https://www.walgreens.com/store/c/walgreens-blood-pressure-cuff-extra-large/ID=300405377-product
That's an extra-large cuff, but it's not conical.
Rats-- it's conical in one picture but you're right. The search continues.
thanks for the information. I have never about or seen a cuff like this before. i was recently at the docotors and they used a cuff that was hard/rigid on the outside w/ an inflatable inside. it was sort of hinged with multiple joints that fold around the arm and then fasten w/ velcro. do up have any idea about what i'm describing and if so, is it any good at measuring. thanks
I've seen those in drugstores-- not sure about the technology behind it, but it always seemed to read higher my average. I find them sus.
thanks for the info. I kind of do as well. Maybe in part since they are always pushing weighing in the office so i don't trust them for being sensitive/aware of the issues of people in bigger bodies at all
First, thanks for all you do for us fats! You have provided such great resources and info! My question is about (and please forgive my privilege here) getting a cuff for not only home use but to take with me to my doctors' offices. I have found one online that seems to have a fairly universal connector. What are your thoughts on not only bringing my one (since I have that economic ability) but also finding one to use at home. I currently have a wrist cuff. Thanks!
Glad to be of a little help. I think taking it to the doctor is a great idea and if the one you found doesn't work, you could return it and then you could ask what company they use and then ask them/purchase one from that company. Unfortunately I don't know of an at-home option, I'll keep looking!
Brilliant! How had I never known about these necessary cuffs, even after decades in fat community!?! Waddling off to buy one now. Thank you!!!
I simply cannot thank you enough!!
I realize I am a week late on joining in on this discussion but I am SO GLAD I realized I missed this and went back to read it! The blood pressure machines that most medical offices like to use do not seem to work for me. Not that they don't work well - they don't - but in many cases, they don't work at all. My arm will fit in the (larger sized cylindrical) cuff but the machine will try to get my reading like four times before erroring out. I had to have a spinal block last spring for an ongoing back issue and when they did my pressure at intake before I went into the surgical suite for my injections, my readings were so high the nurse on duty went "well, you aren't stroking out right now so that's clearly not right." And she basically ignored it and just moved on.
I have told and told and told people "the machines don't work on me" and I've had exactly ONE provider able to do it manually. Most either try and fail, shrug and move on; or try, get a completely absurd reading, note it down in the chart or whatever, and still shrug and move on. It's absolutely ludicrous! At least now I know what to ask for and if I need to get my own to take with me to appointments, so freaking be it.
Thank you SO MUCH for sharing this! Its insane to me how many things should AND COULD be done differently or better for people in larger bodies and just......aren't. Despite the fact that as a people, we are only getting bigger, not smaller. So bananas.
....I'm supposed to be checking my blood pressure at home, and I did buy a larger cuff. And while my upper arm is only 41 cm, and that is in the range for the cuff, I wonder if this is why the cuff always slides down to my elbow.
Also have never seen a conical cuff at any doctor's office. Heck half the time they have to go searching for the larger cuffs.
Do you know what the relative accuracy of a rectangular cuff used on the forearm instead of the upper arm is? That's what they always do at my doctor's office but now I'm wondering. They've got me on meds for HBP.
I can't get a clear answer on this (and a content warning that the studies I'm about to mentioned are absolutely drenched in weight stigma. There seem to be small studies with disagreeing conclusions. For example:
A study in 2004 (Blood pressure measurement in ob*se patients: comparison between upper arm and forearm measurements) found that "forearm blood pressure measurement overestimates the values of arm blood pressure measurement" but a 2018 study (Blood Pressure Measurement in S*v*r*ly Ob*se Patients: Validation of the Forearm Approach in Different Arm
Positions) found "Forearm systolic blood pressure consistently agreed with the gold standard in the supine position"
Sorry I don't have more helpful information.