Blood Pressure Monitoring at Home: Choosing the Right Device & Cuff Size

Are you monitoring your blood pressure at home? Did you know that using the wrong size blood pressure cuff can lead to inaccurate readings? In this episode, we'll discuss the importance of choosing the right blood pressure cuff size and the different types of blood pressure monitors available. We'll provide tips for selecting a validated device and ensuring you get the most accurate readings possible for effective blood pressure management.

Takeaways

• Blood pressure monitoring at home is crucial for accurate health assessment.
• Choosing the correct cuff size is essential for accurate readings.
• Most people need a large or extra-large blood pressure cuff.
• Validatebp.org is a recommended resource for selecting blood pressure monitors.
• Automatic upper arm monitors are preferred over wrist or finger monitors.
• Taking blood pressure in a calm environment yields better results.
• It's important to compare home readings with those taken at the doctor's office.
• Lifestyle changes can significantly impact blood pressure management.
• Engaging with listeners can enhance the podcast experience.
• Thanksgiving can be a time to enjoy personal favorite foods rather than traditional dishes.

Keywords

blood pressure, health, home monitoring, cuff size, patient education, lifestyle changes, healthcare, wellness, medical advice

Transcript

Ed Delsky, MD (00:01)
Hi, welcome back to your checkup. We are the patient education podcast where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm at Delesky a family medicine resident in the Philadelphia area.

Nicole Aruffo, RN (00:15)
And I'm Nicole Aruffo. I'm a nurse.

Ed Delsky, MD (00:17)
And we are so excited that you were able to join us here again today.

That was a long week.

Nicole Aruffo, RN (00:24)
Yeah, yeah, it was a long week

Ed Delsky, MD (00:28)
But we're done. That's it. No more nights in residency. And tonight we're having girl dinner.

Nicole Aruffo, RN (00:35)
I'm so excited.

Ed Delsky, MD (00:37)
There's been a lot of preparation. You are a queen for preparing to host our first annual blended family.

Nicole Aruffo, RN (00:49)
Relax on the annual.

Ed Delsky, MD (00:51)
The first, first monthly annual.

Nicole Aruffo, RN (00:54)
monthly annual Chili's meeting.

Ed Delsky, MD (00:57)
Thanksgiving, Sam's turkey. Yep, I said it. No turkey here.

Nicole Aruffo, RN (01:03)
No turkey, it's gonna be a glorious thing.

Ed Delsky, MD (01:07)
Well, here's the thing. Everyone, anyone who I've ever been around complains about the turkey, maybe save for my brother-in-law on Thanksgiving and ruse the fact that it's there. It's a pain to cook and it's like.

Nicole Aruffo, RN (01:20)
Yeah, you spend like all this time on something that like people don't like.

Ed Delsky, MD (01:24)
Yeah,

so like why?

Nicole Aruffo, RN (01:27)
And like, we're not pilgrims, you know? We have other things besides a turkey to eat.

Ed Delsky, MD (01:36)
Yeah, you take a whole day. mean, homage to the pilgrims. don't the whole tradition of a turkey. Maybe I could do a little bit more. Do you know anything about that?

Nicole Aruffo, RN (01:45)
I think at one point in my life I did, but no.

Ed Delsky, MD (01:48)
little world. you just actually have nothing to

Well, yeah, this is my thought. I remember having a conversation with my mom over the last couple of years about this. And why not have the favorite foods that you like? And so that's exactly what we're going for this year. And we will report back about how it goes. know, who knows how it'll be received? And people walk through the door and they do or don't Not going to be a turkey. Play nice. And we'll see how that goes.

Nicole Aruffo, RN (02:13)
Unless they don't like it, they can leave.

Ed Delsky, MD (02:22)
For updates on the show, mean, we we love when new people listen to the show. And what we've been finding is that people have go back and they listen to a lot of our old episodes, which we're so happy about. And specifically, the treat your blood pressure with lifestyle changes has been a really popular episode recently. And so heading into Thanksgiving week, we wanted to kind of revisit some blood pressure topics and bring some of that to you.

Here, so we're going to continue the conversation today about blood pressure. Before we do that, do you have any other thoughts? Like how excited are you for girl dinner?

Nicole Aruffo, RN (03:04)
I'm so excited for girl dinner. I know it doesn't sound like it, but I am.

have a snack cheese. Well, we went to TJ's because we had to get cheese for our charcuterie board for Thanksgiving. So then obviously, you know, we got us a bunch of snacks and then we decided we're going to have girl dinner. We got a snack cheese for ourselves. We got wait, what else did we get?

Ed Delsky, MD (03:36)
the the butternut squash mozzarella or butternut squash balls

Nicole Aruffo, RN (03:42)
yeah, like mac and cheese bites. Pot stickers.

Ed Delsky, MD (03:44)
potstickers,

which are actually not as bad calorically as you would think. We discovered that this week. That was really great.

Nicole Aruffo, RN (03:53)
you

Ed Delsky, MD (03:56)
We got really excited about that. There's nothing to the potsticker, you remember?

Nicole Aruffo, RN (04:00)
Yeah, I remember.

Ed Delsky, MD (04:03)
We were like, there's only like 100 calories in so many of them. And that's like, it was really exciting for us at the time.

Nicole Aruffo, RN (04:09)
It's still exciting. There's a lot of sodium though. And you eat it with soy sauce, it's more not good for the blood pressure.

Ed Delsky, MD (04:15)
That's fair. Speaking of sodium, what are we going to talk about today, Nick?

Nicole Aruffo, RN (04:19)
Today we're talking about at-home blood pressure measurements, which we kind of already talked about in one of our blood pressure episodes, but more like choosing the correct cuff size. There's a lot that goes into that.

Ed Delsky, MD (04:35)
Yeah, this is always a quick thing that comes up at the end of a visit, I'd say, where people are like, I'm like, you have high blood pressure and I need you to take your blood pressures at home. And since doing this, this podcast, I've, you know, I've definitely had the script about how to tell someone that like both feet on the ground, have your back on the chair, have it gone to the bathroom, sit in a quiet place for five minutes. And, you know, that line comes out, but there's a whole.

There's a whole other step to that is like that person has to acquire a blood pressure cuff themselves. Usually, unfortunately, insurances aren't great at covering blood pressure cuffs. Yeah, everyone's always like, yeah, we'll get it through your insurance. But I really haven't met anyone who has been able to do that. Have you?

Nicole Aruffo, RN (05:22)
Sometimes, at least in Pennsylvania, like one of the Medicaid's will, like might be Keystone first, I don't know, don't quote me on that. But it's like very specific and like has to be ordered by like the PCP that's like assigned to them or whatever. like, you there's a whole to do.

Ed Delsky, MD (05:46)
Yeah. So all that to say, we want to take that specific moment of you need to take your blood pressures at home and expand that out today. So blood pressure measurements at home are incredibly important. They give more information about your blood pressure at all times. When we take a blood pressure measurement in the office, it could be high because there's some clinical entity called white coat hypertension where we see that people have high blood pressure just in health care settings.

So we want to know what your blood pressure is like when you're resting, when you're at home in your environment that you're always living in. so let's dive in. Let's talk about cuff size first. Nick, why is it so important?

Nicole Aruffo, RN (06:37)
important of correct blood pressure size.

yeah.

Ed Delsky, MD (06:45)
Do you want to do that? great. So Nick, can you tell us why it's so important to have the correct size blood pressure cuff?

Nicole Aruffo, RN (06:55)
can.

Ed Delsky, MD (06:57)
May you do that.

Nicole Aruffo, RN (07:01)
Well, if it's not the right size, then the reading of the blood pressure will be wrong. And then that will, if the cuff is too small, it'll be too tight on your arm. And then the blood pressure will be higher than it actually is. And then if it's too big, it'll be too loose and the blood pressure will be too low or it'll read too low and not be accurate. That's a big thing in PEDs.

Especially with those like little baby cuffs and stuff. Yeah.

Ed Delsky, MD (07:31)
That's huge. I didn't consider that when making this episode. That's the beauty of having you around. So I would say that adult sizes are determined by the mid arm circumference. And I would say in all of the reading and education from the American Heart Association and various different articles looking at to produce this.

Nicole Aruffo, RN (07:41)
I know.

Ed Delsky, MD (08:00)
Blood pressure cuffs are broken down into four essential categories that are rather simple. So there are small adult blood pressure cuffs, which are about 26 centimeters or less, about 10 inches, if you take a tape measure and measure around the midarm. Regular adult blood pressure cuffs, which are anywhere from 26 centimeters to 34 centimeters, otherwise set about 10-ish to 13-ish inches.

a large adult cuff, which is about 34 centimeters to 44 centimeters, anywhere from 13 to 17 inches, and an extra large adult cuff, ranging greater than 44 centimeters or more than 17, more than 17 inches or greater. I think that there's something to be said for looking at the cuffs available in the blood pressure cuff that you're ordering.

Like while we said that, that like there are four different sizes, I don't think all of them come with the four different sizes.

Nicole Aruffo, RN (09:02)
Well, a lot of them are adjustable, I think.

Ed Delsky, MD (09:05)
Okay. So that they would cover a number of them. Yeah. Okay. But just to be known that it, like when you're going out and considering ordering a blood pressure cuff and device, considering them as two separate pieces that you need to consider the mid-arm circumference. So I guess what I would say is like you have one of those tape measures that are kind of loose, like a tailor's tape measure. And if you're able to yourself or have a friend or a family member, a loved one, a neighbor maybe who

can actually take the mid arm halfway between your elbow and your shoulder and measure that bicep. So if you are ripped like Ali, maybe you'll have a bigger arm or maybe you have a smaller arm. But it's good to know. And then you can look back and think at this episode and think, where do I fall in one of those categories? So we were able to mention that there are

four different cuff sizes and there's actually been research done. So the National Health and Nutrition Examination Survey and Haines was conducted between 2015 and 2020 and provided a breakdown that we're going to review of the amount of people that live in each of the cuff size ranges. So there are people who live in the small adult cuffs. This is about 6 % of the US adult population.

And that translates to about 16 million people who would need a small adult cuff. The regular quote unquote adult cuff are the sizes that we mentioned earlier, 26 centimeters to 34 centimeters. This actually was about 51 % of U.S. adults. And that was falls and translates to about 125 million people. The large adult cuff, like we said earlier, 34 to 44 centimeters of the circumference of the midarm is about 40%.

or 96 Americans and extra large adult cuffs greater than 44 centimeters was about 3 % of the population or 8 million individuals. And so there's people out there for all shapes and sizes that who need all different shapes and sizes of blood pressure cuffs. And so all of that to say with that breakdown that we provided that you can do the math and say that generally most people need a large or extra large cuff size and

Certainly we've talked about in other episodes how there are rising rates of people having obesity in the United States. And so over time, this will probably just increase. so keeping that in mind of the large and extra large cuffs is definitely something we need to do. So we spent some time talking about blood pressure cuffs, but that's separate from an actual blood pressure device that's able to actually measure the blood pressure.

If you really wanted to measure the blood pressure, you would actually have to stick a needle in your artery and then it would measure it. And this is only just a proxy, which is why we have such a tough time wrestling this down and treating it. But we can only do the best we can. And that's usually with at home blood pressure monitors. So Nick, tell us what blood pressure cuff we should be using.

Nicole Aruffo, RN (12:16)
Well, the American Heart Association and probably every physician everywhere will recommend the kind that goes around your arm. There are ones that can go around your wrist that seem pretty popular and then also like a finger one. Don't get them. Nope.

Ed Delsky, MD (12:38)
No, they're inaccurate.

Nicole Aruffo, RN (12:40)
Yeah, like the farther away from your heart you get, the less accurate it gets.

Ed Delsky, MD (12:44)
Totally. Yeah. I think it's also falsely high. The blood vessels in your in your arteries down there will stiffer and just give wrong information. So if you have a wrist cuff out there that you spent some money on, I'm so sorry. But are there any more specific details that we should just bring this here? No. So what I'm trying to get at is that the American Heart Association

Nicole Aruffo, RN (13:04)
that doesn't know how to do that.

Ed Delsky, MD (13:11)
had recommends specifically an automatic as opposed to manual blood pressure cuff and device with an upper arm motor. you're, you're over there having a reaction to like, yeah, people are measuring their blood pressure cuff manually at home.

Nicole Aruffo, RN (13:28)
Do you know people personally that are doing that at home? Yes. They have a stethoscope and a manual blood pressure cuff? Yes. Who?

Ed Delsky, MD (13:36)
That's not fair. That's not fair. But I've known people to do that. the flaw is not the intent that's wrong. It's the that the fact that the machines like and we had this in our own office, like people don't know how these things are calibrated or when they were last calibrated. They come out of the box and it's like, well, what the heck is going on? So if it's manual, you could be squeezing to whatever pressure and however high up that needle goes. Whenever you're listening to the blood pressure, you're listening for a couple of sounds. So.

Nicole Aruffo, RN (14:03)
What would be so hard to do on yourself?

Ed Delsky, MD (14:05)
Well, I think people have a family member do it. at least in the one that's coming up in my mind of like the people I know.

Nicole Aruffo, RN (14:13)
Okay, when you said doing it on themselves.

You said doing it on themselves. So I thought you meant someone sitting there with the stethoscope in their ear and the blood pressure cuff on. Yeah. Yeah.

Ed Delsky, MD (14:26)
the piece that was like doing a manual.

no, they're having someone in their family do a manual blood. But that's not recommended. I mean, I guess it's the only thing you can do, but that's not the one that's recommended. Yeah, I'm glad we I'm glad we digested that. You know, we're also like fine tuned over here with our delivery. But like there's raw reactions of like people are doing that.

Nicole Aruffo, RN (14:34)
Okay.

Ed Delsky, MD (14:54)
Okay, so then also some of this episode was sparked up because a patient asked me, like, which blood pressure cuff should I do? And she pulled up a website and she pointed her phone at my direction and said, pick one. And I didn't have a great answer at the time. And so I really wanted to take some time and figure out like, well, how the heck are we doing this? Because like cost is of course an issue. There's a lot of like bells and whistles on each of these that we need to do.

But is there one specific place that we can go to that can redirect people about where to go?

Nicole Aruffo, RN (15:31)
There is, and it's a website called validatebp.org.

Ed Delsky, MD (15:37)
Yeah, this website was something that I found when I was looking on like how someone is to choose a blood pressure cuff. This website has a relationship where they are endorsed by the American Medical Association. They don't sell the blood pressure cuffs, but they go through and review each of them and they give the name. They give different parameters of the blood pressure cuff. They tell you what size there is. They tell you what features it has. Like is there a Bluetooth connectivity?

Is there an app that's associated with it? Does the blood pressure cuff have a memory so that it can go back and listen, remember which blood pressure measurements were there in the past? So when you bring it to your doctor, then they can review it. so validatebp.org is a terrific option where you can go through, see which ones the American Medical Association gives the thumbs up on, and you can go from there. Just look today, there's like.

and Omron on there, which is a popular brand that you're gonna hear about that has $1 sign. And we looked at it, you can get it for like $34 at Walmart is what I was seeing. And then there are plenty of others with other bells and whistles, but validatebp.org is the place that you should go looking for that automatic cuff style upper arm monitor that is specifically not a wrist or finger monitor.

Nicole Aruffo, RN (17:00)
and not a manual blood pressure cuff that you're doing on yourself alone with nobody.

Ed Delsky, MD (17:09)
And I was mentioning like bells and whistles. So you might consider there are other things to think about like ease of use or costs. Like, are you willing to spend more money and invest in a blood pressure cuff or are there other features like do they detect an irregular heartbeat, which may be a little iffy. There are other devices out there, like something called cardio mobile. When I was working with a cardiologist, you just like stick your fingers on it and it gives you the heartbeat. Or like I said, the Bluetooth connection where you can log it.

and are you writing your blood pressures down on a piece of paper or do you have a log on your phone? How are you communicating them to the person taking care of you? And so when you have this blood pressure cuff, say you went through Validate BP, you measured your arm, you have the right cuff size, you're ready to go, what should you do next?

Nicole Aruffo, RN (17:58)
You should take it to your doctor next time you go to the office so that you can do your blood pressure there with your cuff and then with their cuff and compare them and make sure that they're both giving you the same readings. So you know if it's right, which like it probably is, but.

Ed Delsky, MD (18:16)
And one more time, because we can't say this message enough, how should you take your blood pressure at home?

Nicole Aruffo, RN (18:22)
You should take your blood pressure first thing in the morning, after you've gone to the bathroom, and before you've had anything to eat or had any of your coffee. You want to be sitting upright. If you can, sit for about five minutes before both feet on the ground. Sitting upright, if I didn't already say that.

and then you're in prime position to take your blood pressure.

Ed Delsky, MD (18:51)
And then you're going to do it with your new correct blood pressure cuff automated upper arm.

Nicole Aruffo, RN (18:59)
everyone's going to be getting beautiful blood pressures at home.

Ed Delsky, MD (19:02)
can't wait. Wonderful. So hopefully today you were able to learn something a little bit more as we expand on blood pressure that would help you, a loved one or...

Nicole Aruffo, RN (19:13)
a neighbor checking their blood pressure.

Ed Delsky, MD (19:16)
We hope that everyone visits our website, sends us some fan mail. If you have any personal experiences that you want us to dive through, go ahead. You had a thought.

Nicole Aruffo, RN (19:25)
I was just going to ask if we heard from our loyal listener this week.

Ed Delsky, MD (19:28)
Unfortunately, the fan mail has been blank. haven't. We haven't heard from our loyal listener.

But you really want to encourage anyone listening that you can reach out. I read them and then I share them with Nikki. And if you have a story that you'd like us to talk about, I'm thinking about adding a segment later in the week, like a second episode later in the week of like someone's story that they want shared, or if anyone has a question or they have a topic or just a thought about how things are going on the show, we would love to hear from you. Please check out our Instagram. Please send us an email at your checkup pod at gmail.com. But most important,

Happy Thanksgiving and stay healthy, my friends. I'm Ed Delesky Thank you and goodbye. Bye.

Nicole Aruffo, RN (20:07)
I'm Nicole Aruffo

Gorgina.

Ed Delsky, MD (20:17)
This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person.

This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. I'm your nurse. And make sure you go get your own checkup with your own personal doctor.

Nicole Aruffo, RN (20:54)
I'm not your