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The changing distribution of arm circumferences in NHANES III and NHANES 2000 and its impact on the utility of the ‘standard adult’ blood pressure cuff

Graves, John W.a; Bailey, Kent R.b; Sheps, Sheldon G.a

Clinical and Pathophysiologic Studies

Background Accurate blood pressure measurement is dependent on using a blood pressure cuff that is appropriate to the patient's arm circumference.

Objective This study identifies the change in distribution of arm circumferences in the United States and its impact on usage of the ‘standard adult’ cuff.

Method The most current National Health and Nutritional Examination Survey (NHANES) data, available on the website (, covers NHANES III (Cycle 1, 1988–1991; 8381 subjects and Cycle 2, 1991–1994; 8566 subjects) and NHANES 2000 (1999–2000; 4,444 subjects). The weighted change in arm circumference between NHANES III as a whole and NHANES 2000 was calculated. Correlates for increased arm circumference were obtained via multivariate analysis. The predicted change in blood pressure cuff usage based on the changing prevalence of arm circumferences was calculated.

Results The mean arm circumference for the whole population increased significantly from NHANES III to NHANES 2000 (31.83±0.08 cm versus 32.86±0.15 cm, p < 0.001) and in the hypertension population without reaching statistical significance (33.07±0.16 to 33.61±0.30 cm, p=0.11). When adjusted regressions were performed, the increases in arm circumference were due to increasing weight in both the whole population and the hypertensives. The numbers of Americans predicted to require the ‘standard adult’ cuff to accurately measure blood pressure decreased from 76.2% to 66.3% while the number of Americans increased from 42.2% to 45%.

Conclusions The increasing prevalence of overweight and obese Americans found in NHANES III and NHANES 2000 has led to larger mean arm circumferences in hypertensives and the total population. This increased frequency of larger arm circumferences predicts that the ‘large adult’ cuff will be increasingly required in clinician's offices for accurate blood pressure measurement.

aDivision of Hypertension

bDepartment of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Correspondence and requests for reprints to John W. Graves MD, Division of Hypertension Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. Tel: +1 507 284 8712; fax: +1 507 284 1161


Received 06 June 2002 Revised 03 October 2003 Accepted 04 October 2003

© 2003 Lippincott Williams & Wilkins, Inc.