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Mean mid-arm circumference and blood pressure cuff sizes for US children, adolescents and adults

National Health and Nutrition Examination Survey, 2011–2016

Ostchega, Yechiama; Hughes, Jeffery P.a; Nwankwo, Tatianaa; Zhang, Guangyub

doi: 10.1097/MBP.0000000000000349
Statistical Methods

Background Measuring blood pressure (BP) requires an appropriate BP cuff size given measured mid-arm circumference (mid-AC).

Objective To provide mid-AC means and percentiles for US population aged more than 3 years and examine the frequency distribution of mid-AC cuffed by Baum and Welch Allyn cuff systems.

Patients and methods The 2011–2016 National Health and Nutrition Examination Survey, a cross-sectional survey, was used to estimate mean mid-AC (n=24 723).

Results Mean mid-AC did not differ from 2011 to 2016 (31.0 vs. 31.3 cm, P>0.05). During 2011–2016, mean mid-AC was greater for males than females (32.0 vs. 30.4 cm, P<0.001) and was largest among adults 40–49 years (34.0 cm). Non-Hispanic Black persons had the largest mean mid-AC (32.0 cm) and non-Hispanic Asian persons the smallest (28.4 cm). Increased BMI was associated with increased mean mid-AC for those 3–19 years (normal, 22.0 cm and obese, 31.5 cm, P<0.001) and more than 20 years (normal, 28.2 cm and obese, 37.8 cm, P<0.001). Among those aged 8–17 years, high BP status was associated with a larger mean mid-AC (normotensive 26.1 cm vs. high BP 28.2 cm, P=0.001). Among adults aged 18 years and older, hypertension status was associated with a larger mean mid-AC (normotensive 32.4 cm vs. hypertensive 34.2 cm, P<0.001). Among those aged 12–19 years, 13.0% required a Baum large cuff (35–46.9 cm mid-AC) and 21.7% required a Welch Allyn large cuff (32–39.9 cm mid-AC). Among those aged more than 20 years, 33.2% required a Baum large cuff, 48.2% required a Welch Allyn large cuff, 1.3% required a Baum extra-large cuff (44–66 cm mid-AC), and 9.5% required a Welch Allyn extra-large cuff (40–55 cm mid-AC).

Conclusion Currently, BP is obtained in clinic, pharmacy, home, and ambulatory setting using single or multiple cuffs. National Health and Nutrition Examination Survey mid-AC data should be considered for accurate cuffing avoiding cuff hypertension or hypotension.

aDivision of Health and Nutrition Examination Surveys

bDivision of Research and Methodology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA

Correspondence to Yechiam Ostchega, PhD, RN, National Center for Health Statistics, NHANES Program, 3311 Toledo Road, Rm. 4319, Hyattsville, MD 20782, USA Tel: +1 301 458 4408; fax: +1 301 458 4028; e-mail:

Received May 16, 2018

Accepted August 18, 2018

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