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.