Accurate arm circumference (AC) measurement is required for accurate blood pressure (BP) readings. Standards stipulate measuring arm circumference at the midpoint between the acromion process (AP) and the olecranon process. However, which part of the AP to use is not stipulated. Furthermore, BP is measured sitting but arm circumference is measured standing. We sought to understand how landmarking during AC measurement and body position affect cuff size selection. Two variations in measurement procedure were studied. First, AC was measured at the top of the acromion (TOA) and compared to the spine of the acromion (SOA). Second, standing versus seated measurements using each landmark were compared. AC was measured to the nearest 0.1 cm at the mid-point of the upper arm by two independent observers, blinded from each other\'s measurements. In 51 participants, the mean (±SD) mid-AC measurement using the anchoring landmarks TOA and SOA in the standing position were 32.4 cm (±6.18) and 32.1 cm (±6.07), respectively (mean difference of 0.3 cm). In the seated position, mean arm circumference was 32.2 (±6.10) using TOA and 31.1 (±6.03) using SOA (mean difference 1.1 cm). Kappa agreement for cuff selection in the standing position between TOA and SOA was 0.94 (p < 0.001). The landmark on the acromion process can change the cuff selection in a small percentage of cases. The overall impact of this landmark selection is small. However, standardizing landmark selection and body position for AC measurement could further reduce variability in cuff size selection during BP measurement and validation studies.

UNASSIGNED: Some brachial cuffs for oscillometric blood pressure (BP) measurement are claimed to cover a wide range of upper-arm circumferences; however, their validation is rarely conducted. Our aim was to compare oscillometric BP measurements obtained with a universal cuff with those obtained with an appropriately sized cuff.
UNASSIGNED: We utilised the Microlife B6 Connect monitor, conducting oscillometric BP measurements in a random sequence with both a universal cuff (recommended for arm circumferences from 22 to 42 cm) and an appropriately sized cuff (medium for circumference 22-32 cm and large for 32-42 cm). We included 91 individuals with an arm circumference of 22-32 cm and 64 individuals with an arm circumference of 32-42 cm.
UNASSIGNED: For arm circumferences > 32 cm, systolic and diastolic BP measured with the universal cuff was higher than that measured with the large cuff (systolic 6.4 mmHg, 95% confidence interval [CI]). 3.9-8.8, diastolic 2.4 mmHg, 95%CI, 1.2-3.7, p < 0.001 for both). Overestimation of BP with the universal cuff was statistically significant after correcting for the sequence of measurements. No statistical difference was found between the universal cuff and medium cuff for circumferences in the 22-32 cm range. The bladder size in the universal cuff matched the dimensions of the medium-sized cuff; however, the cuff was larger.
UNASSIGNED: Overestimation of BP measured with a universal cuff in persons with large arm circumferences is clinically important. It poses the risk of unnecessary initiation or intensification of antihypertensive medication in persons using the universal cuff.
What is the context?Clinical guidelines recommend individualisation of the size of the cuff used for blood pressure measurement according to the circumference of the upper arm.Many blood pressure monitors are sold with a single “universal” cuff claimed to cover a wide range of upper arm sizes.We compared blood pressure obtained with the Microlife B6 Connect monitor and a “universal” cuff with the results obtained with individual sized cuffs (medium size for arm circumference between 22 and 32 cm and large size for arm circumference between 32 and 42 cm).What is new?In persons with large upper arm circumference is the systolic blood pressure 6.4 mmHg higher and the diastolic blood pressure 2.4 mmHg higher with the universal cuff than with the individual-sized large cuff.What is the impact?The universal cuff overestimates blood pressure in persons with large arm circumference.

UNASSIGNED: This study aimed to determine the effect of a cuff properly sized for mid-upper arm circumference on blood pressure measurement in obese surgical patients.
UNASSIGNED: This prospective crossover clinical trial was conducted with 100 patients who had body mass index ≥30 kg/m2 and mid-upper arm circumference ≥27 cm and were admitted to the general surgery unit of a medical faculty hospital in İstanbul, Turkey between January 1, 2015, and December 31, 2015. Blood pressure of the patients was measured using a small-sized adult cuff and a cuff properly sized for mid-upper arm circumference.
UNASSIGNED: Among the patients, 39% were morbidly obese and 67% had mid-upper arm circumference between 35 and 44 cm. Systolic blood pressure of the patients with a small adult cuff was 20.78 mmHg higher than that obtained with a cuff properly sized for mid-upper arm circumference, and their diastolic blood pressure was 10.15 mmHg higher on average (p<0.001). Only 6% of those with systolic hypertension according to the small adult cuff readings were found to have hypertension according to the cuff properly sized for mid-upper arm circumference (p<0.001).
UNASSIGNED: The results showed that, in obese surgical patients, blood pressure is measured inaccurately and found to be falsely high when measurements are not performed using a cuff properly sized for mid-upper arm circumference.

Narrow cuffs cause less discomfort than wide cuffs immediately following elbow flexion exercise in combination with blood flow restriction, possibly due to a balling up effect of the bicep underneath the cuff. In this study, we sought to examine the impact of cuff width, sex, and pressure on perceived discomfort in the quadriceps, following knee extensions. One hundred participants completed three separate experiments. In Experiment 1, we compared participants\' discomfort at rest after using a 5 and a 12 cm cuff. In Experiment 2, we compared the discomfort from these two cuffs after four sets of exercise. In Experiment 3, we used the same exercise protocol as in Experiment 2, but we compared the discomfort between a 12 cm cuff inflated to an inappropriate pressure and a 12 cm cuff inflated to the recommended pressure. We found no sex differences in Experiments 1 and 3. In Experiment 1, the narrow cuff had higher discomfort (16 vs 12 AU). In Experiment 2, men reported higher discomfort than women, with no discomfort differences related to cuff width, though narrow cuffs were most preferred. In Experiment 3, cuffs inflated to a pressure intended for narrow cuffs were associated with higher discomfort, and participants preferred to use it less. In summary, we found no strong evidence for discomfort differences due to cuff width. There was some indication that participants preferred narrow cuffs with pressures inflated to the recommended relative pressure. Muscle shape may influence how cuff width affects discomfort.

To analyze the influence of implantation volume of artificial sphincters (AMS 800) on outcome in a large central European multicenter cohort study.
As part of the DOMINO (Debates on Male Incontinence) project, the surgical procedures and outcomes were retrospectively analyzed in a total of 473 patients who received an artificial sphincter (AMS 800) between 2010 and 2012. Clinics that implanted at least 10 AMS 800 per year were defined as high-volume centers.
Sixteen centers had a mean rate of 9.54 AMS 800/y of which five clinics were identified as high-volume centers. They implanted significantly more double cuffs (55% vs 12.1%; P < .001), used the perineal approach significantly more often (78% vs 67.7%; P = .003) and chose larger mean cuff sizes (4.63 cm vs 4.42 cm; P = .002). With a mean follow-up of 18 months, the revision rate was significantly higher at low-volume centers (38.5% vs 26.7%; P = .037), urethral erosion being the main reason for revision. Social continence (0-1 pads/24 h) was achieved significantly more often in high-volume centers (45.5% vs 24.2%; P = .002).
Our study showed significantly better continence results and lower revision rates at high-volume centers, confirming earlier results that are still true in this decade. We, therefore, recommend surgery for male incontinence at qualified centers.

To determine the recommended blood pressure (BP) measurement methods in neonates after systematically analyzing the literature regarding proper BP cuff size and measurement location and method.
A literature search was conducted in MEDLINE, PubMed, Embase, Cochrane Library, and CINAHL from 1946 to 2017 on BP in neonates <3 months of age (PROSPERO ID CRD42018092886). Study data were extracted and analyzed with separate analysis of Bland-Altman studies comparing measurement methods.
Of 3587 nonduplicate publications identified, 34 were appropriate for inclusion in the analysis. Four studies evaluating BP cuff size support a recommendation for a cuff width to arm circumference ratio of approximately 0.5. Studies investigating measurement location identified the upper arm as the most accurate and least variable location for oscillometric BP measurement. Analysis of studies using Bland-Altman methods for comparison of intra-arterial to oscillometric BP measurement show that the 2 methods correlate best for mean arterial pressure, whereas systolic BP by the oscillometric method tends to overestimate intra-arterial systolic BP. Compared with intra-arterial methods, systolic BP, diastolic BP, and mean arterial pressure by oscillometric methods are less accurate and precise, especially in neonates with a mean arterial pressure <30 mm Hg.
Proper BP measurement is critical in neonates with naturally lower BP and attention to BP cuff size, location, and method of measurement are essential. With decreasing use of intra-arterial catheters for long-term BP monitoring in neonates, further studies are urgently needed to validate and develop oscillometric methodology with enhanced accuracy.

OBJECTIVE: The aim was to study the correlation between cuff size and outcome after implantation of an AMS 800 artificial urinary sphincter.
METHODS: A total of 473 male patients with an AMS 800 sphincter implanted between 2012 and 2014 were analyzed in a retrospective multicenter cohort study performed as part of the Central European Debates on Male Incontinence (DOMINO) Project.
RESULTS: Single cuffs were implanted in 54.5% and double cuffs in 45.5% of the patients. The cuffs used had a median circumference of 4.5 cm. Within a median follow of 18 months, urethral erosion occurred in 12.8% of the cases and was associated significantly more often with small cuff sizes (P<0.001). Multivariate analysis showed that, apart from cuff size (P=0.03), prior irradiation (P<0.001) and the penoscrotal approach (P=0.036) were associated with an increased erosion rate. Continence rate tended to be highest with median cuff sizes (4-5.5 cm).
CONCLUSIONS: Apart from irradiation and the penoscrotal approach, small cuff size is a risk factor for urethral erosion. Results are best with cuff sizes of 4.5-5.5 cm.

This study aimed to assess the difference in blood pressure readings between the standard and large cuff and to determine if such a difference applies over a range of arm circumferences (ACs) in pregnancy. We measured blood pressure on 219 antenatal women. Six blood pressure readings were taken, three with a standard \'adult\' and three with a \'large\' cuff, in random order. A random zero sphygmomanometer was used by a trained observer. Women with an AC >33 cm were similar in age, gestational age and parity but were heavier and had more hypertension than those with AC ≤33 cm. There was a systematic difference between the standard and large cuff of 5-7 mmHg with little effect due to AC. We were unable to demonstrate an association between the standard and large cuff blood pressure difference and increasing blood pressure. Our study has shown that both systolic and diastolic blood pressure measurements are more dependent on the cuff size used than AC and for the individual it is difficult to predict the magnitude of effect the different cuff sizes will have on blood pressure measurements. This study has shown the presence of an average difference in blood pressure measurement between standard and large cuffs in pregnancy, and does not support the arbitrary 33 cm \'cut-off\' recommended in guidelines for the use of a large cuff in pregnancy.

Overcuffing (using too large a blood pressure [BP] cuff), is known to artificially lower auscultatory BP measurements; however, its effect on oscillometric readings is unclear. The possibility that overcuffing biases oscillometric readings is currently widely disregarded. We sought to confirm that overcuffing lowers auscultatory readings and to assess its effect on oscillometric measurements. Community-dwelling adults (aged ≥18 years) with arm circumferences within the standard range of 25-32 cm were recruited. Using primarily the International Standards Organization 2009 protocol, we compared the standard Baum adult (25-35 cm) to the large adult (33-47 cm) cuff. The standard cuff was considered the \"reference standard.\" In Phase I, auscultatory measurements were performed by two trained observers. In Phase II, oscillometric measurements were performed. Each phase was analyzed independently using paired t-tests and by generating Bland-Altman plots. Of 108 participants, 87 contributed data for Phase I, 85 for Phase II, and 69 were common to both phases. Phase I mean age was 38.0 ± 18.5 years, mean arm circumference was 28.0 ± 1.9 cm, and 21% had a past hypertension. The Phase I results confirmed that overcuffing reduced auscultatory BP measurements by 3.6 ± 5.1/2.8 ± 4.0 mm Hg (P-values <.0001 for both). For Phase II, mean age was 39.3 ± 18.3 years, mean arm circumference was 28.0 ± 1.9 cm, and 22% had past hypertension. Mean BPs were 112.2 ± 13.1/67.8 ± 7.3 mm Hg for the large cuff and 117.8 ± 13.3/71.2 ± 7.1 mm Hg for the standard cuff (5.5 ± 5.9/3.4 ± 5.2 mm Hg lower with the large cuff; P-values <.0001).Overcuffing leads to a clinically important downward bias in oscillometric measurements. An upper size limits for oscillometric cuffs should be specified.

OBJECTIVE: To document the prevalence and etiology of sustained blood pressure elevation in children.
RESULTS: It is a school-based prospective cross-sectional study involving healthy school children in age group of 5-15 years (both sexes). Children with any acute or chronic illnesses and the intersexes were excluded from the study group. Total number of hypertensive children were 37. Of these 37 cases, 23 hypertensive cases were boys and 14 were girls. All these hypertensive children maintained their blood pressure above +2SD for the corresponding age and sex. Male and female ratio of hypertensive cases was 62:38. All were primary hypertensives as per working definition. Majority belonged to Class II socio-economic status.
CONCLUSIONS: Hypertension in children is very rare with a prevalence of 0.38% and majority had primary hypertension.