Cuff Design for Home Blood Pressure Monitors

  • Paolo PalatiniEmail author
  • Roland Asmar
  • Grzegorz Bilo
  • Gianfranco Parati
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)


Devices for home blood pressure (BP) measurement must be provided with cuffs that have optimal size and shape in relation to the patient’s arm. However, optimal characteristics of cuffs for BP measurement are still the subject of much debate. This mainly concerns the use of appropriate cuffs in obese individuals which should take into account not only the arm circumference but also its shape. Large-size cylindrical cuffs can hardly fit the arm of obese individuals which often have conically shaped upper arms. Experimental evidence indicates that if cylindrical cuffs are used in large conical arms an overestimation of the true BP may occur with BP discrepancies as large as >10 mmHg. With the use of automatic oscillometric monitors the choice of the appropriate cuff is even more controversial because with these devices the reference point is not the artery occlusion, but the oscillometric peak signal. To overcome the problem of miscuffing in obese individuals special cuffs that can accommodate a wide range of arm sizes have been produced by manufacturers of oscillometric devices. Thanks to a special software algorithm these cuffs proved to be able to provide accurate BP measurements over a wide range of arm circumferences. Although these devices may represent a good option for BP measurement in the very obese, their reliability should be confirmed in future studies in larger samples. Oscillometric devices worn at the wrist or at the forearm have also been profitably used for BP measurement in the obese.


Cuff, bladder, device Oscillometric Blood pressure Measurement 


  1. 1.
    Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, Kario K, Lurbe E, Manolis A, Mengden T, O’Brien E, Ohkubo T, Padfield P, Palatini P, Pickering TG, Redon J, Revera M, Ruilope LM, Shennan A, Staessen JA, Tisler A, Waeber B, Zanchetti A, Mancia G, ESH Working Group on Blood Pressure Monitoring. European Society of Hypertension practice guidelines for home blood pressure monitoring. J Hum Hypertens. 2010;24(12):779–85.CrossRefGoogle Scholar
  2. 2.
    Palatini P, Frick GN. Cuff and bladder: overlooked components of BP measurement devices in the modern era? Am J Hypertens. 2012;25:136–8.CrossRefGoogle Scholar
  3. 3.
    Geddes LA, Voelz M, Combs C, Reiner D, Babbs CF. Characterization of the oscillometric method for measuring indirect blood pressure. Ann Biomed Eng. 1982;10:271–80.CrossRefGoogle Scholar
  4. 4.
    O’Brien E. A century of confusion: which bladder for accurate blood pressure measurement? [review]. J Hum Hypertens. 1996;10:565–72.PubMedGoogle Scholar
  5. 5.
    O’Brien E, Petrie J, Littler WA, De Swiet M, Padfield PD, Dillon MJ. Blood pressure measurement: recommendations of the Britishn hypertension society, 3rd edn. London: BMJ Publishing Group; 1997.Google Scholar
  6. 6.
    Bilo G, Sala O, Perego C, Faini A, Gao L, Głuszewska A, Ochoa JE, Pellegrini D, Lonati LM, Parati G. Impact of cuff positioning on blood pressure measurement accuracy: may a specially designed cuff make a difference? Hypertens Res. 2017;40(6):573–80.CrossRefGoogle Scholar
  7. 7.
    Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on high blood pressure research. Circulation. 2005;111:697–716.CrossRefGoogle Scholar
  8. 8.
    Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I, Authors/Task Force Members. ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36(10):1953–2041.CrossRefGoogle Scholar
  9. 9.
    Fujikawa T, Tochikubo O, Sugano T, Umemura S. Accuracy of the pulse delay time technique with triple cuff for objective indirect blood pressure measurement. J Hypertens. 2013;31(2):278–86.CrossRefGoogle Scholar
  10. 10.
    Parati G, Avolio A. Improvements on cuff measurement of arterial pressure: more cuffs! J Hypertens. 2013;31(2):251–2.CrossRefGoogle Scholar
  11. 11.
    Marks LA, Groch A. Optimizing cuff width for noninvasive measurement of blood pressure. Blood Press Monit. 2000;5:153–8.CrossRefGoogle Scholar
  12. 12.
    Lan H, Al-Jumaily AM, Lowe A, Hing W. Effect of tissue mechanical properties on cuff-based blood pressure measurements. Med Eng Phys. 2011;33:1287–92.CrossRefGoogle Scholar
  13. 13.
    Palatini P, Parati G. Blood pressure measurement in very obese patients: a challenging problem. J Hypertens. 2011;29:425–9.CrossRefGoogle Scholar
  14. 14.
    Palatini P, Benetti E, Fania C, Malipiero G, Saladini F. Rectangular cuffs may overestimate blood pressure in individuals with large conical arms. J Hypertens. 2012;30:530–650.CrossRefGoogle Scholar
  15. 15.
    Maxwell GF, Pruijt JF, Arntzenius AC. Comparison of the conical cuff and the standard rectangular cuffs. Int J Epidemiol. 1985;14:468–72.CrossRefGoogle Scholar
  16. 16.
    Stergiou GS, Alpert B, Mieke S, Asmar R, Atkins N, Eckert S, Frick G, Friedman B, Graßl T, Ichikawa T, Ioannidis JP, Lacy P, McManus R, Murray A, Myers M, Palatini P, Parati G, Quinn D, Sarkis J, Shennan A, Usuda T, Wang J, Wu CO, O’Brien E. A universal standard for the validation of blood pressure measuring devices: Association for the Advancement of medical instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) collaboration statement. Hypertension. 2018;71(3):368–74.CrossRefGoogle Scholar
  17. 17.
    Palatini P, Benetti E, Fania C, Saladini F. Only troncoconical cuffs can provide accurate blood pressure measurements in people with severe obesity. J Hypertens. 2019;37(1):37–41.PubMedGoogle Scholar
  18. 18.
    Palatini P, Asmar R. Cuff challenges in blood pressure measurement. J Clin Hypertens. 2018;20(7):1100–3.CrossRefGoogle Scholar
  19. 19.
    Stergiou GS, Tzamouranis D, Nasothimiou EG, Protogerou AD. Can an electronic device with a single cuff be accurate in a wide range of arm size? Validation of the Visomat comfort 20/40 device for home blood pressure monitoring. J Hum Hypertens. 2008;22:796–800.CrossRefGoogle Scholar
  20. 20.
    Masiero S, Saladini F, Benetti E, Palatini P. Accuracy of the microlife large-extra large-sized cuff (32-52 cm) coupled to an automatic oscillometric device. Blood Press Monit. 2011;16:99–102.CrossRefGoogle Scholar
  21. 21.
    Sprague E, Padwal RS. Adequacy of validation of wide-range cuffs used with home blood pressure monitors: a systematic review. Blood Press Monit. 2018;23(5):219–24.CrossRefGoogle Scholar
  22. 22.
    O’Brien E, Atkins N, Stergiou G, Karpettas N, Parati G, Asmar R, on behalf of the Working Group on Blood Pressure Monitoring of the European Society of Hypertension. European Society of Hypertension International Protocol revision 2010 for the validation of blood pressure measuring devices in adults. Blood Press Monit. 2010;15:23–38.CrossRefGoogle Scholar
  23. 23.
    Bonso E, Saladini F, Zanier A, Benetti E, Dorigatti F, Palatini P. Accuracy of a single rigid conical cuff with standard-size bladder coupled to an automatic oscillometric device over a wide range of arm circumferences. Hypertens Res. 2010;33(11):1186–91.CrossRefGoogle Scholar
  24. 24.
    Parati G, Asmar R, Stergiou GS. Self blood pressure monitoring at home by wrist devices: a reliable approach? J Hypertens. 2002;20(4):573–8.CrossRefGoogle Scholar
  25. 25.
    O’Brien E. What to do when faced with an unmeasurable ambulatory blood pressure? J Hypertens. 2011;29:451–3.CrossRefGoogle Scholar
  26. 26.
    Casiglia E, Tikhonoff V, Albertini F, Palatini P. Poor reliability of wrist blood pressure self-measurement at home: a population-based study. Hypertension. 2016;68(4):896–903.CrossRefGoogle Scholar
  27. 27.
    Hersh LT, Sesing JC, Luczyk WJ, Friedman BA, Zhou S, Batchelder PB. Validation of a conical cuff on the forearm for estimating radial artery blood pressure. Blood Press Monit. 2014;19:38–45.CrossRefGoogle Scholar
  28. 28.
    Stergiou GS, Asmar R, Myers M, Palatini P, Parati G, Shennan A, Wang J, O’Brien E. Improving the accuracy of blood pressure measurement: the influence of the European Society of Hypertension International Protocol (ESH-IP) for the validation of blood pressure measuring devices and future perspectives. J Hypertens. 2018;36:479–87.CrossRefGoogle Scholar
  29. 29.
    Non-invasive sphygmomanometers Part 2: Clinical investigation of automated measurement type. Accessed 21 Oct 2018.
  30. 30.
    Arakawa T. Recent research and developing trends of wearable sensors for detecting blood pressure. Sensors. 2018;18(9):pii: E2772.CrossRefGoogle Scholar
  31. 31.
    Goldberg EM, Levy PD. New approaches to evaluating and monitoring blood pressure. Curr Hypertens Rep. 2016;18(6):49–56.CrossRefGoogle Scholar
  32. 32.
    Plante TB, Urrea B, MacFarlane ZT, Blumenthal RS, Miller ER 3rd, Appel LJ, Martin SS. Validation of the instant blood pressure smartphone app. JAMA Intern Med. 2016;176(5):700–2.CrossRefGoogle Scholar
  33. 33.
    IEEE 1708–2014—IEEE Standard for Wearable Cuffless Blood Pressure Measuring Devices. Accessed 21 Oct 2018.

Copyright information

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG, part of Springer Nature 2020

Authors and Affiliations

  • Paolo Palatini
    • 1
    Email author
  • Roland Asmar
    • 2
  • Grzegorz Bilo
    • 3
    • 4
  • Gianfranco Parati
    • 4
    • 5
  1. 1.Department of MedicineUniversity of PadovaPadovaItaly
  2. 2.Foundation-Medical Research Institutes (F-MRI®)GenevaSwitzerland
  3. 3.Department of Cardiovascular Neural and Metabolic SciencesIstituto Auxologico Italiano, IRCCSMilanItaly
  4. 4.Department of Medicine and SurgeryUniversity of Milano-BicoccaMilanItaly
  5. 5.Istituto Auxologico Italiano, IRCCS, Department of CardiovascularNeural and Metabolic SciencesMilanItaly

Personalised recommendations