Objective: Findings from adult studies suggest that tronco-conical cuffs provide more accurate blood pressure (BP) measurements in individuals with obesity. The aim of the present study was to examine differences in office blood pressure (BP) levels using conical cuffs compared to standard-shaped cylindrical cuffs in children and adolescents with obesity.
Design and method: We performed an observational study, including 37 children and adolescents with obesity, who were consequently recruited from the outpatient clinics of the Obesity and Cardiovascular Risk Unit at General University Hospital Consortium of Valencia. Arm circumference AC was measured in all participants, and the appropriate cuff size was selected for both conical and cylindrical cuffs.
Results: Mean participants' age was 11.82.5 years, mean BMI was 28.83.4 kg/m2, mean BMI z-score was 2.120.32, and mean AC was 30.03.6 cm. There was no statistical significance in BP levels measured by cylindrical compared to conical cuffs (mean difference cylindrical-conical cuff was -0.226.55 mmHg for SBP, -0.020.81 for SBP z-score, -0.704.95 mmHg for DBP, and -0.060.44 for DBP z-score). A significant positive association was found between the measurements obtained by cylindrical and conical cuffs in both mean and z-score SBP and DBP values (p < 0.001). Bland-Altman analysis showed good agreement, with 94.6% of the values for all BP parameters lying between the limits of agreement.
Conclusions: Although the use of conical cuffs in the study showed no advantage in enhancing the performance of BP measurements, they may be considered an alternative for office BP measurements in children and adolescents with obesity. Their reliability should be confirmed in larger populations and different settings.
Keywords: Blood pressure; Obesity; adolescents; children; cuff; hypertension.
What is the context?Largely due to the childhood obesity epidemic, elevated blood pressure (BP) levels or hypertension are observed in a significant percentage of children and adolescents.Accurate BP measuring is a challenging process in this special population, and choosing the appropriate cuff is of major importance.In individuals with obesity, the cuff selection depends not only on the arm circumference but also on its shape. Arm’s conicity, presented in obesity, makes it difficult to fit the cuff to the arm, increasing the likelihood of inaccurate BP measurements.The use of conical cuffs has been widely proposed in the adult population. BP values obtained with the common cuff, compared to the conical ones, seem to be higher, causing an overestimation of true BP levels.What is new?We conducted an observational study to evaluate differences in BP levels using conical cuffs compared to standard-shaped cylindrical cuffs in office BP measurement in children and adolescents with obesity.We did not find significant differences in BP levels between the two different shapes of cuffs, suggesting no advantage of using conical cuffs for office BP measurement in children and adolescents with obesity. Our results are contrary to several available studies in adults.BP measurement in paediatric patients with obesity using conical cuffs could enhance the correct diagnosis of hypertension. Still, available cuffs are currently designed for the adult population and may not fit paediatric patients’ arms.What is the impact?This is the first study that examines the role of tronco-conical-shaped cuffs for BP measurement in paediatric patients.The characteristics of the optimal cuff for BP measurement are still a subject of debate, but we consider the shape of the cuff as crucial for obtaining reliable BP readings. Establishing the ideal characteristics of cone-shaped cuffs gives rise to further research for both clinicians and manufacturers.