Of the many different ailments affecting men and women across the globe, some are easily prevented through early detection. Unfortunately, some of the more fatal ones can be hard to detect, resulting in deaths even for the young and able. Monitoring blood pressure with a blood pressure cuff allows a caregiver to monitor the blood pressure of their elderly clients and aid in the prevention of poor health outcomes.
What is hypertension?
Before we discuss the basics of blood pressure cuffs, let us first tackle the main reason why they were made: hypertension. Considered by experts to be a “silent killer” (because it may show no symptoms), hypertension is a systolic blood pressure greater than 130 mmHg. Hypertension can also be a diastolic blood pressure that’s greater than 80 mmHg. Because the condition may not showcase any symptoms, millions of people find out they have hypertension once heart failure or stroke happens.
About 47% or 116 million adults In the United States have hypertension, according to the CDC. Moreover, hypertension-related medication and treatments account for $131 billion in annual costs. Another alarming fact is that only 1 in 4 hypertensive adults is able to control his condition accordingly.
Thankfully, there’s a tool that can help detect hypertension and prevent its myriad of complications. It is the sphygmomanometer or blood pressure cuff. What exactly is a blood pressure cuff? How does it work? Is it a wise investment, especially for the elderly?
Continue reading below for a comprehensive lowdown on this life-saving medical device.
What is a blood pressure cuff?
A blood pressure cuff or a sphygmomanometer is a medical device that features a piece of rubber that you wrap around a patient’s arm or wrist, depending on the type you’re using. The rubber is then inflated to initiate the process of taking and determining the patient’s blood pressure. As a blood pressure monitor, the sphygmomanometer uses these components to give doctors an idea of a patient’s condition in relation to his blood pressure. From there, a medical practitioner can help advise or provide the necessary steps to address or manage the situation.
History of recording blood pressure
To get a better appreciation of blood pressure cuffs, it is best to look back at how it all began. The device went through a long and interesting history before reaching its current form and shape. The idea of taking one’s blood pressure dates back to the early 1600s when Dr. William Harvey developed a broader appreciation and understanding of blood circulation.
In 1628, the physician published the “Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus” (translated as “On the Movement of the Heart and Blood in Animals”). His work eventually became a foundation in the study of the circulatory system. Over the next century, medical experts discovered the correlation between the heart rate and the pulse, making it possible to determine blood pressure and blood volume.
In 1733, another important breakthrough happened when Rev. Stephen Hales, a clergyman, and philanthropist, recorded the world’s first-ever blood pressure measurement. Using a horse as his test subject, Hales used a long glass tube, which he inserted into the horse’s artery in an upright position. This allowed Hales to observe the increase in pressure as the blood rose up the tube.
With the concept of observing blood pressure now a reality, it led to another milestone: the creation of the sphygmomanometer. The device presented a less-invasive approach for testing blood pressure repeatedly.
In 1881, Samuel Siegfried Karl Ritter von Basch introduced the first-ever sphygmomanometer. The device featured a rubber bulb filled with water. This design prompted blood flow restriction in the artery, which is crucial in determining blood pressure. Furthermore, a mercury column connected to the bulb and was responsible for translating the required pressure necessary for obscuring the pulse into milliliters of mercury.
Fifteen years later, Scipione Riva-Rocci further improved the sphygmomanometer by introducing the cuff. The cuff was designed to wrap around the arm to provide even pressure. By 1905, systolic and diastolic blood pressure were differentiated from one another by listening to the presence of systolic and diastolic sounds or “Korotkoff sounds.” The presence or absence of these sounds occurs when pressure is applied to the arm and then released.
Further improvements in the blood pressure cuffs were introduced. The Velcro, for example, helped tighten the cuff easier. The following are the integral parts of a sphygmomanometer:
- Bladder – An inflatable bag that compresses the arm to obstruct the artery.
- Cuff – A material that holds the bladder around the arm during measurement.
- Bulb – Responsible for pumping air into the cuff.
- Manometer – Measures the air pressure in mmHg.
- Valve – Deflates the bulb to control the cuff.
Different types of blood pressure cuffs and how they work
How does a blood pressure cuff work? The answer depends on the type you’re using. Today, blood pressure cuffs also come in different forms: the mercury sphygmomanometer, the aneroid sphygmomanometer, and the automatic digital sphygmomanometer. Let’s look at how they differ from one another.
- Mercury sphygmomanometer – this type of blood pressure cuff is the most popular iteration of the sphygmomanometer, and is considered by many as the gold standard. It comes with cuffs that are manually inflatable and attached to tubes infused with mercury. For the device to yield accurate readings, it must be used upright and placed on a flat and stable surface.
It is also easy to use and requires low maintenance and can even last a lifetime. However, the mercury sphygmomanometer can easily sustain damage when accidentally dropped. In addition, though it may be the most conventional type of sphygmomanometer, some countries already moved for its banning because of its mercury content.
- Aneroid sphygmomanometer – as its name “aneroid,” (which means “without fluid”) implies, this type of sphygmomanometer doesn’t come with any mercury. Instead, it uses a stethoscope that’s attached to the cuff. Also, the cuff is attached to a tube with a dial gauge. This gauge comes with a mechanical component that enables the conversion of cuff pressure to gauge pressure.
Interestingly, the aneroid sphygmomanometer can be divided into three types: the palm style, the pocket style, and the clock style. Aneroid sphygmomanometers also require recalibration to ensure reading accuracy.
- Automatic digital sphygmomanometer – unlike the first two types of sphygmomanometers discussed above, this one is the most advanced. An electronic sensor measures blood pressure. It also comes with a digital monitor that displays the readings in detail. The sensor specifically measures the fluctuations of the arteries to come up with the readings.
Factors affecting blood pressure readings
There are important factors to consider when using your blood pressure monitor. The first one involves the correct tightness of the cuff. Having your blood pressure cuff very tight will not only result in discomfort but will also affect the accuracy of the readings. On the flip side, a loose cuff will also translate to misdiagnosis.
The tightness of the cuff depends not only on the adjustments you apply but also on its size in relation to the patient’s arm. For example, patients classified as “obese” tend to have a higher risk of getting inaccurate readings. Because of the size of their arms, they require blood pressure cuffs in either large or extra-large sizes. Matching the right size of cuffs can be achieved by measuring the patient’s mid-arm circumference.
A study revealed that 39% of its participants who used cuffs that are too small received higher blood pressure readings. On the other hand, cuffs that were too large failed to detect hypertension in 22% of the participants. Of the total number of test participants, 40% were obese, and most of those who needed larger cuffs posted significantly higher blood pressure readings. The difference in the systolic readings of those who required large cuffs was 4.8 mmHg higher compared to those who used regular-sized cuffs.
Meanwhile, participants who needed extra-large cuffs posted systolic readings 19.7 mmHg higher than those who used regular sized-cuffs. So, how do you determine the right blood pressure cuff size? The American Heart Association recommends that the length and width of the bladder should be 80% and 40% of the arm circumference, respectively. The caveat with this method is it can be time-consuming, which is the reason why many people choose to skip it.
A good tip for measuring is to find a blood pressure cuff that covers about two-thirds of the distance between the patient’s shoulder and elbow.
Using blood pressure cuffs the right way
One of the most common topics surrounding sphygmomanometers is knowing how to use a blood pressure cuff properly. After getting the right size of the cuff, follow these steps below:
- Bring the cuff right around the patient’s upper arm. Make sure that the cuff’s lower edge is an inch above the antecubital fossa or the transition area between the forearm and the anatomical arm. You should only wear the cuff over your bare skin.
- Take the stethoscope and press its bell lightly below the cuff’s edge. This area is the brachial artery, a major blood vessel responsible for supplying blood to the upper arm, forearm, hand, and elbow.
- Using a moderate rate to 180mmHg, release the air from the cuff.
- Through the stethoscope, listen for the first knocking sound. You can also look at the mercury gauge while monitoring the sound.
- Make sure to perform the procedure on both arms. Record the pressure, cuff size, and patient’s position.
- If the blood pressure reading is more than 180/120 mmHg, wait for a few minutes before performing the second reading on the other arm.
- If the final reading remains more than 180/120 mmHg, seek immediate medical attention. A reading of 140/90 is already an indication of possible hypertension.
Understanding the different Korotkoff sounds
As we mentioned earlier, the systolic and diastolic sounds or Korotkoff sounds are used in the process of taking a person’s blood pressure. Interestingly, the Korotkoff sounds can be divided into five phases:
Phase 1: These sounds pertain to the first detectable sounds you hear through the stethoscope. These sounds also confirm the presence of a palpable pulse.
Phase 2: Upon reaching this phase, the Korotkoff sounds become longer but softer. You may also notice the sounds transiently disappearing occasionally.
Phase 3: In this phase, you’ll start to notice the sounds changing from soft to loudest. The sound will also have a distinct thumping quality.
Phase 4: In the penultimate phase, the sounds start to get muffled. You’ll also notice changes in pitch intensity.
Phase 5: Once the Korotkoff sounds reach the final phase, they will begin to disappear, signaling the end of the process of recording the patient’s blood pressure.
Preparing for a blood pressure measurement
A patient should also prepare accordingly to help ensure accurate blood pressure diagnosis. Whether the blood pressure check is during a doctor’s appointment or at home before sleeping, make sure not to eat or drink anything 30 minutes before wearing the blood pressure cuff. In addition, empty your bladder before the actual reading.
If you love drinking coffee or alcohol, or if you’re a smoker, stay away from these things 30 minutes before the reading.
Find a comfortable chair with ample back support. Sit on the chair about 5 minutes before the blood pressure reading. Sitting on a good, supportive chair will help keep you calm. For the feet, make sure they’re flat on the ground and avoid crossing your legs.
For the arms, rest them on the table at chest height. If you’re wearing a long-sleeved shirt, roll up the sleeves until the antecubital fossa area is bare. After wearing the cuff, check if it’s snug but not too tight. Avoid talking during the process and focus on relaxing your mind and body. Studies reveal that talking to the nurse or doctor during the reading may raise the measurement by 10 to 15 points.
Furthermore, cold temperatures can also increase your blood temperature. Lower temperatures may cause the blood vessels to contract. In turn, the blood needs more pressure to flow, particularly along the narrow vessels. Hence, if the room is cold and you start to feel chilly, you may get a reading that’s higher than normal.
In summary, the accuracy of the readings depends on the patient’s preparation, positioning, cuff size, and measurement technique.
Common concerns about blood pressure cuffs
There are many concerns about blood pressure monitors ranging from safety to accuracy. Here are a few that need some clarification.
- Why do blood pressure cuffs hurt? – Some patients including the elderly complain about feeling pain after getting their blood pressure checked. Generally, blood pressure monitoring shouldn’t hurt. Aside from being non-invasive, it’s also quick and simple. There may be slight discomfort during the cuff’s inflation but the discomfort generally lasts for only a few moments.
However, discomfort may escalate into pain when the cuff is worn too tight. Another is when you have arterial stiffness. It is a condition wherein the arteries are not as flexible as they ought to be. Because of the lack of flexibility, the cuff needs to apply more pressure to get a reading. As a result, the cuff becomes too tight leading to pain.
- Can a blood pressure cuff damage the arm? – The answer is “yes,” though the instances of having a damaged arm after blood pressure monitoring are quite rare. Common injuries involve the blood vessels and nerves in the arms. These injuries may lead to skin irritation or bruising. On very rare occasions, some patients end up having nerve damage and blood clots.
Another instance involves patients who go through the knife. During or after the surgery, the pressure from automatic blood pressure cuffs may be too tight for the capillaries. As a result, the capillaries may swell and burst.
- Are blood pressure monitors accurate? It has been reported that some blood pressure monitors yield inaccurate results. In turn, the patients don’t get the proper dose of medications required to address their condition. The issue of accuracy can be tricky considering the different factors that affect it. As mentioned earlier, certain factors affect blood pressure readings.
Hence, the key is to keep these factors in check to achieve accurate results. Factors that are patient and procedure-related can be easily managed. However, equipment-related concerns can be quite tricky. Apart from having cuffs with incorrect sizes, some patients may be using automated devices that lack testing for accuracy. The key is to invest in a blood pressure cuff that’s been clinically validated.
Reasons to invest in a blood pressure cuff
Though blood pressure monitoring devices may not be perfect, their benefits far outweigh any risk or inaccuracy you may encounter. The key to managing hypertension is early detection. One can only detect the disease early if you have a reliable tool like the blood pressure cuff by your side.
If you’re already diagnosed with hypertension or if you’re already a senior, it is crucial to have a blood pressure monitor at home. The device will help you monitor not only your blood pressure but also help evaluate your lifestyle. It can guide you if the changes you’ve been making to your diet and other daily regimen are working. If you’re taking maintenance drugs, your blood pressure readings can help your doctor determine if your medicines need tweaking.
Unfortunately, less than half of older Americans with hypertension regularly check their blood pressure. With regular monitoring, you can avoid not only stroke and heart attack, but also dementia, loss of vision, and memory problems that arise from hypertension. With these complications come soaring medical expenses that you can avoid through proper monitoring.
Choosing the right blood pressure cuffs
Here are some valuable tips that’ll help you find the perfect blood pressure cuff:
- Stick to the upper cuff – When choosing a blood pressure monitor, pick one that comes with an upper cuff. Avoid getting devices that measure on the wrist or finger, as these are less accurate options.
- Get the sizing right – We cannot stress this enough. Make sure the cuff size is perfect for your arm. The rule of thumb is it should fit your arm snugly, not tightly, leaving enough space for your two fingertips to slide underneath.
- Be wary of smart apps – Though these technological advancements do make lives easier with only a few taps on your smartphone, their accuracy is questionable. Some of these apps use other methods like pulse wave velocity for measuring blood pressure. Unfortunately, such methods lack rigorous clinical testing.
- Price matters – Last but not least, check the price tag of the blood pressure cuffs. Avoid overpaying by sticking to the basics. Cloud features sure can help store your readings but do you really need that edge at the moment? Weigh the different features and see which ones suit your requirements.
Aneroid monitors are affordable but you need to be careful, as they can easily get damaged. The digital ones are more expensive but offer ease of use.
Having a blood pressure cuff at home can be a lifesaver. People who are not yet aware that they are hypertensive can make that crucial detection. Those who are diagnosed can keep their monitoring on the right track.
As different factors may affect the accuracy of these cuffs, proper attention to the process and the device itself is imperative to determine the right results. Whatever type of blood pressure monitors you choose, getting accurate results should be paramount in preventing and managing hypertension.
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