Posts Tagged ‘loose cuff hypertension’

It is often said medical   professionals lack engineering sense and vice versa. The filed of bio medical  engineering is is not  a new one . It is  there for over 50 years .The gap is narrowing very fast.

We are in the era of developing hybrid imaging , where a PET and CT come together. Raman spectroscopy is sending live  images of tissue histology from the coronary arteries .

A  journal exclusively catering to the cardiovascular enginnering is new development . Let us thank to the unique initiative from Purdue university .

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Blood pressure  measurement ,   probably  is the commonest investigation done  in our patients  in  the entire field of medicine . It is such a common thing ,  both physicians  and patients  fail to perceive  it as  an investigation . (It indeed is !)

Even though BP is  considered as a  clinical sign , measuring it requires a device called sphygmomanometer  . The BP apparatus has to be properly calibrated  with the mercury  , the tubing, the bladder  , inflation balloon  etc   need to be perfect.

The following fallacies are noted in the measurement of  blood pressure . Some of them are rampant* !


  • Posture of recording
  • Anxiety -White coat /Gender


  • Cuff width/Length
  • Arm circumference

Ocular errors

It is surprising , such an important tool has a scale of 2mm markings which is prone for parallax errors of light with  mercury column undulating .

Physician factors*

  • Hasty cuff syndrome , Rapid deflation .
  • Absent minded recording – Failure to note phase 4 to phase 5  due to inattention
  • Failure to hear phase 4 muffling  (Aging  medico  -Auditory insufficiency !)

It is  not at all  surprising  to note,   two BP readings rarely match ,  even if it is recorded by the same person with  same machine at the same time !

There are many  articles that describe in detail  ,  how to record blood pressure properly. But this article from  a relatively unknown  journal   from Purdue university  ,  tells  us  most   scientifically  , what  has been taken for granted  by the medical  community for so long  .

Loose cuff  hypertension (Link to the journal of  Cardiovascular engineering )

How much  stiffness  is to be applied in  the arm for optimal pressure recording ?

What is the incidence of hypertension due to  loose cuff  ?

Final message

The BP apparatus ,  though appears  as  an   innocuous   machine ,   the readings  that emerge  from it  determines ,  how millions of our fellow human beings are going to be labeled  ! ( High pressured  humans ,  slaves to  anti hypertensive  drug marketeers    for  rest of their  life ) .

So , realise  how important  it is , to measure  the blood pressure properly    !  Never be casual . . . with  this  machine .

Experience has taught us ,  while  it is very easy to name an  individual  wrongly as hypertensive  , it  often needs  Herculean  efforts  to remove this medical tag from their neck . The reasonings  are  many .( Academic , non academic and patient factors included )

Finally , in this funny planet  it is  a personal observation ( Or is it  an imagination ?)    some  men and women   tend to  enjoy  ,   being  referred to  as  high pressured !   Loose cuff  or tight cuff   ,  it simply do not bother them  !

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