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Clinical Effectiveness Group

Blood Pressure Monitoring at Home (BP@h)

We have developed a cuff size predictor, based on patient BMI, to support NHS England and NHS Improvement’s Blood Pressure at Home (BP@h) initiative.

We suggest healthcare professionals use the following BMI cut-offs to predict the correct cuff size for patients who are using equipment to monitor their blood pressure remotely. This is based on the manufacturer recommended arm circumference valid ranges:

Cuff (Code)

Arm circumference range

 BMI (kg/m2
Small (S) 17-22cm  <18
Medium (M) 22-32cm >=18 to <29
Large (L) 32-42cm >=29 to <40
Extra-large (XL) 42-50cm >=40
Wide-range (W) 22-42cm >=18 to <40

This "18_29_40" scheme is easy to remember if healthcare professionals recall the starting BMI is 18 and that the lower cuff range intervals are all 11 kg/m2 appart.

The overall predicted accuracy of the scheme is 80%, so it is useful for a broad estimation of cuff procurement for large-scale home blood pressure monitoring initiatives. At individual patient level, we recommend that clinicians use the scheme to identify patients at the intervals between sizes - they may benefit from having their mid upper arm circumference measured. Patients squarely within BMI ranges could be advised which cuff size to use with reasonable confidence.

How and why did we generate the scheme?

 

More information

 

Tools for EMIS and SystmOne

We are considering developing a tool that will identify patients eligible for blood pressure monitoring at home and will stratify them by clinical risk and predicted cuff size. If you would be interested in this tool, please email ContactCEG@qmul.ac.uk and include "FAO Stuart Rison - @h-PGI" in the subject line.

In the interim, practices interested in identifying patients who are most likely to benefit from a blood pressure monitor should consider using the Hypertention Search and Risk Stratification tool developed by CEG and UCLPartners.  

Previous tools for Blood Pressure at Home Phase 2

We produced EMIS and SystmOne tools to identify Blood Pressure at Home Phase 2 patients and stratify these by predicted cuff size. The initiative is now in Phase 3 and the Phase 2 criteria are no longer relevant, so we are no longer supporting these tools. If you would like to read about the development of the Phase 2 tools and download a copy (at your own risk), please click here.   

 

Please note: The information above is intended to support practices participating in the national Blood Pressure at Home Quality Improvement programme. Although every care has been taken to ensure the information is accurate and fit for purpose, use of the cuff prediction scheme and ancillary software and tools are at the user's own risk. We are not able to offer 1:1 support for the tools but would welcome feedback, suggestions or corrections by email to ContactCEG@qmul.ac.uk - please include "FAO Stuart Rison - @h-PGI" in the subject line.

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