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Clinical Effectiveness Group

Blood Pressure Monitoring at Home (BP@h)

We are supporting NHS England and NHS Improvement’s national remote Blood Pressure Monitoring initiative: Blood Pressure at Home (BP@h).

We produced EMIS and SystmOne search tools to identify BP@h Phase 2 patients and stratify these by predicted cuff-size.  As the BP@h initiative in now in Phase 3 and the Phase 2 criteria are no longer relevant, we are no longer supporting these tools.  If you would still like to read about the Phase 2 tools and download a copy of them (at your own risk), please click here.   

We have since then refined our BMI-based cuff-size prediction strategy.  We suggest healthcare professionals use the following BMI cut-offs to predict the correct cuff-size for patients (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 scheme, known as the 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% and the scheme is therefore useful for a broad estimation of cuff procurrement needs for large scale home blood pressure monitoring initiatives.  At individual patient level, we recommend healthcare professionals use the scheme to identify patient at cuff intervals who may benefit from mid upper arm circumference measurment or cuff-fittings; patients "squarely" within BMI ranges could, however, reasonable confidently be advised on which cuff-size to use.

How and why did we generate the scheme?

 

Conference poster

We presented our work on cuff sizing at the European Society of Cardiology's 2021 Congress.  Click BMI MUAC Cuff - ESC poster [PDF 845KB] to download a PDF of the poster.

Paper

We have submitted a paper for publications.  If you would like a copy of the manuscript, please email ihse-ceg-admin@qmul.ac.uk - please include "@h-PGI - Preprint" in the subject line.

 

EMIS and SystmOne tools

We are considering developing a tool which would identify "eligible" BP@h patients and to stratify such patients by clinical risk and predicted cuff size. 

If you would be interested in such a tool, please email ihse-ceg-admin@qmul.ac.uk - please include "FAO Stuart Rison - @h-PGI" in the subject line.

In the interim, practices interested in risk-stratifying their patients with hypertension to identify patient most likely to benefit from provision of a BP@h initiative BP monitor should consider using the UCLP Hypertention Search and risk stratification tool

 

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

 

© CEG Stuart Rison 2021

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