Extra-Large Blood Pressure Cuff Need and Cost Burden in United States Adults with Hypertension.

BACKGROUND: Accurate home blood pressure (BP) monitoring depends on appropriate cuff sizing, but the prevalence and cost implications of extra-large cuff need among US adults with hypertension are unknown. METHODS: Using pooled data from 2017-2023 National Health and Nutrition Examination Survey (NHANES) with survey weighting, we estimated the prevalence of having a mid-arm circumference >43cm among US adults with hypertension, overall and by race/ethnicity. We also categorized home BP monitors listed on the US Validated Device Listing as standard (accommodating arm circumferences from 22-43cm) or extra-large cuff compatible (accommodating arm circumferences >43cm). RESULTS: Approximately 6.6% of US adults with hypertension (∼ 7.2 million individuals) had an arm circumference >43cm. Prevalence was highest among Non-Hispanic (NH) Black adults (11.4%) followed by Other Race/Multiracial (8.2%), NH White (6.2%), Hispanic (5.3%) and NH Asian adults (0.9%). Of the 51 validated devices, only 22 (43.1%) accommodated arm circumferences >43cm. The mean total cost of an extra-large cuff compatible system was 32.7% higher ($99.06 versus $74.70 for standard devices). CONCLUSIONS: More than 7 million US adults with hypertension require an extra-large BP cuff; the substantially higher cost of extra-large cuff-compatible devices represents an important and underrecognized barrier to accurate home BP monitoring.