CUFF DI MENSI ON FOR CHI LDREN AND ADOLESCENTS: A STUDY I N A
NORTHEASTERN BRAZI LI AN CI TY
1Thelm a Leit e de Ar auj o2 Mar cos Venicíos de Oliv eir a Lopes2 Nir la Gom es Guedes3 Tahissa Fr ot a Cav alcant e4 Raf aella Pessoa Mor eir a4 Em ília Soar es Chav es5
Ar au j o TL, Lopes MVO, Gu edes NG, Cav alcan t e TF, Mor eira RP, Ch av es ES. Cu ff dim en sion for ch ildr en an d adolescen t s: a st u dy in a n or t h east er n br azilian cit y. Rev Lat in o- am En f er m agem 2 0 0 8 set em br o- ou t u br o; 1 6 ( 5 ) : 8 7 7 - 8 2 .
The goal of t his st udy was t o m easure t he arm circum ferences ( AC) and appropriat ed cuff sizes for children and adolescent s and t o relat e t hese dim ensions t o specific age ranges. This is a cross- sect ional st udy, developed in For t aleza, Cear á, Br azil, w it h 596 people bet w een 6 and 17 year s old. The AC w as m easur ed at t he m idpoint bet w een t he olecranon and t he acrom ion. The select ed cuff w idt h follow ed t he recom m ended rat io of 40% t he AC. The m ore suit able cuff sizes were 7× 14 cm , 8× 16 cm and 9× 18 cm , at 19.8% , 26.5% and 25% , respect ively. A st at ist ically significant associat ion bet ween AC and age range was found in bot h genders, as well as bet ween t he cuff and t he age range, showing t hat t he 7× 14 cm ( 38.9% ) and 8× 16 cm ( 29.6% ) cuffs were m ore suit able for childr en, and 8× 16 cm ( 23.7% ) and 9× 18 cm ( 36.1 % ) cuffs w er e bet t er for adolescent s. Adequat e cuffs w er e concluded t o be differ ent fr om t he st andar d cuffs used for childr en and adolescent s.
DESCRI PTORS: nur sing; blood pr essur e; child; adolescent
DI MENSI ONES DE MANGUI TOS PARA NI ÑOS Y ADOLESCENTES: UN ESTUDI O EN UNA
CI UDAD EN EL NORESTE DE BRASI L
El obj et iv o de est e est u dio fu e m en su r ar , en n iñ os y adolescen t es, las cir cu n fer en cias br aqu iales ( CB) y el ancho de los m anguit os m ás adecuado, y relacionar est as dim ensiones a los int ervalos de edad. Es un est udio t ransversal desarrollado en Fort aleza, est ado de Ceará, en Brasil, con 596 j óvenes de 6 a 17 años. La CB fue m ed id a en el p u n t o m ed io en t r e el olécr an on y el acr om io. El an ch o d el m an g u it o seleccion ad o sig u ió la r elación r ecom endada de 40% de la CB. Los m anguit os m ás adecuados fuer on los de 7x14, 8x16 y 9x18 cm , con 19,8% , 26,5% y 25% , respect ivam ent e. Se encont ró una asociación significat iva ent re la CB y el int ervalo de edad, en am bos sexos, así com o ent re el m anguit o y el int ervalo de edad; indicando que los m anguit os de 7x 14 cm ( 38, 9% ) y 8x 16 cm ( 29, 6% ) fuer on m ás adecuados par a niños y de 8x 16 cm ( 23, 7% ) y 9x 18 cm ( 36, 1% ) par a adolescent es. Se concluy e que los m anguit os adecuados son difer ent es de los ut ilizados com o est ándar par a niños y adolescent es.
DESCRI PTORES: en fer m er ía; pr esión san gu ín ea; n iñ o; adolescen t e
DI MENSÕES DE MANGUI TOS PARA CRI ANÇAS E ADOLESCENTES: ESTUDO EM UMA
CI DADE NO NORDESTE DO BRASI L
O obj et iv o dest e est u do f oi m en su r ar , em cr ian ças e adolescen t es, as cir cu n f er ên cias br aqu iais ( CB) e as lar gur as dos m anguit os m ais adequadas e r elacionar essas dim ensões às faix as et ár ias. Est udo t r ansver sal foi desenvolvido em For t aleza, Cear á, com 596 j ovens de 6 a 17 anos. A CB foi m edida no pont o m édio ent r e o olécr ano e o acr ôm io. A lar gur a do m anguit o selecionado seguiu a r elação r ecom endada de 40% da CB. Os m an gu it os m ais adequ ados f or am os de 7 x 1 4 , 8 x 1 6 e 9 x 1 8 cm com 1 9 , 8 , 2 6 , 5 e 2 5 % , r espect iv am en t e. Encont rou- se associação significant e ent re CB e faixa et ária, em am bos os sexos, bem com o ent re o m anguit o e a faixa et ária, indicando que m anguit os de 7x14 cm ( 38,9% ) e 8x16 cm ( 29,6% ) foram m ais adequados para crianças e de 8x16 cm ( 23,7% ) e 9x18 cm ( 36,1% ) para adolescent es. Conclui- se que os m anguit os adequados são difer ent es daqueles ut ilizados com o padr ão par a cr ianças e adolescent es.
DESCRI TORES: en fer m agem ; pr essão ar t er ial; cr ian ça; adolescen t e
Federal Universit y of Ceará, Brazil:
1 Funded by Brazilian Scient ific and Technological Developm ent Council, CNPq nº 306149/ 2006- 0; 2 Ph.D. in Nursing, e- m ail: t helm aarauj [email protected] .br,
m ar cos@u f c. br ; 3 RN, Mast er ’s st u den t in Nu r sin g, e- m ail: n ir lagom es@h ot m ail. com ; 4 Mast er ’s st u den t in Nu r sin g, e- m ail: t ah issa@ig. com . br ; rafaellapessoa@hot m ail.com ; 5 Doct oral st udent in Nursing, e- m ail: em [email protected] .br.
I NTRODUCTI ON
T
he prevalence of hypert ension in childhood and adolescence is not clear ly defined. Accor ding t oa sp e ci a l i ze d p u b l i ca t i o n o n h y p e r t e n si o n( 1 ), t h i s
disease is present in 2% t o 13% of t he child/ adolescent
popu lat ion . Pr ev iou sly, on ly v er y ser iou s alt er at ion s
i n b l o o d p r e ssu r e w e r e i d e n t i f i e d i n ch i l d r e n o r
adolescent s, and t he secondary causes were t he m ost
p r ev alen t . Now ad ay s, ev en t h ou g h h y p er t en sion in
y oung indiv iduals is m or e lik ely t o hav e it s or igin in
secondar y causes, t he pr ev alence of t he pr im ar y ( or
essen t ial) f or m h as been in cr easin g in t h e y ou n ger
age r anges( 2 ).
Thus, t he incr eased am ount of hy per t ension
c a s e s i n y o u n g p e o p l e j u s t i f i e s t h e p e r i o d i c
m easurem ent of blood pressure in children over t hree
y e a r s o l d , a n d t h e i n c l u s i o n o f b l o o d p r e s s u r e
v e r i f i c a t i o n a s a n i n t e g r a l p a r t o f t h e c l i n i c a l
appoint m ent , wit h a view t o prevent ing or m inim izing
t he dam aging effect s of hy per t ension( 3).
Pr e c i s i o n i n t h e m e a s u r e m e n t o f b l o o d
pr essu r e h as been a gr eat ch allen ge, ch ar act er ized
by at t em pt s t o r educing m ist ak es int r oduced by t he
obser v er or t he client , w ho can pr esent an incr ease
i n b l ood p r essu r e l ev el s d u e t o t h e m easu r em en t
p r o c e d u r e s a n d t h e p r e s e n c e o f t h e h e a l t h c a r e
pr ofessional, par t icular ly because of t he inst r um ent s
used( 4).
I n ch ild r en an d ad olescen t s, an im p or t an t
a sp e ct o f h y p e r t e n si o n i s t h e d i f f i cu l t y t o d e f i n e
reference values t o be adopt ed for diagnosis and t he
m et h od olog ical st an d ar d izat ion of t h e p r oced u r e( 5 ).
This happens due t o several fact ors, am ong t hem t he
s e l e c t i o n o f t h e a p p r o p r i a t e c u f f . Th e c o r r e c t
m easu r em en t , i n cl u d i n g t h e ch o i ce o f t h e cu f f, i s
ex t r em ely im por t an t f or t h e r eliabilit y of t h e blood
pressure m easurem ent , since cuffs t hat are t oo narrow
or w ide in r elat ion t o t he ar m cir cum fer ence t end t o
cau se o v er - o r u n d er - est i m at es o f t h e r eal b l o o d
pr essu r e valu es, r espect iv ely.
The difficult y t o use t he correct cuff does not
seem t o be relat ed wit h t he inexist ence of t he m at erial
i n t h e m a r k e t , b u t w i t h t h e l a ck o f i m p o r t a n ce
c o n f e r r e d t o t h e co r r e ct m e a su r e m e n t o f b l o o d
pressure in children and adolescent s. The low am ount
of syst em at ic st udies about t he m easurem ent s of arm
circum ference in lit erat ure m akes it difficult t o indicat e
t h e co r r ect cu f f w i d t h s f o r u se w i t h ch i l d r en a n d
adolescent s. I t is wort h not ing t hat , in Brazilian clinical
pract ice, t he choice of cuff, when it occurs, is relat ed
t o age ( m odels for children, adolescent s and adult s) ,
a f a c t t h a t c o u l d h a r m t h e c o r r e c t d i a g n o s t i c
ev alu at ion .
Dur ing t he lit er at ur e r ev iew , t he fact of t he
st an dar d- w idt h cu ff bein g con sider ed adequ at e on ly
for a sm all shar e of t he populat ion w as int r iguing. A
st u d y( 6 ) f o u n d t h a t t h e st a n d a r d - w i d t h cu f f w a s
adequ at e t o 5 % of t h e adu lt popu lat ion , w it h 9 3 %
requiring t he use of widt hs narrower t han 12 cm . An
aler t abou t it s u se in ch ildr en an d adolescen t s w as
m ade in anot her st udy, where t he 12- cm cuff had no
ex p r essiv e u se, ev en f or t h e 1 7 - an d 1 8 - y ear old
individuals( 7). Despit e evidences about t he inadequacy
of t he st andar d cuff, t he r ealit y of t he available cuff
sizes an d st an dar d r ou t in es in in st it u t ion s h av e n ot
ch an ged y et .
Since t he deficit in clinical pract ice regarding
b l o o d p r e s s u r e m e a s u r e m e n t i n c h i l d r e n a n d
adolescent is known, t he school environm ent , wit h it s
h igh con cen t r at ion of in div idu als in t h is age r an ge,
can be considered a favorable place for t he evaluat ion
of healt hcare condit ions, especially in t his param et er.
I n t h e f a ce o f t h i s co n t e x t , t h i s st u d y a i m e d a t
m easur ing, in childr en and adolescent s aged 6 t o 17
y ear s old at a p u b lic sch ool in For t aleza, t h e ar m
cir cum fer ences and m ost adequat e cuff w idt hs, and
also t o relat e t he adequat e cuff dim ensions wit h each
age r an ge.
The developm ent of t his st udy is j ust ified by
t h e i m p o r t a n c e o f u s i n g c u f f s w i t h t h e c o r r e c t
d im en sion s t o g u ar an t ee t h e v alid it y of t h e b lood
pressure m easurem ent , which will cert ainly cont ribut e
as t he base for t her apeut ic act ions.
METHOD
Th is cr oss- sect ion al, ex plor at or y st u dy w as
p e r f o r m e d a t a p u b l i c sch o o l f o r t h e e l e m e n t a r y
an d h igh lev els locat ed in For t aleza, w h er e pr ev iou s
s t u d i e s a b o u t t h e t h e m e w e r e p e r f o r m e d w i t h
The populat ion consist ed of 596 children and
adolescent s bet w een 6 and 17 y ear s old, enr olled in
t h e sch ool f or d ay t im e classes, in 2 0 0 3 , 2 0 0 4 an d
2005. The pr im ar y inclusion cr it er ia w er e: m inim um
age of 6 and m axim um of 17 years old; being present
at sch ool on t h e d ay an d t im e sch ed u led f or d at a
collect ion, and accept ance by t he child or adolescent
and t heir legal guardians t o part icipat e in t he st udy.
Dat a were collect ed in t hree dist inct periods:
Sept em ber / 2003 t o Febr uar y / 2004, Oct ober / 2004 t o
Mar ch / 2 0 0 5 an d Ju n e/ 2 0 0 5 t o Oct ob er / 2 0 0 5 , w it h
each st udent being evaluat ed only once. A form wit h
t opics w as used for dat a collect ion in or der t o m eet
t he pr oposed goals.
Th e ar m cir cu m fer en ce ( AC) w as m easu r ed
w it h a n on - st r et ch able m easu r em en t t ape, w it h 0 . 1
cm i n t e r v a l s a n d t o t a l l e n g t h o f 1 0 0 cm , a t t h e
m idpoin t bet w een t h e olecr an on an d t h e acr om ion .
Th e cu f f t o b e i n d i cat ed f o r each p ar t i ci p an t w as
select ed accor d in g t o t h e r ecom m en d ed cu f f w id t h
r at io, cor r esponding t o 40% of t he cir cum fer ence of
t he ar m used for blood pr essur e m easur em ent( 1). For t he evaluat ion of t he associat ion bet ween
t h e AC an d age r an ge, an d adequ at e cu f f an d age
r a n g e , t h e b i d i r e ct i o n a l Mo n t e Ca r l o Si m u l a t i o n
m et hod w as used, w it h a confidence int er val of 99%
for t h e calcu lat ion of Fish er ’s ex act pr obabilit y. Th e
dat a w er e or gan ized in MS- Excel v. 8 . 0 , pr ocessed
and analy zed w it h SPSS soft w ar e, v er sion 13.0, and
present ed as t ables. The adopt ed level of significance
w as 5% ( p < 0.05) .
A d m i n i s t r a t i v e p r o c e d u r e s t o r e q u e s t
p er m ission f or t h e ex ecu t ion of t h e r esear ch w er e
per f or m ed, by u sin g m em or an du m s an d con t act in g
t he subj ect s inv olv ed. The pr oj ect only st ar t ed aft er
a u t h o r i z a t i o n f r o m t h e i n s t i t u t i o n ’ s b o a r d
m anagem ent . Besides, accor ding t o Resolut ion 19 6/
1996, t he st udy pr oposal w as sent t o and appr ov ed
b y t h e Re v i e w Bo a r d o f Co m p l e x o Ho sp i t a l a r d a
Univ er sidade Feder al do Cear á ( COMEPE) , com ply ing
wit h t he requirem ent s of t he aforem ent ioned resolut ion
for research involving hum an beings( 9). Dat a collect ion st art ed aft er being approved, and also aft er m eet ings
wit h t he st udent s’ parent s, where t he proposed goals
w er e clar ified and t heir aut hor izat ion w as r equest ed
so t hat t he children and adolescent s could part icipat e
in t he research, by signing t he t erm of consent .
s e l b a i r a
V No. % Statistics
r e d n e G .
1 TrustInterval(IC)95%
e l a
M 301 50.5 46.4% 54.6%
e l a m e
F 295 49.5 45.4.0% 53.6%
l a t o
T 596 100
) s r a e y ( e g A .
2 Average:11.75 Standarddeviaiton:3.06 1
1
-6 280 47 Median:12 Minimum:6
7 1 -2
1 316 53 Mode:11 Maximum:17
l a t o
T 596 100 25-percentlie:10 75-percentlie:14
e l b a i r a
V No. % Statistics
) m c ( C A . 1 8 . 8 1 -5 . 3
1 142 23.8 Average:21.51 Standarddeviaiton:3.64
8 . 4 2 -0 . 9
1 348 58.4 Median:21 minimum:13.5
5 . 0 3 -0 . 5
2 97 16.3 Mode:19 Maximum:36
0 . 6 3 -0 . 1
3 9 1.5 25-percentlie:19 75-percentlie:23.5 l
a t o
T 596 100
RESULTS AND DI SCUSSI ON
A t o t a l o f 5 9 6 ch i l d r e n a n d a d o l e sce n t s,
f r om 6 t o 1 7 y ear s old , w er e in clu d ed in t h e st u d y.
Th e ch ar act er i zat i o n o f t h e g r o u p b y g en d er, ag e
a n d a r m c i r c u m f e r e n c e ( A C) i s p r e s e n t e d n e x t
( Tab les 1 an d 2 ) .
Tab le 1 – Dist r ib u t ion of ch ild r en an d ad olescen t s
accor ding t o gender and age. For t aleza, 2005
I n t h e e v a l u a t e d g r o u p , t h e r e a r e 3 0 1
( 50.5% ) m ale part icipant s and 295 ( 49.5% ) fem ales.
The higher presence of m ale children and adolescent s
w as al so r ep o r t ed i n o t h er st u d i es( 8 , 1 0 ). Th e m o st frequent age was 11 years, and t he average age was
1 1 . 7 5 y ear s old, w it h a st an dar d dev iat ion of 3 . 0 6
y ear s and m edian of 12 y ear s old.
Tab le 2 - Dist r ib u t ion of ch ild r en an d ad olescen t s
according t o arm circum ference ( AC) . Fort aleza, 2005
Th e AC v a r i e d b e t w e e n 1 3 . 5 a n d 3 6 cm ,
av er aging 2 1 . 5 1 cm and st andar d dev iat ion of 3 . 6 4
cm . 384 individuals ( 58.4% ) in t he populat ion, of bot h
gender s, pr esent ed an AC bet w een 19 and 24.8 cm ;
142 ( 23.8% ) bet w een 13.5 and 18.8cm ; 97 ( 16.3% )
bet w een 25 and 30.5 cm , and 9 ( 1.5% ) bet w een 31
and 36 cm .
A l t h o u g h t h e a r m c i r c u m f e r e n c e i s a n
e s s e n t i a l p a r a m e t e r f o r t h e c h o i c e o f c u f f, a n d
con sequ en t ly for t h e pr ecise m easu r em en t of blood
pr essur e, few dat a about t his par am et er in childr en
The dist ribut ion of t he populat ion is present ed
next, in function of the arm circum ference and age range.
Tab le 3 - Dist r ib u t ion of ch ild r en an d ad olescen t s
a c c o r d i n g t o a g e a n d a r m c i r c u m f e r e n c e ( B C) .
For t aleza, 2005
e g n a r e g A ) s r a e y ( ) m c ( C A l a t o T 8 . 8 1 -5 . 3
1 19-24.8 25-30.5 31-36
1 1
-6 133 125 21 1 280
% e n i
L 47.5 44.6 7.5 0.4 100.0
% n m u l o
C 93.7 35.9 21.6 11.1 47.0
7 1 -2
1 9 223 76 8 316
% e n i
L 2.8 70.6 24.1 2.5 100.0
% n m u l o
C 6.3 64.1 78.4 88.9 53.0
l a t o
T 142 348 97 9 596
% e n i
L 23.8 58.4 16.3 1.5 100.0
% n m u l o
C 100.0 100.0 100.0 100.0 100.0
Fisher’s exact t est , p < 0.001
I nit ial seed for Mont e Carlo sim ulat ion: 2000000
A h igh er f r equ en cy of in div idu als w it h ar m
cir cu m f er en ce in t h e 1 9 - 2 4 . 8 r an g e w as ob ser v ed ,
wit h a predom inance of t he 12- 17 year old age range.
I n t he 6- 11 year old age range, 133 ( 47.5% ) children
had an AC bet w een 13. 5 and 18. 8 cm ; 25 ( 44. 6% )
bet ween 19 and 24.8 cm ; 21 ( 7.5% ) bet ween 25 and
30.5 cm ; and 1 ( 0.4% ) bet ween 31 and 36 cm . Am ong
t he adolescent s in t he 12- 17 year old age range, m ost
223 ( 70.6% ) had t heir AC bet w een 19 and 24.8; 76
( 24.1% ) bet ween 25 and 30.5 cm ; 9 ( 2.8% ) bet ween
13.5 and 18.8; and 8 ( 2.5% ) bet ween 31 and 36 cm .
Si m i l a r v a l u e s w e r e f o u n d i n a n o t h e r st u d y w i t h
children and adolescent s bet ween 6 and 18 years old,
w her e m ost of t he gr oup had an ar m cir cum fer ence
varying bet ween 19 and 23 cm( 7).
I n t he evaluat ion of t he associat ion bet w een
t h e AC a n d a g e r a n g e , a st a t i st i ca l l y si g n i f i ca n t
associat ion ( p = 0. 000) w as found in bot h gender s,
i n d i c a t i n g t h a t c h i l d r e n h a v e s h o r t e r A C a n d
adolescent s hav e longer AC. How ev er, alt hough less
frequent ly, children w it h arm circum ferences bet w een
31 and 36 cm were found, as well as adolescent s wit h
m uch shor t er cir cum fer ences, lik e bet w een 13.5 and
1 8 . 8 cm .
Li t er at u r e h as o f t en em p h asi zed t h at ag e
det erm ines t he widt h of t he cuff t o be used. However,
f r om 1 9 6 7 on w ar d s, t h e cir cu m f er en ce of t h e lim b
w as em phasized as t he det er m iner of t he cuff w idt h
t o be used, inst ead of age( 11).
I n agr eem ent w it h anot her st udy( 7 ), sev er al circum ference lengt hs were found in all ages, showing
that there are large growth and developm ent changes in
these age ranges, which would therefore prevent the age
factor to be the determ iner for the choice of cuff.
The indicat ion of t he cuff was perform ed while
s e e k i n g t h e c l o s e s t a p p r o x i m a t i o n w i t h t h e
r ecom m en d ed g u i d el i n e, w h i ch con si d er s t h at t h e
widt h and lengt h of t he rubber bag should correspond
t o 4 0 % an d 8 0 - t o- 1 0 0 % of t h e ar m cir cu m fer en ce,
respect ively( 1). I n clinical pract ice, it is observed t hat t he choice of cuff, when it happens, is relat ed only t o
ag e ( m od els f or ch ild r en , ad olescen t s an d ad u lt s) ,
w h ich cou ld h ar m t h e cor r ect diagn ost ic ev alu at ion
by over - or under- est im at ing t he real blood pressure
v alu es.
Table 4 shows t he adequat e cuff widt h values,
accor ding t o age r ange.
) s r a e y ( e g n a r e g
A Adequatecuff Total
2 1 ×
6 7×14 8×16 9×18 10×20 11×22 12×24 13×26 14×28
1 1
-6 25 109 83 35 17 7 4 0 0 280
% e n i
L 8.9 38.9 29.6 12.5 6.1 2.5 1.4 0.0 0.0 100.0
% n m u l o
C 100.0 92.4 52.5 23.5 19.8 17.1 33.3 0.0 0.0 47.0
7 1 -2
1 0 9 75 114 69 34 8 2 5 316
% e n i
L 0.0 2.8 23.7 36.1 21.8 10.8 2.5 0.6 1.6 100.0
% n m u l o
C 0.0 7.6 47.5 76.5 80.2 82.9 66.7 100.0 100.0 53.0
l a t o
T 25 118 158 149 86 41 12 2 5 596
% e n i
L 4.2 19.8 26.5 25.0 14.4 6.9 2.0 0.3 0.8 100.0
% n m u l o
C 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Table 4 – Dist ribut ion of t he children and adolescent s according t o t he adequat e cuff and age range. Fort aleza,
2 0 0 5
Fisher’s exact t est , p = 0.000
I nit ial seed for Mont e Carlo sim ulat ion: 624387341
I t c a n b e o b s e r v e d t h a t t h e c o r r e c t
d i m e n si o n s o f t h e cu f f s f o r t h e e v a l u a t e d g r o u p
w er e 7 × 1 4 , 8 × 1 6 , 9 × 1 8 a n d 1 0 × 2 0 cm , a t 1 9 . 8 % ,
2 6 . 5 % , 2 5 % a n d 1 4 . 4 % , r e sp e ct i v e l y. I t sh o u l d
b e n o t e d t h a t t h e se si ze s w e r e a d e q u a t e f o r a l l
When t he associat ion bet w een t he adequat e
cuff and t he age range in bot h genders is analyzed, a st at ist ically significant associat ion ( p = 0.000) is found, indicat ing t hat t he 7× 14 cm ( 38. 9% ) and 8× 16 cm ( 2 9 . 6 % ) cu f f s w e r e m o r e a d e q u a t e f o r ch i l d r e n ,
w hereas t he 8× 16 cm ( 23.7% ) , 9× 18 cm ( 36.1% ) e 1 0 × 2 0 cm ( 2 1 . 8 % ) cu f f s w er e m or e ad eq u at e f or a d o l e sce n t s. Th e se f i n d i n g s a r e o p p o se d t o t h e in d icat ion of t h e 9 × 1 8 cm an d 1 2 × 2 4 cm cu f f s as
st andar ds for childr en and adolescent s, r espect iv ely. I t is also wort h not ing t hat t he 9× 18 cm cuff, co n si d e r e d t h e st a n d a r d w i d t h f o r ch i l d r e n , w a s adequat e for only 35 ( 12. 5% ) childr en. I n a sim ilar
st udy, t he m ost adequat e cuff for 6- t o 11- y ear old children was t hat of 6 cm , followed by t he 8- cm wide cuff( 12). The 12× 24 cm cuff did not present expressive u sage, n ot ev en am on g adolescen t s, con f ir m in g it s
in adequ acy as a st an dar dized in st r u m en t for adu lt s and people over 12 years old. I t should be highlight ed t hat 13× 26 cm and 14× 28 cm cuffs w er e adequat e for t w o and fiv e indiv iduals, r espect ively.
Th ese fin din gs ar e cor r obor at ed by a st u dy about t he indir ect m easur em ent of blood pr essur e in funct ion of t he cuff widt h in school children aged 6 t o 10, which found t hat t he cuff widt h does not depend
on t h e age, sin ce t h e st at ist ical an aly sis sh ow ed a very low correlat ion and t he variance analysis showed v alues t hat w er e not significant . This w as associat ed t o t he fact t hat bot h t he wide cuffs and t he narrower
cuffs were used in all ages( 13). This result st rengt hens t he idea t hat t he choice of t he cuff should not be based o n t h e ch i l d ’ s g e n d e r a n d a g e , b u t o n t h e a r m cir cum fer ence, as st at ed in t he 2004 Task For ce( 14).
Furt herm ore, research shows t hat t he syst olic p r essu r e ( SP) an d t h e d iast olic p r essu r e ( DP) ar e u n d er est i m at ed b y t h e st an d ar d w i d t h cu f f, w h en com par ed w it h t he pr essur e levels evaluat ed w it h an
adequat ely sized cuff( 6,13,15). I n one st udy( 15) t hat aim ed t o ev a l u a t e t h e p r essu r e l ev el s o f w o m en i n t h e pr egn an cy - pu er per al cy cle, differ en ces of 2 3 m m Hg for SP and 20.7 m m Hg for DP w er e obser ved. When
t he SP and DP were evaluat ed in funct ion of t he cuff widt h, differences in blood pressure values were found at 3, 4 and 6 m m Hg, as well as 10 m m Hg and even 40 m m Hg.
These st udies show increased blood pressure lev els w h en ev alu at ed w it h t h e cor r ect cu f f w id t h . Therefore, t hey elucidat e t he im port ance of t he widt h as an er r or fact or for blood pr essur e m easur em ent ,
as w ell as t he need for im pr ov em ent , at t ent ion and pr ecision in blood pr essur e m easur em ent , seek ing t o adequat ely det er m ine t he cuffs t hat w ill be used.
The im port ance of being able t o depend on a b r oad er of f er of n ar r ow er cu f f s t h an t h e st an d ar d
w idt hs for t he ev aluat ion of t he Br azilian populat ion is em phasized, since t he need t o use wider cuffs has
been const ant ly em phasized due t o increasing obesit y cases in Br azil, including t he Nor t heast( 16).
So m e ci r cu m f er en ces d et ect ed i n ch i l d r en an d adolescen t s in t h is st u dy con f ir m t h is t en den cy,
bu t at t en t ion sh ou ld be paid t o sk in n y people, w h ose d i ag n o si s i s al so i m p ai r ed , i n a w ay t h at i s ev en
m o r e co n cer n i n g t h a n o b ese p eo p l e. Ho w ev er, i n ou r r ealit y, t h e f r equ en t u se of t h e st an dar d- w idt h
cu f f s in st ead of adequ at e- w idt h cu f f s is an im por t an t
e r r o r f a c t o r f o r t h e m e a s u r e m e n t o f b l o o d p r e s s u r e , a n d s t i l l a r e a l i t y o b s e r v e d i n m o s t
h eal t h car e i n st i t u t i o n s.
FI NAL CONSI DERATI ONS
The result s obt ained confirm t hat t he ut ilizat ion of st andard cuffs as t he correct ones can subj ect t he
blood pr essur e m easur em ent t o er r or s, show ing t he n e e d t o s t a r t v e r i f y i n g t h e b l o o d p r e s s u r e b y
m e a s u r i n g t h e a r m c i r c u m f e r e n c e , s o t h a t a n adequat e cuff can be chosen.
Th e n e e d f o r i m p r o v e m e n t a n d p r e ci si o n
dur ing blood pr essur e m easur em ent is indispensable, ai m i n g t o co n t r i b u t e t o t h e m i n i m i zat i o n o f er r o r
sou r ces an d , con seq u en t ly, ob t ain in g m or e r eliab le
b l o o d p r e s s u r e v a l u e s , s i n c e b l o o d p r e s s u r e m easur em ent is fundam ent al t o suppor t t her apeut ic
act ion s.
Alt h ou gh r ecom m en dat ion s abou t t h e n eed t o have cuffs of different dim ensions t o m easure blood
pr essu r e adequ at ely for an y age ar e lon g- st an din g,
t he inadequat e use of cuffs nowadays is an im port ant
er r or f act or f or blood pr essu r e m easu r em en t , it self o n e o f t h e m o s t i m p o r t a n t a s p e c t s o f
sp h y g m o m an o m et r y.
I t i s b e l i e v e d t h a t m o r e a t t e n t i o n t o t h e s t a n d a r d s a n d r e c o m m e n d a t i o n s a b o u t t h e
st andardizat ion of blood pressure m easurem ent , bot h
in t he cont ent of t he under gr aduat e cur r icula and by healt hcar e m anager s and pr ofessionals at Healt hcar e
Unit s and t he Hospit al Unit s, could cont r ibut e t o t he
n ecessar y ch an g es.
I f r o u t i n e l y, c a r e f u l b l o o d p r e s s u r e m easu r em en t is on e of t h e m ost ef f icien t an d saf e
act ions now aday s for t he cont r ol of hy per t ension in
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