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It’s not unusual for patients presenting to urgent care to have elevated blood pressure that doesn’t necessarily indicate that they have hypertension. Even extreme blood pressure may not mean the patient needs to be dispatched to the emergency room. There are any number of possible explanations for high BP reading besides “hypertension” in urgent care patients—pain, anxiety, and stimulant use being just a few. An article just published in JAMA Internal Medicine highlights another possible cause that should be considered and easily accounted for, however. The results of a randomized crossover trial that included 195 community-dwelling adults indicate that cuff size makes a bigger difference than you might have thought. Using a “regular size” cuff resulted in a 3.6 mmHg lower systolic reading with patients who really needed a small cuff. Conversely, patients who needed a large cuff but were measured with a regular cuff had BP readings 4.8 mmHg higher than they did with an appropriate-size cuff. The difference was even more pronounced in patients who should have been measured with an extra-large cuff (19.5 mmHg). Be sure your clinical team considers arm size and knows the parameter for various sizes of cuffs. For a good overview of the unique needs of assessing patient with high blood pressure in UC, read The Approach to the Hypertensive Patient in the Urgent Care Setting in the JUCM archive.

Don’t Jump to Conclusions If That BP Reading Seems Off; You Might Want to Check the Equipment