Blood Pressure Cuff Innovations and the Role of Nurses

Blood pressure readings aid in our understanding of patients’ cardiovascular health. Accurate measurements are crucial for diagnosing and managing health conditions that may hemodynamically impact our patients.1,2 Traditionally, the stethoscope and blood pressure cuff have been our trusted tools for external blood pressure assessment.2 However, recent innovations have ushered in cuffless alternatives, marking a significant stride in blood pressure monitoring technology. This article will cover blood pressure cuff innovations and the role of nurses in embracing and enhancing these technologies.

Cuff-Based Methods

Our conventional method of blood pressure measurement lies in cuff-based techniques, commonly known as the auscultation method. This approach involves selecting an appropriate cuff size based on the patient’s arm circumference, locating the brachial artery, inflating the cuff to occlude blood flow, following the gradual deflation of that cuff, and using a stethoscope to detect Korotkoff sounds while simultaneously observing the manometer for pressure readings.2

Another prevalent cuff-based method is the oscillometric method, where an automatic blood pressure cuff is employed to measure blood pressure without the need for Korotkoff sound identification. Despite their accuracy, cuff-based methods present challenges (described below) that can limit the reliability of readings obtained in this manner.

Challenges with Cuff-Based Methods

Some of the challenges identified with the utilization of cuff-based methods include lack of access to cuff-based blood pressure devices, such as in rural or low-income areas, and monitoring disruptions due to the cuff’s cumbersome nature.3

Lack of access to these devices

Individuals living with hypertension who reside in rural low-income areas may not have access to these devices, which impacts their ability to adequately monitor their blood pressure outside of the clinical setting.4 Social determinants of health, like health coverage, can hinder access to these devices, as insurance generally does not cover them. With blood pressure devices costing anywhere from $30 to $100, financial obstacles arise for certain individuals.5 In a previous study,6 concerns were raised about pregnant mothers’ access to blood pressure devices during the COVID-19 pandemic. Thirty-six percent of pregnant mothers purchased devices, while twenty percent received them at their 28-week visit. Nearly nine percent lacked a blood pressure device due to cost barriers. This raised concerns among mothers about potential delays in diagnosing complications.

Disruptions in hypertension monitoring

The standard measure for diagnosing a patient with hypertension is to frequently monitor their blood pressure.7,8 Some studies have reported this practice can be disruptive to the patient, especially at night, leading to inaccuracy or further delay in diagnosis.9 However, other studies report that patients are not significantly impacted during ambulatory blood pressure monitoring (such as at night).10–12

User error

User error poses a significant challenge with cuff-based methods, often resulting in inaccurate blood pressure measurements. Kallioinen et al.13 found that trained clinicians were identified as a source of blood pressure error in the clinical setting. Reported causes of these errors included time constraints, insufficient training, equipment shortages, unfavorable environments, and patient-specific factors like mobility constraints.14 Additionally, selecting the wrong cuff size can exacerbate incorrect readings or misdiagnoses.15

Cuffless Blood Pressure Monitoring Methods

Innovative cuffless blood pressure measurement methods are emerging as potential game changers, offering a more convenient approach to monitoring without a blood pressure cuff. These methods may rely on technology or sensors to measure pulse and blood pressure.3

Cuffless methods can be further differentiated into requiring or not requiring cuff calibration.16 Cuffless devices requiring calibration require an individual to take their initial blood pressure with a traditional device and input that data into the monitor. This form of calibration has to be done either every day, every few weeks, or monthly.16

Some current forms of cuffless blood pressure devices include smartwatches, wearable rings, and smartphone devices. Smartwatches use a technology known as photoplethysmography (PPG) to monitor blood pressure. This process involves the use of light sensors to detect variations in blood flow in the skin.17 Wearable rings use bioimpedance sensors to detect arterial blood flow and pressure in our digits.18

Currently, the FDA has not approved the use of smartphone devices for blood pressure monitoring as these devices primarily use phone applications, and there is concern regarding the accuracy of results.19,20 The current process for measuring blood pressure with a smartphone app includes taking a photo of the person’s artery to capture a 30-second report or using a self-portrait to analyze the arteries in a person’s face.20

Challenges with Cuffless Blood Pressure Monitoring Methods

Despite their potential, each cuffless blood pressure measurement method has its own limitations, particularly regarding accuracy and validation.19,21–23 Concerns persist regarding the reliability of data obtained from smartphone applications, with studies indicating discrepancies and false readings, especially in individuals with hypertension.24 Additionally, there is limited validation of cuffless devices, raising questions about their diagnostic agreement with conventional blood pressure monitoring methods such as ambulatory blood pressure monitoring.21,22,24

Implications for Cardiovascular Nurses

The advent of cuffless blood pressure measurement methods heralds a new era in cardiovascular health monitoring, offering benefits such as convenience, continuous monitoring, and integration of cutting-edge technology. These methods hold promise in alleviating patient discomfort associated with traditional cuffs and facilitating non-invasive, real-time blood pressure monitoring. However, further research is imperative to validate the accuracy and efficacy of cuffless devices, particularly in diverse patient populations.

Nurses, equipped with their profound understanding of blood pressure pathophysiology and clinical practice, are poised to play a pivotal role in advancing these technologies. Collaborative efforts between nurses, researchers, engineers, and technology experts can drive the development and validation of these innovative technologies, paving the way for a multidisciplinary approach to healthcare research and ultimately enhancing patient care and cardiovascular health outcomes.

Clinical Takeaways

  • The advancement of blood pressure monitoring technologies, particularly the emergence of cuffless methods, represents a significant stride towards more accessible and convenient cardiovascular health management.
  • However, challenges persist, including concerns about accuracy, validation, and equitable access, especially for vulnerable populations.
  • Despite these hurdles, nurses stand at the forefront of embracing and enhancing these technologies, leveraging their expertise to drive innovation and improve patient outcomes.
  • Through collaborative efforts and continued research, nurses can lead the way in realizing the full potential of cuffless blood pressure monitoring, ultimately advancing cardiovascular healthcare delivery.


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