Hi XXXXXXX
Thanks for writing in.
I am a qualified and certified cardiologist and I read your mail with diligence.
The regular recording of pressure of 88/76 is low but 8 mm Hg of pulse pressure (upper systolic minus the lower diastolic blood pressure) makes the reading a suspect. Problem seems to be wrong use of cuff for your body.
Let me quote some relevant excerpts from associations whose responsibility is to make guidelines in such situations. I quote here on: American Heart Association have researched this topic.Research differs on exactly when the larger-sized cuff becomes necessary, but the most common rule of thumb is that if the arm circumference is greater than 13 inches (33 cm) or so, a larger cuff size is definitely needed. Although most large people will be served by an "Adult Large" cuff, some will need an even bigger cuff. With your body weight of 322 lbs (height 6.4") arm circumference must be on the higher side. For example, the American Association of Family Physicians (AAFP) states: Accurate measurement of blood pressure requires special consideration. A standard-sized blood pressure cuff should not be used on persons with an upper-arm circumference of more than 34 cm [Kmom note: just over 13 inches]. Large arm cuffs or thigh cuffs can aid in an accurate determination of blood pressure.

Some research indicates that blood pressures taken with a regular cuff begin becoming more inaccurate at about 11.4 inches (29 cm) or so, so a number of studies advocate use of the large cuff at this level. If you are borderline in size, you can have your blood pressure taken with both a regular cuff and a larger cuff; if the two numbers are different by very much, the pressure taken on the larger cuff is the valid one, and the larger cuff should be utilized regularly from then on.

Some medical personnel will tell you that if the cuff can go around your arm, it is an appropriate size for you. This is NOT TRUE and demonstrates a basic lack of understanding of blood pressure cuffs. It is NOT whether the cuff will go around your arm, it is whether the inflatable "bladder" inside the cuff is the appropriate length and width for your arm size. A cuff can go around your arm just fine and still have the wrong-sized "bladder" inside the cuff.

Research is VERY clear that measuring blood pressure with a cuff bladder that is the wrong size artificially alters the blood pressure result. Fit is NOT the correct criteria for whether you are using the appropriately-sized cuff. Length and width of bladder is.
Step Three - Figure Out Which Cuff Size You Need
There are several sizes of large cuffs available, depending on the circumference of your arm:
Adult 'Standard' or 'Regular' Cuff - fits most average-sized people
Large Adult Cuff - fits most plus-sized people
Adult 'Thigh' Cuff - fits most supersized people or mid-sized people with heavy arms
Most providers carry plenty of 'regular' cuffs plus one or two 'large' cuffs, which should work for most mid-sized fat people. Some providers also carry a 'thigh' cuff, which often works for supersized people or those with heavy arms.

The most common errors in blood pressure cuffing are:

Providers using a 'regular' cuff when a 'large' cuff is needed. This error is extremely common.
Providers using a 'large' cuff for all obese people, even when a 'thigh' cuff is really needed. This is also common, but unfortunately it is rarely recognized as a problem.
Using a 'thigh' cuff for super-obese people, even when the upper limits of the thigh cuff are surpassed
Because cuff sizes are NOT standardized, no absolute size guidelines can be given for each cuff type. However, the American Heart Association has developed general guidelines for cuff sizes. They are summarized in the following table.

Table B* - Cuff Size Guidelines

Acceptable Bladder Dimensions for Arms of Different Sizes**

Cuff Arm Circumference Range at Midpoint
(cm) Arm Circumference Range at Midpoint (inches)
Adult 27-34 cm up to 13.38 inches
Large Adult 35-44 cm 13.7 inches to 17.3 inches
Adult thigh Cuff 45-52 cm 17.7 inches to 20.4 inches
End of quotes.
So going by the above narrative it is more than likely that appropriate cuff is not being used in your case therefore, it would be wrong to call a reading as low or high.
I hope that answers your questions to an extent. Good luck.
If you have any more query I will be most happy to answer it so that for future you can advise your health care providers for using appropriate cuff and bladder for recording your blood pressure.
Regards
Dr Anil Grover,
Cardiologist & Internist
M.B.;B.S, M.D. (Internal Medicine) D.M(Cardiology)
http://www/ WWW.WWWW.WW





*These guidelines are from a study in the journal,

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