The other day, someone asked me if it mattered what arm was used to take blood pressure. This led to a whole discussion about, how come there are times when blood pressure is different in each arm? In addition, we talked about when blood pressure should be taken in each arm. I decided to wrap my arms around this topic and write everything you need to know in this blog post.
How come blood pressure is different in each arm? A small difference of less than 10 mm HG is quite normal and nothing to worry about. A blood pressure difference of more than 10 mm Hg could indicate a blocked artery. In addition, it could indicate an increased risk of peripheral vascular disease, or narrowing of the arteries and the development of cardiovascular disease.
As a patient, you have a certain expectation of things to expect when showing up for a doctor visit. Things like height, weight, pulse, current medications and blood pressure are normal things a nurse does. Have you ever had your blood pressure checked in both arms?
The American Heart Association recommends that nurses and doctors check blood pressure in each arm during every visit (resource). Other organizations like the International Society of Hypertension Guidelines and the European Society of Hypertension suggests blood pressure should be taken in each arm during a patient’s initial visit. Did you know that years ago it was standard practice for doctors to check their patient’s blood pressure in both arms during the initial visit? In addition, they also checked their pulses in all 4 extremities. Unfortunately, this practice is no longer the standard.
Prior to knowing what I already know about blood pressure, it never happened to me. Now, every time I’m at the doctor, I request the nurse to take my blood pressure in both arms. After you find out why in this article, I bet you’re going to do the same. Checking to see if blood pressure is different in each arm is something every doctor should be doing, especially on a first visit.
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Reasons Why Blood Pressure Can Be Different In Each Arm
A Small Difference Is Normal
The most common reason is a small difference in blood pressure readings in each arm is normal and nothing to be concerned about. It’s not uncommon to have different blood pressure readings less than 10 mm Hg. Studies (resource) have concluded that different readings of less than 10 mm Hg between arms were attributable to random variation.
Peripheral Artery Disease
Peripheral artery disease (PAD) is also known as peripheral vascular disease or peripheral arterial disease. PAD are diseases of the blood vessels located outside the brain and heart. PAD causes blood vessels to narrow which restricts the blood flow to the legs, arms, kidneys and stomach. It is most common in the legs. If one artery is blocked or more blocked than the other, it can cause your blood pressure to be different in each arm (resource).
PAD affects between 12 an 20% of Americans over age 60. It is more common in African-Americans than other racial groups and men are slightly more to develop it than woman. Causes and risk factors of PAD include the following:
- Atherosclerosis: The narrowing of arteries due to plaque buildup inside the arteries.
- Blood clots
- Injuries to the limbs
- High blood pressure
- High cholesterol
- Family history of heart disease
Untreated PAD can lead to loss of a leg, increased risk of coronary artery disease and carotid atherosclerosis, narrowing of the arteries that supply the brain. Although untreated PAD can have serious consequences, the following can substantially improve the symptoms:
- Nutrition: Since high cholesterol can lead to PAD, a diet low in saturated and trans fat is recommended.
- Regular Physical Activity: A routine that consists of walking, leg exercises and treadmill activity can improve symptoms in just 4-8 weeks.
- Medications: An ACE inhibitor, cholesterol medicine and antihypertensive drugs may be prescribed.
- Smoking Cessation: Tobacco smoke significantly increases the risk of PAD. By quitting smoking, the progression of PAD and other heart-related diseases can be slowed down.
If the above treatments don’t improve PAD, a doctor may recommend angioplasty, the repair and unblocking of blood vessels by surgery.
An aortic dissection is when the inner layer of the large blood vessel branching off the heart, the aorta, tears. Blood surges through the tear which causes the middle and inner layers to separate. If this blood filled area breaks through the outside wall of the aorta, the result is often fatal (resource). Aortic dissection is uncommon and typically occurs to men in their 60s and 70s. Aortic dissection is a less common cause of blood pressure different in each arm.
Problems In Younger People
In younger people there are 2 reasons why blood pressure can be different in each arm. The first is a structural problem that interrupts the blood flow through an artery. The second is when something, such as a muscle, compresses an artery that is supplying the arm.
Studies Indicating A Difference In Blood Pressure In Each Arm
The 2 studies indicate that a difference in blood pressure in each arm is a marker for higher cardiovascular events including death. In addition, this was even more pronounced when the difference in blood pressure in each arm was greater.
A study (resource) published in 2016 showed how a blood pressure difference in each arm was associated with an increase in death from cardiovascular events. Researchers reviewed seven prior studies that evaluated the mortality rate in people with a difference in systolic blood pressure in each arm. The study included 17,439 people from 4 different countries (U.S, U.K., China and S. Korea). The follow-up period was 3-16 years and there was a total of 693 deaths related to a cardiovascular event.
A group of participants who had a systolic blood pressure difference (SBPD) ≥10 mm Hg was compared to another group who had a SBPD of <10 mm Hg. The rate of cardiovascular death was 58% higher in the group who had a SBPD ≥10 mm Hg. When a group with a SBPD ≥15 mm Hg was compared to those with a SBPD <15 mm Hg, the rate of cardiovascular death was 88% higher in the ≥15 group (almost double).
A group of British researchers (resource) examined the results of 20 prior studies which looked at groups who had a difference in blood pressure in each arm. They found that people who had a difference of blood pressure in each arm ≥15 mm Hg were twice as likely to have peripheral artery disease. In addition, people who had a difference in each arm 10-15 mm Hg or higher had an increased chance of a stroke or dying from a cardiovascular disease.
I Surveyed 100 People And Asked Them, Did Your Doctor Ever Take Your Blood Pressure In Each Arm?
I’m not sure about you, but I’ve never had a doctor or a nurse take my blood pressure in each arm until I started asking them to do so. I’ve asked a lot of people in the past and never had anyone tell me yes. Unfortunately, I never documented my results so I don’t know how many I asked or other statistics like age or medical history.
I decided to survey 100 people and asked them the following questions:
- How old are you?
- Do you have a history of any cardiovascular disease?
- Do you have a history of high blood pressure?
- Has a doctor or nurse ever take your blood pressure in each arm?
|Avg Age||Yes||No||% Yes|
|History of Cardiovascular Disease?||*||8||92||8%|
|History Of HBP?||*||43||57||43%|
|BP Taken In Each Arm?||*||12||88||12%|
I know 12% is not a lot but I honesty thought the amount that said yes about having their blood pressure taken in each arm would be less. But after examining the results it made sense to me because 11 of the 12 who answered yes had a cardiovascular or high blood pressure history. Only 1 out of the remaining 49 people said they had their blood pressure taken in each arm which was more like what I expected.
Of the 43 people who had a history of high blood pressure 6 of them, 14%, answered yes. Of the 8 people who had a history of cardiovascular disease 5 of them, 63%, answered yes. I wasn’t surprised the people who had a history were the ones who answered yes at a higher percentage. Even though, I wish the percentage was much higher. Hopefully blog posts like this one can convince people to ask their doctors and nurses to check both arms. This way the percentages will go up which means cardiovascular problems and risks can be identified much sooner.
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The Proper Technique On How To Take Blood Pressure In each Arm
At your next doctor visit ask the nurse taking your blood pressure to take it in each arm. Typically, a nurse will take your blood pressure only in one arm. It’s usually the more convenient arm for her. Sometimes, the nurse will ask if you have a preference in which arm. The nurse may be unhappy with your request, but don’t worry about it. After all, this is your health that is at risk. Unfortunately, we have an assembly line at the doctor’s office today. Gone are the days of home visits, blood pressure taken in each arm and the pulse taken at 4 extremities.
If there is a difference in each arm, your blood pressure should be taken again to verify the difference. If one arm is consistently higher than the other arm, that arm should be the arm that is used for all future blood pressure measurements. It shouldn’t be which arm is easier for the nurse or which arm you prefer.
A TRUE STORY: (resource) a 69-year-old women was admitted for a surgical procedure and her blood pressure was recorded at 130/80 mm Hg. Three days later a different nurse recorded the women’s blood pressure at 70/40 mm Hg. The woman was transferred into ICU and underwent a series of testing and visits from different specialists. In ICU, her blood pressure was measured at 130/80. After leaving ICU because her low blood pressure hadn’t returned she was transferred to a medical service for more observation. There, her blood pressure was recorded in her left arm at 70/40 mm Hg. They checked her right arm which had a measurement of 130/80 mm Hg. It turned out she had a narrowing artery in her left side.
Therefore, the failure to check to see if blood pressure is different in each arm can lead to false diagnosis, wrong therapy, improper medications and unnecessary testing. In addition, larger medical bills. I’m unsure about you, but I haven’t won the lottery yet, every dollar counts! But more importantly is your health.
Home Tips On Taking Blood Pressure In Each Arm
If you already take your blood pressure at home or want to start, I applaud you. There are many reasons why you should be monitoring your blood pressure at home. The most important reason is your blood pressure readings at home might be more accurate than what is measured at the doctor office. At the doctor office there is white coat syndrome and often there is little chance to relax prior to your blood pressure being checked.
If you’re thinking about buying a home blood pressure machine or aneroid sphygmomanometer, I wrote a blog post about which ones I recommend. You’ll be surprised how affordable you can get a name brand, you can read about them here.
At the same time, if you don’t measure your blood pressure properly at home, you’ll end up with inaccurate readings. Making sure you take your blood pressure the correct way is crucial to your health. Follow these guidelines when checking your blood pressure (resource).
- Use the proper cuff size for your arm. Measure your upper arm using a cloth measuring tape. Blood pressure monitors come with different size cuffs, make sure your cuff matches your arm measurement.
- Stay away from all caffeine and don’t smoke for 30 minutes prior to taking your blood pressure.
- Have 5 minutes of quiet time prior to measuring you blood pressure and make sure you have an empty bladder.
- Don’t wrap the blood pressure cuff around any clothing no matter how thin.
- Sit in an upright position with your back straight, feet flat on the floor and legs uncrossed. It’s best to sit in an upright chair with a supported back.
- Support your arm on a flat surface like an arm rest or table. Make sure your upper arm is at the same level as your heart. If you are using a wrist monitor, raise your wrist to heart level in front of your chest. This is the most common mistake people make when using a wrist monitor.
- The cuff should be above the bend of your elbow. Your blood pressure cuff usually has pictures showing you exactly how to position the cuff.
- Measure your blood pressure at the same time every day under the same conditions. I find it best in the morning before drinking my coffee and prior to experiencing any of the day’s stress.
- Take 3 measurements about one minute apart and record all your results. If I’m measuring in each arm, I like to alternate between arms.
Is blood pressure higher in the dominant arm? Blood pressure could be higher or lower in the dominant arm. Typically, there is a small difference less than 10 mm Hg in each arm and is nothing to worry about. A difference of more than 10 mm Hg could indicate a blocked artery, an increased risk of peripheral vascular disease and the development of cardiovascular disease.
Why take blood pressure in the left arm? You should only take blood pressure in your left arm if it’s the consistently higher arm. Your blood pressure should be initially checked in both arms. Whichever arm has the higher blood pressure measurement should be the arm that is used in the future.
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