The Research Behind These Recommendations
An analysis of 24 previous blood pressure studies involving 57,000 participants revealed that people with a difference in systolic blood pressure of more than 5mmHg between their arms had a higher mortality rate than those with a difference of less than 5 mmHg. Furthermore, over ten years, each 1-point difference in intra-arm blood pressure was associated with a 1% increase in death from any cause and a 1% to 2% increase in the risk of cardiovascular death.
Differences in blood pressure between arms are fairly common, with 3.6% of healthy adults having a difference in blood pressure. The prevalence of blood pressure differences between the left and right arm rises to 7% in people with diabetes and 11.2% in individuals diagnosed with hypertension.
Individuals with increased blood pressure differences between the left and right arms are associated with an increased risk of cardiovascular disease. Researchers discovered that those with high blood pressure, diabetes, and pre-existing cardiovascular disease, as well as those without a diagnosis of cardiovascular disease, are at a higher risk.
In people with diabetes, a significant difference in intra-arm blood pressure can also signal chronic kidney disease. These high-risk individuals should monitor their blood pressure on both arms often.
Why Should I Monitor My Blood Pressure At Home
The American Heart Association recommends that anyone with, or at risk of high blood pressure, should monitor their blood pressure at home. Home blood pressure monitoring is one of the best methods of trending a persons blood pressure in their own environment.
Click here for more information from the American Heart Association on who should monitor at home, and why.
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Blood Pressure Assessment Tips
Keep learning about blood pressure assessment by reading how to mitigate NIBP and auscultating innacuracies by watching the plethysmography waveform on your pulse oximeter and noting the mean arterial pressure.
Read next: Learn how to read a MAP.
References:
1. James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee . JAMA. 2014 311:507-520.
2. Pickering TG, Hall JE, Appel LJ, et al. AHA Scientific Statement: Recommendations for blood pressure measurement in humans and experimental animals, part 1: blood pressure measurement in humans. Hypertension. 2005 45: 142-161.
3. Deakin CD, Low JL. Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study. BMJ. 2000 321: 673674.
4. Lehman LH, Saeed M, Talmor D, Mark R, Malhotra A. Methods of blood pressure measurement in the ICU. Crit Care Med. 2013 41:34-40.
This article, originally posted Apr. 9, 2014, has been updated.
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One sheet: Common blood pressure reading mistakes
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How To Correctly Use A Blood Pressure Cuff
A blood pressure cuff is a medical device that is used to measure a persons blood pressure. It works by applying pressure to the arteries in the arm and provides medical professionals with an indication of a persons blood pressure and heart health.
In this guide to correctly using a blood pressure cuff, we will introduce the simple steps required to correctly fit a blood pressure cuff and take your blood pressure reading.
If you are seeking to measure your blood pressure at home without the assistance of a medical professional, this guide can help you obtain the most accurate reading.
In addition, there is no need to worry about complicated readings as blood pressure machines are designed to be simple to use in both clinical and home settings.
Accurate Blood Pressure Measurements And The Other Arm
When duty calls, some people are never at home.
Anonymous
The examiner, a nationally prominent cardiologist, began my ordeal with a simple question: What is the blood pressure in both arms of your patient?
The scene was Charity Hospital in New Orleans, where I took my oral examination for board certification in internal medicine 51 years ago. Fortunately, I answered his question easily, because in those days, doctors routinely took their patients’ blood pressure in both arms and checked the pulses in all 4 extremities at the initial examination. It was a standard of practice.
Some doctors tell me that they don’t have time to take their patients’ BP. Others claim that checking a patient’s BP is elementary and that practically anybody can do it. Still others, especially house officers and young private practitioners, say that questions regarding who took the patient’s BP and how it was taken virtually never came up during their training.
I believe that our current training programs lack sufficient emphasis on basic clinical skills, including emphasis on accurate BP measurements. I also believe that a responsible doctor is never too busy to take a patient’s BP. And measuring the BP accurately is, in fact, vitally important and cannot be done by just anybody. Consider the following.
Failure to compare the BP and pulses in both arms can have serious consequences, as the following case summary illustrates.
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My Doctor Wants To Compare The Reading From My Home Bp Monitor With The Reading Taken In The Office What Are The Instructions On How To Do This
When doing this type of a comparison, it is very important that the measurements are taken in a certain manner in order for the reading on the Omron monitor to be accurate. The Omron monitor uses oscillometric technology that measures the vibration of the blood as it moves through the arteries. The doctor is using a different method of measurement and listens to the sound of your heart. It is necessary for the doctor to take the first measurement using the Omron monitor. The brachial artery is fully open and not restricted so vibration of the blood is accurately measured. It is also important to note that the different test methods may give slightly different readings due to the test methods or due to the normal fluctuation in blood pressure.
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How Is Blood Pressure Measured
Blood pressure is measured in many ways including manual/auscultatory, automatic/electronic, cellular phone applications, and arterial catheters. Whatever method is used, blood pressure must be measured using validated equipment. It has been found that blood pressure is often not measured accurately in clinical practice, particularly when using the auscultatory/manual method. It is important to ensure correct technique to obtain an accurate measurement. Hypertension Canada recommends electronic blood pressure measurement as the preferred method in clinical practice.
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Check The Arm Size Range On The Cuff
Every home blood pressure cuff is made for a particular size range. The home monitor I use, came with a range of 8.75 to 16.5. All you have to do is check the size of the cuff to your arm circumference prior to ordering.
If youre looking for a new, affordable machine thats high quality, you can read about it in my blog post, Home Blood Pressure Monitors. It has cuff options up to 21.25. If the monitor doesnt come with the correct size cuff for you, try these options:
- Find out if the cuff can be changed.
- Shop for an appropriate size for your arm that will attach to your monitor. Here are some extra large size cuffs you can check out.
- Find a monitor with the correct size for you. Here are some monitors with extra large cuffs.
- Consider using a wrist cuff monitor instead. Heres the wrist monitor I recommend.
Welcome To Our Home Monitoring Resource Hub
Here you can find resources for home monitoring, see our simple steps to get an accurate reading and make the most out of home monitoring.
Plus, read more about .
The first step to managing your blood pressure is to Know Your Numbers! Watch our video to see how to measure your blood pressure at home and use our tips and resources below to check your own blood pressure at home.
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Different Blood Pressure In Right And Left Arms Could Signal Trouble
- By Patrick J. Skerrett, Former Executive Editor, Harvard Health
The next time you have your blood pressure checked, dont be surprised if your doctor, nurse, or other health-care provider measures it twiceonce in each arm. A significant difference in the pressure recorded in the right and left arms can signal circulatory problems that may lead to stroke, peripheral artery disease, or other cardiovascular problems.
British researchers looked at the results of 20 studies in which blood pressure was measured in both arms. People with an arm-to-arm difference of 15 points or more were twice as likely to have peripheral artery diseaseessentially cholesterol-clogged arteries in the arms, legs, or other non-heart parts of the body. The name may sound dismissive, but the disease isnt. Peripheral artery disease affects at least 12 million Americans, more than heart disease and stroke combined. It kills some, maims others, and makes life painful for countless more.
A blood pressure difference of 10 to 15 points or more between arms also boosted the chances of having a stroke or dying from cardiovascular disease.
The Wrong Diagnosis Of Low Or High Blood Pressure
There is a checklist in the new blood pressure guidelines for medical professions to follow when taking BP. Failure to do any of them can lead to a wrong diagnosis of low or high blood pressure. One of the things on the checklist is taking blood pressure in both arms during the initial visit or if the pressure is not normal in one arm.
Lets say you go for a doctor visit one day, and the nurse takes your BP in only one arm and the measurement indicates high blood pressure. Your doctor will be under the impression your blood pressure is high. In addition, the reverse can happen if the BP is low in one arm. The doctor will think your pressure is low or normal when it might actually be high because they never checked the other arm. Or even worse, like the 69 year old woman, they may miss that you have a serious narrowing of an artery on one side of your body.
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Is It Normal For My Blood Pressure To Vary
Yes, it is quite normal for peoples blood pressure to change throughout the day and night, or in different settings where you may measure your blood pressure. Many things, such as stress levels, food or drink intake, activity levels, even time of day can all affect a persons blood pressure reading at any given time. In fact, there are published studies that show a given persons blood pressure can change by up to 20mm within a day, based on activity levels, food/drink intake, stress, etc. This is why it is important to take your blood pressure on a regular basis, and review the overall trend of your blood pressure readings with your doctor.
For a convenient tool to help you easily track your blood pressure readings, click here.
Dont Take My Blood Pressure In That Arm
Lymphedema can be a problem worse than a cold rain in spring. Lymphedema is swelling of the arm that can occur after breast cancer surgery and is akin to your kitchen sink sponge soaked with water.
Traditionally, women who have had lymph nodes removed from their armpit, what is known medically as the axilla and the procedure an Axillary Lymph Node Dissection, were at a 40% risk for developing lymphedema.
However, today, most women have a Sentinel Lymph Node Biopsy as opposed to a full Axillary Lymph Node Dissection, and the risk of lymphedema is only 8%. You would need to ask your surgeon which procedure you had, a Sentinel Lymph Node Biopsy or a full Axillary Lymph Node Dissection, before you know what your risk of lymphedema is.
How can you prevent lymphedema? The two biggest risk factors for lymphedema are infection in the arm and obesity.
The first step is to eat a healthy diet, exercise and get your weight down to a body mass index less than 25. The second step is to protect your arm from infection. When you are gardening or walking in the woods, wear a long sleeve shirt, because scratches from plants and bites from insects can lead to infection, which can lead to lymphedema.
Will having your blood pressure done on your arm cause lymphedema? No. Dont worry about having someone take your blood pressure in the affected arm, although again, prudence may dictate that you use the other arm for blood pressure measurement.
May you live long and prosper.
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How Do I Measure My Arm Circumference
To determine your arm size, use a cloth tape measure and place midway between your elbow and your shoulder around the circumference of your upper arm. Wrap the tape measure evenly around your arm. Do not pull the tape tight. Note the precise measurement in inches. Determine which size cuff is best for you, then purchase a home blood pressure monitor with that size cuff included.
Proper Technique For Blood Pressure Measurement
Is your blood pressure being measured correctly? Accurate blood pressure measurements are essential for diagnosing and treating high blood pressure. A specific set of techniques and procedures have been developed for obtaining the most accurate blood pressure readings possible.
But research has shown that medical professionals often do not completely follow these guidelines. It is important for you as a patient to be able to identify when proper protocol is being followed, or not.
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When And Where To Get Your Blood Pressure Tested
You should have a blood pressure test if youâre worried about your blood pressure at any time.
If youâre over 40, you can have this test done as part of an NHS Health Check, which is offered to adults in England aged 40 to 74 every 5 years.
If you have been diagnosed with high or low blood pressure, or you have a high risk of developing either, you may need more frequent checks of your blood pressure.
You can get your blood pressure tested at a number of places, including:
- your local GP surgery
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Simple Steps To Achieving An Accurate Blood Pressure Reading
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Does Measuring Your Blood Pressure On The Left Or Right Arm Matter
Home»Blogs»Does Measuring Your Blood Pressure on The Left or Right Arm Matter?
Your body may look symmetric, but if you look a little closer, you may notice that one eye may be a bit lower than the other, or maybe one hand or foot is a little larger. Inside your body, most of your organs, including blood vessels, are arranged asymmetrically, so what does this mean for your blood pressure?
Blood pressure can vary between your right and left arms and the reason for this could simply be caused by a muscle pressing on a blood vessel, causing turbulence in the body. However, it could be much more serious and a sign of cardiovascular disease, which can lead to strokes, heart attacks, or blood vessel damage. Continue reading to find out why its important to check your blood pressure in both arms and what to do if theyre not the same.
Why Cant I Get A Reading From My Omron Wrist Blood Pressure Monitor With Heart Guide Technology
The most common cause of this situation is due to the user not having the unit at heart level. Please follow the below directions.
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Youre Not Factoring In Electronic Units Correctly
Electronic blood pressure units also called Non Invasive Blood Pressure machines, sense air pressure changes in the cuff caused by blood flowing through the BP cuff extremity. Sensors estimate the Mean Arterial Pressure and the patients pulse rate. Software in the machine uses these two values to calculate the systolic and diastolic BP.
To assure accuracy from electronic units, it is important to verify the displayed pulse with an actual patient pulse. Differences of more than 10 percent will seriously alter the units calculations and produce incorrect systolic and diastolic values on the display screen.
Given that MAP is the only pressure actually measured by an NIBP, and since MAP varies little throughout the body, it makes sense to use this number for treatment decisions.
A normal adult MAP ranges from 70 to 105 mmHg. As the organ most sensitive to pressure, the kidneys typically require an MAP above 60 to stay alive, and sustain irreversible damage beyond 20 minutes below that in most adults. Because individual requirements vary, most clinicians consider a MAP of 70 as a reasonable lower limit for their adult patients.
Finally, and especially in the critical care transport environment, providers will encounter patients with significant variations between NIBP and arterial line measured blood pressure values.