Effect Of Arm Position Straight Down Or Unsupported
Having your arm cuff at the correct height and position is ideal but your arm needs to be supported. A hanging or unsupported arm will typically raise your blood pressure. In a study of 240 people, the average blood pressure was 8 mmHg higher when the arm was unsupported and lowered as compared to the arm supported at heart height .
When an arm is unsupported, it forces you to perform isometric exercise to hold the arm in place. This raises blood pressure and heart rate. By having an arm raised while unsupported can raise diastolic BP by as much as 10%. The effect of isometric exercise is greater in people with high BP .
Another study found systolic blood pressure was 8 mmHg higher when the arm was down and unsupported and diastolic was 7 points higher. The same study then checked people who had high blood pressure and found systolic pressure increased 23 mmHg and diastolic increased 10 mmHg when the arm was unsupported .
Researchers from the University of California, measured blood pressure in 100 different patients who visited the emergency room. Patients were measured 2 different ways, one with their arm in the correct position and supported, the other with their arms parallel to their body. People with their arm in the correct position were classified with high blood pressure 22% of the time while the other group were classified 41% .
A Wrong Diagnosis Can Lead To Serious Medical Problems That Can Be Fatal
The following are medical conditions that can result from having different BP in each arm. If BP is never taken in both arms, the opportunity to correct or prevent these conditions is reduced.
Peripheral Artery Disease : PAD is a narrowing of your arteries that serve your stomach, legs, arms and head. People with PAD are at a higher risk of stroke, heart attack and coronary artery disease. PAD can also lead to an amputation and gangrene. If PAD is diagnosed early, it may be treated with lifestyle changes and medication .
Aortic Dissection: Its uncommon and is a less common cause of blood pressure different in each arm. Aortic dissection happens when the inner layer of the aorta tears. Blood flows through the tear which causes the inner and middle layers of the aorta to separate. If this blood filled area breaks through the outer wall of the aorta, the result is often fatal.
Problems In Young People: A younger person can have BP different in each arm but usually for different reasons. Blood flow through an artery may be disrupted because of a structural issue. Another reason may be when something inside the body, like a muscle, can press down on an artery and restrict the blood flow.
Before Checking Your Blood Pressure
- Find a quiet place to check your blood pressure. You will need to listen for your heartbeat.
- Make sure that you are comfortable and relaxed with a recently emptied bladder .
- Roll up the sleeve on your arm or remove any tight-sleeved clothing.
- Rest in a chair next to a table for 5 to 10 minutes. Your arm should rest comfortably at heart level. Sit up straight with your back against the chair, legs uncrossed. Rest your forearm on the table with the palm of your hand facing up.
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Applying The Wrist Cuff
The first thing is to make sure your wrist doesnt have any clothing over it. Its ideal to wear short sleeves or a pushed up long sleeve shirt. If youre rolling up a long sleeve, make sure its loose, if not it can create a tourniquet effect.
Applying a cuff over clothing can increase systolic between 10 and 50 mmHg higher 3.
The monitor should be on the inside of your wrist and forearm and tightened snug. There shouldnt be any loose space between the cuff and your skin but not too tight either. Take a look on the outside of your wrist where the bone protrudes on the little finger side. The cuff should not be covering the protrusion.
The edge of the cuff should be approximately 1/2 to 1 away from the crease of your wrist or where the bottom of your palm is.
How do you know which wrist to use? Its typical to have a slight difference in blood pressure between each arm. The arm that consistently has the higher readings should be the wrist to use 4.
How to use a wrist cuff is one of 14 sections in my article about blood pressure cuffs. Learn more about BP cuffs, including how to apply them, errors made and sizes, here in the article, Blood Pressure Cuffs.
When The Arrow On A Bp Cuff Is A Size Indicator Marker
On some blood pressure cuffs the arrow is not an artery marker and is meant to help indicate the cuff is properly sized. After securing the cuff and lining up the artery marker, the arrow should be pointing towards the size range indicator line on the cuff.
Typically the arrow will point towards the upper part of the cuff towards the shoulder. Most cuffs will have the size range indicator line on the opposite side of the cuff from the artery marker.
Depending on the manufacturer, the size indicator arrow may be labeled differently. The following are some of the more popular terms used:
- Fit Indicator
The size indicator line runs from left to right on the edge of the cuff. It is there to help make sure the cuff is the appropriate size for the upper arm. If the cuff is at the proper tightness and is the correct size for your arm, the arrow will point somewhere to the line.
On my home monitor, the Welch Allyn 1700 Series, the artery marker is a small circle with a line drawn through it 2. There is an arrow on the other side pointing towards the size range line.
Every manufacturer may have a slightly different marker for the artery.
I have a detailed review of the Welch Allyn 1700 Series. If you want to check it out and see photos of it and the phone app, click here, Welch Allyn Home 1700 Series Blood Pressure Monitor Review.
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How To Use An Automated Blood Pressure Cuff Correctly
Using an upper arm blood pressure cuff might require practice, but once you get it down, its very simple. Follow the below steps suggested by Dr. Del Conde:
- Relax. Sit quietly and in an upright position for two to five minutes before checking your blood pressure.
- Keep your feet flat on the ground and your arm supported at heart levelon a table, for example.
- Place the machine on a table next to you so while youre seated, you can keep your arm next to it comfortably.
- Wear the cuff over bare skin. Place it around your upper arm about one inch above the bend of your elbow. Secure the cuff tightly and evenly, but make sure you still have room to slide two fingers under the top edge of the cuff.
- Turn the power on.
- Press the start button to begin inflation. Automatic models inflate on their own and, once inflated, release air slowly.
- Look at the screen to get your blood pressure reading, separated into two numbers: your systolic and diastolic pressures.
- Write down your blood pressure reading so you can track it over time. The systolic pressure is listed before the diastolic pressure, so it should look something like 120/80 mmHg.
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.
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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What Steps Should I Take While Checking My Blood Pressure At Home
Before taking your blood pressure
- Find a quiet place.
- Check to be sure you have the correct size cuff. If you are not sure, or if you have questions, talk to your healthcare provider.
- Roll up the sleeve on your left arm or remove any tight-sleeved clothing, if needed.
- Rest in a chair next to a table for 5 to 10 minutes.
- Sit up straight with your back against the chair, legs uncrossed and on the ground.
- Rest your forearm on the table with the palm of your hand facing up.
- You should not talk, read the newspaper, or watch television during this process.
Taking your blood pressure
If you buy a manual or digital blood pressure monitor , follow the instruction booklet carefully.
Record your blood pressure
If you have been asked to record your blood pressure and bring your readings to the office, please write down the date, time of day, systolic and diastolic numbers, heart rate, and which arm you took the reading on. If you are taking part in a program that has remote monitoring, your blood pressure readings are automatically shared with your medical provider. If you are unsure, please ask your provider.
Last reviewed by a Cleveland Clinic medical professional on 10/23/2018.
Youre Using The Wrong
The most common error when using indirect blood pressure measuring equipment is using an incorrectly sized cuff. A BP cuff that is too large will give falsely low readings, while an overly small cuff will provide readings that are falsely high.
The American Heart Association publishes guidelines for blood pressure measurement . recommending that the bladder length and width should be 80 percent and 40 percent respectively, of arm circumference. Most practitioners find measuring bladder and arm circumference to be overly time consuming, so they dont do it.
The most practical way to quickly and properly size a BP cuff is to pick a cuff that covers two-thirds of the distance between your patients elbow and shoulder. Carrying at least three cuff sizes will fit the majority of the adult population. Multiple smaller sizes are needed if you frequently treat pediatric patients.
Korotkoff sounds are the noises heard through a stethoscope during cuff deflation. They occur in 5 phases:
- I first detectable sounds, corresponding to appearance of a palpable pulse
- II sounds become softer, longer and may occasionally transiently disappear
- III change in sounds to a thumping quality
- IV pitch intensity changes and sounds become muffled
- V sounds disappear
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How To Measure Blood Pressure
Blood pressure levels change over the course of time. They can also change according to physical or mental conditions, the measurement environment, or other factors. It’s also nearly impossible to get accurate readings unless you follow the correct procedures. So make sure to measure your blood pressure correctly and keep a record of your readings.
Watch The Person Taking Your Blood Pressure Closely
The technique is extremely important and can give a false reading if not done correctly.
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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.
Tips For Checking Your Own Blood Pressure
There are certain factors that can cause blood pressure to temporarily rise. For example, blood pressure normally rises as a result of:
- Certain medicines
Try to avoid as many of these factors as you can when taking your blood pressure. Also, try to measure your blood pressure at about the same time each day. Your doctor may want you to check your blood pressure several times during the day to see if it fluctuates.
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New Aha Recommendations For Blood Pressure Measurement
Am Fam Physician. 2005 Oct 1 72:1391-1398.
Diagnosis and treatment of hypertension depend on accurate measurement of auscultatory blood pressure. The lowering of target blood pressure for patients with diabetes or renal disease has made detection of small differences more important. However, blood pressure reading is one of the most inaccurately performed measurements in clinical medicine.
True blood pressure is defined as the average level over a prolonged duration. Thus, in-clinic blood pressure measurement, which generally makes no allowance for beat-to-beat variability, can be a poor estimation and may fail to catch high blood pressure that occurs only outside the clinic setting. In addition, faulty methods and the white coat effect may lead to misdiagnosis of hypertension in normotensive patients.
To increase accuracy of clinic readings, and in recognition of major changes over the past 10 years , the American Heart Association has published a new set of recommendations for the measurement of blood pressure. The AHA scientific statement, written by Pickering and colleagues, was first published in the January 2005 issue of Hypertension and also appears in the February 8, 2005, issue ofCirculation. It can be accessed online at. A summary of the AHA scientific statement follows.
Blood Pressure Cuff Placement
There are so many variables involved when measuring blood pressure. If one of them is not performed properly, your blood pressure readings will not reflect your typical pressure. Blood pressure cuff placement is one of those variables. Therefore, what is the correct blood pressure cuff placement?
A properly sized blood pressure cuff should be placed around your bare upper arm. The middle of the cuff should be positioned at the level of the right atrium. In addition, home monitor cuffs should be positioned slightly above the arm bend with the artery marker on the cuff lined up to the artery. The cuff should be pulled taught, enough to fit two finger tips under the top edge of the cuff.
There are many blood pressure articles explaining tips and proper techniques for measuring your blood pressure at home. Of course, they all address arm cuff placement, but they rarely go into complete detail. Often its just one numbered step out of many others.
This post will go into the nitty gritty and tell you everything you need to know about arm cuffs and how it can affect your blood pressure readings.
BP TIP: Lower BP by just breathing? A device is FDA approved and The American Heart Association gave it the thumbs up. It simply guides your breathing for you a few minutes a day which has been proven to lower BP in studies. Check it out in the manufacturers website by .
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Check The Cuff For Correct Sizing
The Welch Allyn cuff has an arrow on it labeled index. Many people think the arrow is supposed to point down your arm towards your hand, but its not. The index arrow is supposed to point up towards your shoulder.
The purpose of it is to check the size of the cuff and make sure its the correct size for your arm. The Welch Allyn cuff has a size range indicator line. If the cuff is the correct size, when its tightened and secured, the arrow will point somewhere on the line.
If the cuff is too small or big, the arrow will point somewhere before or after the size indicator line. If you need a different size cuff, luckily Welch Allyn has the widest size range cuffs available for the 1700 series.
The extra large cuff fits arms up to 21.25 They also have a small cuff which fits upper arms from 5.75 to 9.5 They can both be ordered on Amazon here, 1700 series cuffs.
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