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Which Arm For Blood Pressure

Variability Of Blood Pressure

Wrist or Arm Blood Pressure Monitors: Which is More Accurate?

The observer must be aware of the considerable variability that may occur in blood pressure from moment to moment with respiration, emotion, exercise, meals, tobacco, alcohol, temperature, bladder distension, and pain, and that blood pressure is also influenced by age, race, and circadian variation. It is usually at its lowest during sleep. It is not always possible to modify these many factors but we can minimise their effect by taking them into account in reaching a decision as to the relevance or otherwise of a particular blood pressure measurement.

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Blood Pressure Risk Indicator

This alerts you to whether your blood pressure reading falls within recommended levels, which could be useful if youre not having your blood pressure regularly monitored by a health professional or if you dont always remember the recommended limits.

But if youre good at monitoring this yourself, you might not want to pay extra for fancier features to keep an eye on whether your blood pressure is within recommended limits.

For more details on blood pressure ranges, have a look at our guide Blood pressure ranges explained and how to measure yours.

Youve Incorrectly Positioned Your Patients Body

The second most common error in BP measurement is incorrect limb position. To accurately assess blood flow in an extremity, influences of gravity must be eliminated.

The standard reference level for measurement of blood pressure by any technique direct or indirect is at the level of the heart. When using a cuff, the arm where the cuff is applied must be at mid-heart level. Measuring BP in an extremity positioned above heart level will provide a falsely low BP whereas falsely high readings will be obtained whenever a limb is positioned below heart level. Errors can be significant typically 2 mmHg for each inch the extremity is above or below heart level.

A seated upright position provides the most accurate blood pressure, as long as the arm in which the pressure is taken remains at the patients side. Patients lying on their side, or in other positions, can pose problems for accurate pressure measurement. To correctly assess BP in a side lying patient, hold the BP cuff extremity at mid heart level while taking the pressure. In seated patients, be certain to leave the arm at the patients side.

Arterial pressure transducers are subject to similar inaccuracies when the transducer is not positioned at mid-heart level. This location, referred to as the phlebostatic axis, is located at the intersection of the fourth intercostal space and mid-chest level (halfway between the anterior and posterior chest surfaces.

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Proper Arm Position For Blood Pressure

Before telling you how different arm positions can change your measurement, Im going to tell you the right way to position your arm. For now on, you will be taking your pressure with your arm in this position, if youre not doing it already. You can put an end to false blood pressure readings, if you follow all the steps, especially with the arm.

This arm position is the recommended guideline as per the American College of Cardiology and The American Heart Association . Besides arm position, there are other steps needed for proper measurement. For the purpose of this blog post, Im only honing in on arm position. For the complete guide on all the steps, you can check out my blog post here, How To Use A Home Blood Pressure Monitor The Right Way. The following steps for proper arm position are:

  • To position your arm properly, your body needs to be in the correct position. Sit in a chair with a supported, upright back. Your feet should be flat on the floor. How many times has a nurse taken your pressure while sitting on an exam table with your back unsupported? This is one of the many errors they make while measuring blood pressure.
  • Your arm should be positioned outwards from your body and supported, either by a desk, arm rest or similar support.
  • More Difference Between Arm

    Care Touch Automatic Wrist Blood Pressure Cuff Monitor

    Small difference between arm-to-arm blood pressure is normal. If you observe that the difference between blood pressure in both of your hands is more, then you should get yourself checked by a specialist. Difference of around 5 points in systolic pressure is normal. But if it is more than 10 points then you should be more aware about your heart health, as your chances of heart diseases is more than an average person.

    If you are ever diagnosed with more arm-to-arm blood pressure difference then you should always get your blood pressure checked with that arm which shows higher blood pressure and get appropriate treatment. Usually higher arm-to-arm difference may be an indication of :

    • Blocked arteries in your arms
    • Kidney disease
    • Heart defect

    Blocked arteries in your arm may show some visible symptoms like tightness, weakness, heaviness or cramping in that arm. Finger pain and sensitivity to cold are some of the other symptoms. Rarely fingers of the affected arm may turn pale or blue due to blockage. So such symptoms should not be ignored. Measuring blood pressure in both of your arms can be used to diagnose this disease at home.

    Our kidneys perform blood filtration and high blood pressure is directly related to their performance and capacity. Some researches have shown that high blood pressure in any one arm may be a symptom of kidney disease.

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    Why Wrist Bp Monitors Give Higher Or Lower Readings

    Wrist blood pressure monitors are frequently criticized for inaccurate readings. Some of these readings are not the fault of the wrist monitor but because of some other reason. Therefore, lets find out the answer to, why do wrist blood pressure monitors give higher or lower readings?

    A wrist blood pressure monitor can give higher or lower readings for the following reasons:

  • The cuff is above or below heart level
  • The cuff is too tight or loose
  • The cuff size is incorrect
  • The cuff is positioned improperly
  • The wrist or hand is unrelaxed
  • The wrist is bent
  • The arm or body is unsupported
  • In this blog post Ill explain how each one of the above reasons can be easily corrected. Once the correct way to measure your blood pressure with a wrist cuff is learned, your measurements will become more accurate. Therefore, lets dive right in and start learning your true BP!

    BP TIP: Can you lower BP by just breathing? Its FDA approved and The American Heart Association gave it the thumbs up. It simply guides your breathing a few minutes a day which has been proven to lower BP as shown in studies. Check it out in the manufacturers website by .

    Disclaimer: Some links in this article are affiliate links which means I may earn a small commission at no extra cost to you. As an Amazon associate I earn from qualifying purchases.

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    My Own Blood Pressure Cuff Study

    I wanted to conduct my own study about how my blood pressure was affected using my home monitor with a proper cuff size. First, I measured my blood pressure with the cuff wrapped with the proper tightness.

    I measured my blood pressure three times to achieve accurate results. The following were my blood pressure measurements:

    After resting for one minute, I immediately tightened the cuff too tight. I was barely able to slip one finger under the lower edge of the cuff. I measured my blood pressure three more times with the following results shown in the table below.

    BP With Proper Cuff Adjustment BP With Cuff Too Tight

    The following were my average blood pressure readings:

    • Proper Tightness: 117/71.3 mmHg
    • Cuff Too Tight: 112.3/70.5 mmHg

    After making the cuff too tight, the systolic blood pressure dropped almost 5 mmHg and diastolic almost dropped 1 mmHg. The results of my study confirmed the research saying blood pressure will measure lower when more of the arm circumference is squeezed by the cuff bladder.

    A cuff secured too tight doesnt always indicate a lower reading. Remember, the cuff used in my study is the correct size for my arm. If the cuff is too tight for a different reason, as discussed in the articles next section, the measurement may be higher.

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    Tips To Measure Your Blood Pressure Correctly

    To determine whether you have hypertension, a medical professional will take a blood pressure reading. How you prepare for the test, the position of your arm, and other factors can change a blood pressure reading by 10% or more. That could be enough to hide high blood pressure, start you on a drug you don’t really need, or lead your doctor to incorrectly adjust your medications.

    National and international guidelines offer specific instructions for measuring blood pressure. If a doctor, nurse, or medical assistant isn’t doing it right, don’t hesitate to ask him or her to get with the guidelines.

    Here’s what you can do to ensure a correct reading:

    Don’t drink a caffeinated beverage or smoke during the 30 minutes before the test.

    Sit quietly for five minutes before the test begins.

    During the measurement, sit in a chair with your feet on the floor and your arm supported so your elbow is at about heart level.

    The inflatable part of the cuff should completely cover at least 80% of your upper arm, and the cuff should be placed on bare skin, not over a shirt.

    Don’t talk during the measurement.

    Have your blood pressure measured twice, with a brief break in between. If the readings are different by 5 points or more, have it done a third time.

    For more on getting your blood pressure under control, buy Controlling Your Blood Pressure, a Special Health Report from Harvard Medical School.

    Image: cheyennezj/Getty Images

    If You Get A High Blood Pressure Reading

    How to Use the OMRON Evolv® Upper Arm Blood Pressure Monitor
    • A single high reading is not an immediate cause for alarm. If you get a reading that is slightly or moderately higher than normal, take your blood pressure a few more times and consult your healthcare professional to verify if there s a health concern or whether there may be any issues with your monitor.
    • If your blood pressure readings suddenly exceed 180/120 mm Hg, wait five minutes and test again. If your readings are still unusually high, contact your doctor immediately. You could be experiencing a hypertensive crisis.
    • If your blood pressure is higher than 180/120 mm Hg and you are experiencing signs of possible organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, difficulty speaking, do not wait to see if your pressure comes down on its own. Call 911.

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    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.

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    Strength And Weakness Of The Paper

    Papers published before the year 1960 were excluded from the present review. Although this line is arbitrary it may be justified by the following arguments. First, although the mercury sphygmomanometer could be of sufficient quality in the early years stethoscopes were of lesser quality and a poor quality stethoscope has a major influence on accuracy. Second, most of the studies from before 1960 lack a detailed method description which makes it complicated or impossible to know how to interpret the values. Third, at that time the 4th Korotkoff sound was commonly used to determine the diastolic BP value. Fourth, as can be seen from the review of Clark et al. many studies from before 1960 show very high prevalences of patients with relevant IADs these values seem not comparable with the values from younger papers and imply that this is the result of methods or patient selection. Several large-scale studies have been published that were excluded for the present paper because of the methods that were used., Although these papers contain interesting information, for the present review we chose only to compare those studies in which double-arm measurements were performed with regular BP monitors. Although, Doppler devices are commonly used to measure systolic upper-arm pressure when assessing ankle brachial index it is not recognized as routine tool to perform upper-arm BP measurements.

    Systolic Differences The Key

    Digital Upper Arm Blood Pressure Monitor Device With Adaptor Health ...

    The American Heart Association considers blood pressure normal when the top number is less than 120 and the bottom number is less than 80.

    A difference of 10 millimeters of mercury or less between arms is considered normal by the AHA and is not a cause for concern. However, higher readings between the two arms might be a sign of a narrowing or stiffening of the arteries, which can affect blood flow.

    Unlike guidelines inthe US, those inboth UK and the European Union recognize a systolic difference of 15 mmHg or more between the two arms as the threshold indicative of additional cardiovascular risk, the study said.

    Research coauthor Victor Aboyans, professor and head of the department of cardiology at the Dupuytren University Hospital in Limoges, France, said the study shows that international guidelines should be reevaluated.

    We believe that a 10 mmHg difference can now reasonably be regarded as an upper limit of normal for systolic inter-arm blood pressure, when both arms are measured in sequence during routine clinical appointments, Aboyans said in a statement.

    This information should be incorporated into future guidelines and clinical practice in assessing cardiovascular risk. It would mean many more people were considered for treatment that could reduce their risk of heart attack, stroke and death, Aboyans added.

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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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    What To Look For

    Optimal blood pressure is less than 120/80 mm Hg. In addition to reaching that goal, you want the difference in systolic blood pressure the upper number of the reading between your arms to be within 5 points.

    If its greater than 10 or 15 points, the first step is to recheck because you may have simply settled down and lowered your blood pressure between arm readings. If the difference persists, it should be investigated. Itâs all about your bodyâs plumbing and blood flow.

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    What Size Cuff Do I Need

    The correct size of cuff is based on the circumference of your upper arm, or your wrist, depending on which type of model you want. Omron monitors cover a variety of sizes as mentioned below:

    D-Ring Upper Arm Cuff Sizing

    • Small adult cuff: fits upper arm with circumference between 7-9 inches
    • Standard adult cuff: fits upper arm with circumference between 9-13 inches
    • Large adult cuff: fits upper arm with circumference between 13 and 17 inches

    ComFit Cuff Sizing

    • ComFit cuff: fits upper arm with circumference between 9-17 inches

    Wrist Model Sizing

    • Wrist model: first wrists with circumference between 5¼-8½ inches.


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