When Its Time To See A Health Care Provider
If you have a significant blood pressure difference between arms , you should see your health care provider. If they also measure a blood pressure difference of more than 10 points between arms, they may order another test referred to as the ankle-brachial index test to rule out peripheral artery disease.
How Do Health Care Professionals Measure My Blood Pressure
First, a health care professional wraps an inflatable cuff around your arm. The health care professional then inflates the cuff, which gently tightens on your arm. The cuff has a gauge on it that will measure your blood pressure.
The health care professional will slowly let air out of the cuff while listening to your pulse with a stethoscope and watching the gauge. This process is quick and painless. If using a digital or automatic blood pressure cuff, the health care professional will not need to use a stethoscope.
The gauge uses a unit of measurement called millimeters of mercury to measure the pressure in your blood vessels.
If you have high blood pressure, talk to your health care team about steps to take to control your blood pressure to lower your risk for heart disease and stroke.
Use this list of questions to ask your health care team pdf icon to help you manage your blood pressure.
When To Check Both Arms
The practice of taking blood pressure in both arms is not yet a mainstream activity with all patients. But, as mentioned, it is best practice for those with hypertension and other risk factors for heart disease, from age, sex, or family history to the presence of underlying conditions like diabetes.
As we learned from the UK study, a difference between the arms of 10 points or more is reason for the physician to dig more deeply into the patients condition. For example, it may indicate a narrowing in the artery that feeds the arm from the shoulder. Atherosclerosis, or plaque, is a systemic process, and narrowing in an arm artery could be an early warning of narrowing in other critical areas. A narrowing in the coronary arteries that supply blood to the heart could cause a heart attack in the arteries of the neck, it might lead to stroke.
Everyones metabolism, risk, and genetic makeup are different, and your doctor is the best source of sound advice. If you have risk factors for heart disease and routinely monitor your blood pressure, its best to have a conversation with your doctor about checking both arms. He or she will work with you to determine next steps and any additional testing required, such as a CT scan to detect arterial calcification, a stress test, or an ultrasound of the blood vessels to determine plaque burden.
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New Aha Recommendations For Blood Pressure Measurement
LIZ SMITH
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.
How Do I Take My Blood Pressure
Before taking your blood pressure:
- Find a quiet place.
- 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 five to 10 minutes.
- 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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Playing An Active Role
Hypertension is often known as a silent killer because a patient can have mild or no symptoms for several years, in spite of ongoing damaging effects of high blood pressure on their critical organs, such as the heart, brain, or kidneys. Because they feel fine, some people may resist taking the steps needed to correct their high blood pressuretypically a combination of weight management, reducing sodium in the diet, and medication.
Education is a key part of treatment planning and execution, and fortunately, my patients tend to be very responsive once we emphasize the serious potential for heart attack, stroke, kidney failure, and peripheral vascular disease, vision loss, bowel disease, limb loss, and other problems.
At-home blood pressure gauges can store results, empowering our patients to provide us with high-quality and detailed information that is valuable in helping us tailor a specific treatment plan for them.
My patients also bring their portable units to their office visit, where we can also check its readings for accuracy by comparing them to those of our medical-grade, calibrated office equipment. Access to the portable machines recorded results is useful during telehealth visits as well.
When And Where To Get Your Blood Pressure Tested
You should have a blood pressure test if you’re worried about your blood pressure at any time.
If you’re 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
- some workplaces
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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.
Choosing A Home Blood Pressure Monitor
The American Heart Association recommends an automatic, cuff-style, bicep monitor.
- Wrist and finger monitors are not recommended because they yield less reliable readings.
- Choose a monitor that has been validated. If you are unsure, ask your doctor or pharmacist for advice or find options at validatebp.org.
- When selecting a blood pressure monitor for a senior, pregnant woman or child, make sure it is validated for these conditions.
- Make sure the cuff fits measure around your upper arm and choose a monitor that comes with the correct size cuff.
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Influence Of Body Position On Bp Readings
A total of 57 hypertensive patients years, BMI 25.7±4.4 kg/m2, arm circumference right 29.2±3.3 cm and left 28.9±3.3 cm) participated in this part of the study. Of these, 50 patients were on antihypertensive drug treatment. Two sessions of BP measurements, separated by a 10min pause, were performed in two positions: lying on a bed with the arms supported with the palms upwards and both the cubital fossa and the upper arm at halfway between the bed and the sternum and sitting on a chair with the arms supported horizontally with the palms upwards and again both the cubital fossa and the upper arm at the level of the midsternum. The arm was placed at the approximated right atrium level using a levelling instrument. Each session started with 5min rest in the respective position. Then BP recordings were taken in triplicate 1min apart, simultaneously at both arms, using a Hawksley random-zero sphygmomanometer and a stethoscope at the right arm and an automatic oscillometric device at the left arm. In between, a 20s heart rate was counted at the right radial artery.
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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Which Arm To Choose For Blood Pressure Measurement
According to the recommendations by the American Heart Association, the health care provider should measure your blood pressure in both your arms in case theres a difference. Your health care provider will use the higher blood pressure number to make decisions about treatment. You should also follow the below-mentioned guidelines during blood pressure measurement:
- Avoid drinking caffeinated beverages or smoking about half an hour before BP measurement.
- Sit quietly for at least five minutes before being measured.
- During BP measurement, sit comfortably in a chair. Keep your feet on the ground and support your arm so that your elbow is at the level of your heart.
- The inflatable portion of the cuff should cover about 80 percent of your upper arm. The health care provider will place it on your skin and not over a shirt.
- Avoid talking during the measurement.
What Is Systolic Pressure
The heart is a pump that works in tandem with the lungs. The right side of the heart sends oxygen-deficient red blood cells to the lungs for gas exchange and the left side of the heart receives back oxygen-rich blood to pump to the rest of the body.
During the pumping phase, pressure in the blood vessels naturally rises. We measure that as systolic pressurethe top number of your resting blood pressure. Normal systolic blood pressure should be around 120.
The UK study identifies 10 points as the critical threshold of difference between the arms. Thats lower than the previous guideline of 15. For example, systolic blood pressure of 118 in one arm and 120 in the other causes little concern. But a reading of 120 in one arm and 131 in the other does. Recognizing this often-overlooked difference and delving further into a personal history and physical exam, together with additional targeted testing, may prevent a catastrophic cardiovascular event down the line.
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If Cuff Fit Isnt The Issue
If youre experiencing intense arm pain when you take your blood pressure even after youve measured your arm circumference and made sure you have a cuff that fits, double check your cuff placement to be sure the monitor is able to correctly detect your blood pressure. If the device cant get the signals it needs because the cuff is not in the right place, it may end up over-inflating. Similarly, if youre moving during the reading, your monitor may be thrown off and the cuff may remain inflated for a longer period in order to take a measurement.
Keep in mind, too, that your cuff needs to inflate to a higher pressure than your systolic blood pressure in order to take a measurement so if your blood pressure is especially high, the cuff may inflate to a higher level than usual and cause some pain.
If you find that arm pain frequently occurs at the doctors office with an automatic blood pressure monitor, you can ask your nurse or doctor to measure your blood pressure manually with a pump instead to see if that helps.
And if you cant seem to find a way to take your blood pressure without experiencing pain, talk to your doctor. You could be dealing with an underlying injury or other condition thats causing your discomfort.
Those Blood Pressure Numbers Explained
In a young person, the big difference could signal a congenital heart defect called coarctation of the aorta, or a narrowing of your main artery. In an older person or somebody who is at risk for atherosclerosis, it could indicate a blockage. It could also be a potential sign of aortic dissection, a tear in the wall of the aorta.
Typically, if one arm registers higher, then that arm should be used for future measurements, whether at the doctors office or if you monitor your blood pressure at home, Hayes said.
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How Did Bfr Training Begin
Congratulations! If youve made it this far you are really dedicated to learning about BFR training. So Ill give you a little bonus info about how it got started.
BFR was invented by a Japanese therapist, Yoshiaki Sato, around 1994. After sitting in a traditional kneeling position for a long time at a funeral, Sato realized that his calves felt just as if hed done a vigorous workout.
From there he wondered if sitting on his calves had slowed blood return, trapping CO2, lactic acid, and other waste products. This, he thought might trick the muscles into growing because they felt like they had done a heavy bout of exercise.
Further research proved his hypothesis, and he started KAATSU training the origin of BFR. He tried it out on himself as one of the first test subjects. After breaking his ankle, he decided to use BFR on the injured leg while he was in a cast for 8 weeks. He found that hed prevented almost all of the atrophy that usually comes from being in a cast for that long. And the rest is history.
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This does not constitute specific medical advice and does not indicate a physician-patient relationship between Dr. Larson and readers of this website. Please consult your own physician regarding any of these recommendations before starting them.
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. It’s all about your body’s plumbing and blood flow.
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Blood Pressure Differences Between Arms
Finding blood pressure differences between arms can be a sign of atherosclerosis, which is basically plaque buildup in arteries. Finding a difference in pressure between sides of the body tells doctors that they need to investigate further to see if atherosclerosis is in the main blood vessel leaving the heart or in other parts of the body.
One study published in the medical journal The Lancet stated that a blood pressure difference of 10 to 15 points between arms increases the risk of dying from heart disease or a stroke.
A small difference in blood pressure between arms is nothing to panic about. A large difference could signal health problems that include not only plaque buildup, but also kidney disease, diabetes, and heart defects.
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Blood Pressure Higher In The Right Arm
It is normal to have a blood pressure difference of about five points or fewer between arms. The right arm tends to be a bit higher. According to a study published in the American Journal of Medicine, the average systolic blood pressure difference between arms is about five points. Your health care provider will make treatment decisions based on the higher blood pressure number.
A significant difference in your blood pressure readings may indicate a health issue such as:
- Peripheral arterial disease
- Heart defect
- Kidney disease
One of the less common causes of a blood pressure difference between arms is an aortic dissection, which is a tear in the aortic wall. The aorta is the largest blood vessel and supplies oxygen-containing blood to the whole body from the heart.
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