Which Arm To Check Blood Pressure

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.

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.

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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What Should I Do If My Blood Pressure Is 160 Over 100

Your doctor If your blood pressure is higher than 160/100 mmHg, then three visits are enough. If your blood pressure is higher than 140/90 mmHg, then five visits are needed before a diagnosis can be made. If either your systolic or diastolic blood pressure stays high, then the diagnosis of hypertension can be made.

What Is A Healthy Blood Pressure Reading

Your blood pressure measures the force of the blood being pushed through your body as your heart beats.

The first number is called your systolic pressure. It measures the pressure in your blood vessels when your heart pumps. The second number is called your diastolic pressure, which measures the pressure in your blood vessels in between heartbeats.

A blood pressure reading is considered healthy if it is 120/80 millimeters of mercury or below. Any blood pressure above this is considered elevated or abnormal.

A single blood pressure reading in the higher range isnt cause for concern, but if youre regularly getting higher readings, a medical professional will make a plan to help you lower your numbers.

Elevated blood pressure categories include:

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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.

References

Effect Of Arm Position On Blood Pressure

Taking blood pressure seems like a simple task. It appears even easier at home. All you have to do is wrap the cuff around your arm, turn on the machine and press the button. After a few moments your blood pressure is measured and shows up on the screen. Unfortunately, theres more to it than meets the eye. Measuring your pressure is easy, but most people do it wrong, especially when it comes to arm position.

Does arm position affect blood pressure? Arm position has an effect on blood pressure. The wrong height, position and angle of your arm can change your blood pressure measurements. Even when your upper arm is positioned properly, the measurement can change if your arm is not supported properly.;

The arm positioning is crucial when measuring your blood pressure. Your pressure will change if your arm is held higher or lower. In addition, your measurement can change if your arm is hanging down or bent at an angle. Even at the right height and angle, your pressure can change if an important step is not followed.

This blog post will tell you that important step, which if not done, can measure your blood pressure higher. I also want you to think about arm position, not only at home, but at the doctors office too. You might be surprised how often they get arm position wrong. After reading this blog post, you will start getting it right!

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At Home Vs The Doctors Office

Many people find that they have higher blood pressure readings at the doctors office, sometimes because theyre less at ease there and because professional tools may be more accurate.

Readings taken at home can be less accurate than those taken at the doctors office where manual checks are a possibility. One way to make sure that youre getting consistent blood pressure readings is to bring your monitor with you to an appointment.

Trying to get an accurate reading? Start with these steps.

Get settled in. Make sure that your bladder is empty and youve had a minute to breathe. Remove any bulky clothing on the upper body. Place your feet uncrossed on the floor and rest your forearm on a table or chair arm that is heart level.

Apply the cuff. If using an upper arm cuff, the lower edge should be about an inch above the pit of your elbow. It should feel snug, but not tight.

Power up the monitor. Make sure to check out your monitors specific directions.

Inflate the cuff and wait patiently. Remember to breathe as you usually would.

Note the numbers. Read the monitor to get your numbers and make note of them somewhere if needed.

Take a second reading. Release the pressure of the cuff all the way before you take a second reading. Always wait at least 1 minute between readings.

Once you have an accurate reading, you may wonder what it means. Healthy blood pressure in adults is a reading of less than 120/80 millimeters of mercury , but what if your numbers dont match?

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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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.

How Do I Apply The Pre

Remove tight fitting clothing from your upper arm.

Sit in a chair with your feet flat on the floor. Rest your left arm on a table so that the cuff is at the same level as your heart. Turn the palm of your hand upward.

Hold the cloth closure on the cuff with your other hand.

Turn the palm of your hand upward. Apply the cuff on your upper arm.

Align the marker on the cuff over the brachial artery on the inside of your arm.

The cuff tube should run down;the;center of the arm even with the middle finger.

The bottom of the cuff should be approximately;½-1 inch above the elbow.

Secure the cuff around your arm using the cloth closure.

Make sure the cuff is wrapped firmly in place.

Relax your arm and place your elbow on the table so that the cuff is at the same level as your heart.

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Wellue Checkme Pro Health Monitor Heart Monitor Upper Arm Blood Pressure Monitor Sleep Oxygen Monitor All In 1 App For Phone & Pc Software For Fitness And Wellness

• Continuous SpO2 monitor: You can monitor, record, and track overnight SpO2 and pulse rate up to 10 hours.;Mobile APP and PC software enable you to look into the SpO2 change in detail.
• Heart health tracking: Simply place your fingers on the sensor to know your heart condition in 30s. With;wrist band, Checkme Pro provides continuous heart health monitoring and recording up to 24 hours.;
• Work with NIBP unit: Checkme Pro can work with the;AirBP;Wireless Blood Pressure Monitor;via Bluetooth.;Test and manage all the BP data including;SYS;,;DIA;, and;PR; together.
• Wireless remote monitoring: Under the mini monitor mode, heart condition and oxygen saturation can be monitored at the same time via the multi-parameter splitter. Real-time data is displayed on the mobile APP when connected by Bluetooth.
• Telemedicine is as simple as a Call: With Checkme Pro, it is never been easier for you to get doctors diagnosis at home by phone/video call or email. On your smart device and computer, share your health data by one click, or send your doctor the detailed PDF reports.;

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.;

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Why Can’t 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.

Hold your arm across your chest at arm level.

Hold your elbow firmly to avoid body movement.

Press START/STOP button. All symbols will appear on the display.

When arm is in correct position blue light will turn on and cuff will inflate automatically. As the cuff inflates. the monitor automatically determines inflation level. This monitor detects your blood pressure and pulse rate during inflation. The Heartbeat Symbol flashes at every heartbeat.

Remain still and do not move until the entire measurement process is complete.

Variability Of Blood Pressure

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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Millions Is That An Exaggeration

Unfortunately not. Millions of men and women around the world know they are suffering from hypertension, while millions more are unaware they have the problem.

For example, roughly one third of all American adults suffer from this problem. That is a staggering 78 million people.

As youll soon find out

Inflate Then Deflate The Cuff

If using a manual machine

Use your right hand to hold the bulb and place the pressure gauge on your left.

Use the screw on the bulb to close the valve that allows the flow of air.

Squeeze the bulb to allow air into the cuff. At this point, your pulse can be heard in the stethoscope.

Squeeze in as much air as you can, preferably about 30 mmHg, while watching the gauge. It is now hard to hear the pulse.

Open the valve to allow air out, and slowly deflate the cuff while watching the gauge. The gauge needs to fall by about three mmHg in every heartbeat.

Carefully time the first pulse and note the reading as this is your systolic pressure.

Keep on deflating the cuff slowly.

Once the pulse beats disappear, note the reading as it is your diastolic pressure.

Let the cuff deflate completely.

With a digital machine;

Use your right hand to hold the bulb

Put on the device on the power button. Once you see display symbols and 0, your machine is ready for the work.

Allow air into the cuff as you watch the gauge until it is somewhat 30 points more than your normal systolic pressure.

Relax and keep your eyes on the monitor.

Pressure readings and pulse rates will start to appear on the screen.

When you hear a beeping sound, it means the whole process is complete. Take note of the readings on both sides of the display. Systolic readings come on the left while diastolic on the right. After this, you can see your pulse rate.

Let the cuff slowly lose the collected air.

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