Study Area And Study Population
The study area is the field practice area of the Urban Health Training Center attached to the Medical College and Hospital. The total population of this area is 45,562 with an adult population of 34,657. The study population was identified as any adult male or female in the age group of 20 years and above.
Health & Wellnesswhats The Best Diet For Heart Health Dietitians Weigh In
Specifically, the arm with the lower blood pressure likely has blockages in the arterial flow that cause the lower blood pressure, McDermott said in an email.
To take a closer look at the importance of different readings between arms, the researchers scoured the medical literature for studies that included blood pressure measurements from both arms and long-term health outcomes.
They ultimately focused on 24 studies which included data from 53,827 patients.
The new study is an important paper, said Dr. Matthew Muldoon, a professor of medicine at the University of Pittsburgh School of Medicine and director of the UPMC Heart and Vascular Institute Hypertension Center. It is the most important paper to address the question of blood pressure arm difference, said Muldoon, who was not affiliated with the new research.
One limitation of the study is that it didnt address the variability of blood pressure from moment to moment even in one arm, Muldoon said. When you measure blood pressure repeatedly, its not stable, he added.
Inclusion And Exclusion Criteria
The inclusion criteria for the study were any adult male or female, who is apparently healthy looking and willing to participate in the study. The exclusion criteria for not including in the study were any adult who is suffering from any form of severe illness and pregnant women and those not willing to participate.
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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.
Does Aortic Dissection Raise Or Lower Blood Pressure
Research has shown in some cases blood pressure is high while in others, low blood pressure is one of the symptoms 9. An aortic dissection can decrease blood flow which results in low blood pressure 10.
A study released in 2009, examined aortic dissection cases over the prior 15 years. A higher percentage of patients younger than 40 years in age did not have high blood pressure. Patients who were aged 70 or more years were found to have blood pressure equal or higher than 150/90 mmHg 11.
The story of a 57 year-old woman with an aortic dissection was published in 2020. She was removed to the hospital because she suddenly collapsed while undergoing therapy for an ankle injury. In the hospital, her blood pressure measurement was 87/53 mmHg. Luckily, she was checked out of the hospital nine days later after surgery 7.
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Is 2 Better Than 1 For Blood Pressure
In the study, British researchers examined 20 studies covering differences in systolic blood pressure — the pressure of blood in arteries when the heart is contracting — between arms.
The results, published in The Lancet, showed that a difference of 15 points or more in the systolic readings between the left and right arms was associated with an increased likelihood of several heart-related risks, including:
- The risk of peripheral vascular disease was two-and-a-half times higher.
- The risk of cerebrovascular disease was 60% higher.
- The risk of dying from heart and circulatory diseases rose by 70%.
The risk of peripheral vascular disease was also higher when there was a difference in blood pressure readings of 10 points or more.
If peripheral vascular disease is detected at an early stage, treatments such as stopping smoking, lowering blood pressure, or offering statin medication can reduce death rates.
“Findings from our study should be incorporated into future guidelines for hypertension and blood-pressure measurement … to promote targeted screening for peripheral vascular disease and aggressive risk factor management,â write Christopher Clark, MD, of the Peninsula College of Medicine and Dentistry at the University of Exeter, and colleagues.
Why Aortic Dissection Causes Blood Pressure Higher Or Lower In One Arm Or Leg
To understand how blood pressure is affected, its important to describe what happens during an aortic dissection. The aorta, which is the largest artery in the body, carries oxygen rich blood from the heart to your body. Its about an inch in diameter and a foot long, similar to a garden hose. It rises up from the left side of the heart, curves over it and travels down through the chest to the stomach area.
An aortic dissection occurs when the inner layer of the aorta tears. The blood flows through the tear causing the inner and middle layers of the aorta to separate from each other. The area between the two separated layers fills with blood. If the blood breaks through the outer wall of the aorta, the rupture often causes death.
The tear can occur in the upper part of the aorta, known as type A, or the lower part, called Type B. The Type A is more common and dangerous. The dissection can lead to internal bleeding, organ damage or heart valve damage.
The dissection can interrupt the blood flow throughout the body. If the blood flow to the brain is decreased, it can lead to a stroke. Most patients complain of severe pain in the stomach, chest or back. There may be shortness of breath, weakness and pain in the legs or arms. The changes in blood flow to different parts of the body can cause the differences in blood pressure between the right or left side of the body 8.
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Blood Pressure Higher In The Left Arm
Higher blood pressure is more often found in the right arm. Having varying blood pressure in different arms is statistically normal and may not necessarily be a cause for concern. However, if the difference is persistent, your health care provider will use the arm with the higher blood pressure for all further blood pressure measurements.
Your health care provider might want to check for certain medical conditions if you have a blood pressure difference between your arms, particularly if its persistent and large. They might check for:
- Coarctation of the thoracic aorta
- Dissection of the thoracic aorta
- Aneurysm of the aorta
- Various kinds of extra- and intra-arterial obstruction in the upper extremities
- Takayasu disease
These causes for a blood pressure difference between arms become more likely when the arm with the lower blood pressure also has a diminished pulse.
According to studies, people with a blood pressure difference of 15 points or more between arms are twice as likely to develop peripheral artery disease. Peripheral artery disease is when your arteries become clogged or blocked by cholesterol. It affects about 12 million people in the United States. A blood pressure difference of 10 to 15 points between arms may also raise your likelihood of dying from heart disease or getting a stroke.
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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Differential Blood Pressure In Arms
A 26-year woman comes to the office complaining about pain and numbness in her upper arms, exacerbated by strenuous activity. She also reports a 12-pound weight loss, joint pain and fatigue in the past six months. She has no smoking history and denies any use of illicit drugs. Her blood pressure is 143/89 mmHg in the right arm and 87/56 mmHg in the left. Her temperature is 37.6°C and her heart rate is 90 bpm. Auscultation of the heart shows no murmurs and lungs are clear. The brachial pulses in her left arm are decreased compared to her right arm. No skin or mucosa lesions are identified, and the abdominal examination is unremarkable. The results of complete blood count and renal function are normal, except for mild anemia and an erythrocyte sedimentation rate of 56 mm/hr.
Bp Difference Between Arms Warrants Investigation
Aging WellVol. 5 No. 4 P. 32
A patient visiting a physicians office has an expectation of what will occur in the course of the workup. Healthcare personnel will record height, weight, and blood pressure and note lifestyle changes and current medications. But there may be a missing component that can provide additional important patient information.
According to a study conducted by a team led by Christopher Clark, FRCP, PhD, at the Peninsula College of Medicine and Dentistry in England, and recently published in The Lancet, physicians and their nursing staff should measure blood pressure in both arms rather than the current standard of only one arm.
The latest research included 20 studies that examined differences in systolic blood pressure between an individuals left and right arms. If there was a difference of at least 10 mm Hg in the systolic blood pressure readings between the two arms, it indicated the likelihood of a blocked artery. The results of the research indicated that a difference of 15 mm Hg or more was linked to an increased risk of peripheral vascular disease, or the narrowing arteries supplying the arms and legs, and the development of cardiovascular disease. The same study also found an increased risk of developing peripheral vascular disease, characterized by a difference of 10 mm Hg or higher.
Kristin Rile is an editorial intern at Great Valley Publishing Company.
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How Aortic Dissection Treatment Can Affect Blood Pressure
After a diagnosis of an aortic dissection is made, one of the main treatments is to control the tear in the aorta. To accomplish this, blood pressure is reduced as much as possible. Typically, beta-blockers or calcium channel blockers is prescribed to lower it.
There is much pain with an aortic dissection. The pain and stress can cause blood pressure to rise, and thats the last thing anyone wants. Pain medications will typically be prescribed to help control the stress of the pain which can help keep BP lower 8.
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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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.
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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Should Blood Pressure Be Taken In Both Arms
Differences in Blood Pressure Between Arms May Signal Blood Vessel Problems
Researchers found that a difference of 15 points or more in the readings between the left and right arms raised the risk of peripheral vascular disease, a narrowing or blockage of the arteries, by two-and-a-half times.
That same 15 point-difference in systolic readings also increased the risk of cerebrovascular disease by 60%. Cerebrovascular disease is associated with thinking problems, such as dementia, and an increased risk of stroke.
Researchers say the results suggest that doctors should routinely compare blood pressure readings from both arms to prevent unnecessary deaths.
Although the practice of taking blood pressure from both arms as a part of heart disease screening has been adopted in Europe, and some guidelines in the U.S. recommend it, American Heart Association spokesman Richard Stein, MD, says itâs not routinely done in the U.S.
âThis is very interesting,â says Stein, professor of cardiology at the New York University School of Medicine. âIt can translate immediately, as we learn more about it, into better detection of people at higher risk of disease.â
The Proper Technique On How To Take Blood Pressure In Each Arm
At your next doctor visit ask the nurse taking your blood pressure to take it in each arm. Typically, a nurse will take your blood pressure only in one arm. Its usually the more convenient arm for her. Sometimes, the nurse will ask if you have a preference in which arm. The nurse may be unhappy with your request, but dont worry about it. After all, this is your health that is at risk. Unfortunately, we have an assembly line at the doctors office today. Gone are the days of home visits, blood pressure taken in each arm and the pulse taken at 4 extremities.
If there is a difference in each arm, your blood pressure should be taken again to verify the difference. If one arm is consistently higher than the other arm, that arm should be the arm that is used for all future blood pressure measurements. It shouldnt be which arm is easier for the nurse or which arm you prefer.
Therefore, the failure to check to see if blood pressure is different in each arm can lead to false diagnosis, wrong therapy, improper medications and unnecessary testing. In addition, larger medical bills. Im unsure about you, but I havent won the lottery yet, every dollar counts! But more importantly is your health.
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