From the Guidelines
It is essential to measure blood pressure in both arms at least at the first visit, as a between-arm systolic BP difference of >10 mmHg is associated with an increased cardiovascular disease risk and may indicate arterial stenosis. This recommendation is based on the latest guidelines from the European Heart Journal, 1.
Key Points to Consider
- A consistent difference greater than 10-15 mmHg between arms may indicate underlying health issues such as peripheral artery disease, atherosclerosis, or other vascular problems.
- When measuring blood pressure at home, it's best to check both arms initially and then continue monitoring with the arm that shows the higher reading, as suggested by the 2020 International Society of Hypertension Global Hypertension Practice Guidelines, 1.
- For accurate readings, sit quietly for 5 minutes before measuring, use a properly sized cuff, position your arm at heart level, and avoid caffeine, exercise, and smoking for 30 minutes beforehand.
- Blood pressure differences between arms occur because of natural anatomical variations in blood vessel structure, potential blockages, or narrowing in the arteries supplying the arms.
- Regular monitoring of these differences can help detect cardiovascular issues early and guide appropriate treatment, as emphasized by the 2024 ESC Guidelines for the management of elevated blood pressure and hypertension, 1.
Recommendations for Clinical Practice
- Measure blood pressure in both arms at the first visit to identify any significant differences.
- Use the arm with the higher blood pressure reading for subsequent measurements if a difference of >10 mmHg is found.
- Consider further investigation if the difference is >20 mmHg, as suggested by the 2020 International Society of Hypertension Global Hypertension Practice Guidelines, 1.
From the Research
Blood Pressure Readings Difference Between Arms
- There is no direct evidence in the provided studies to suggest that blood pressure readings are different between arms.
- The studies primarily focus on comparing the effects of angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs) on blood pressure and cardiovascular outcomes 2, 3, 4, 5.
- None of the studies mention or investigate the difference in blood pressure readings between arms, making it impossible to draw a conclusion on this topic based on the provided evidence.
- The studies do compare the efficacy and safety of ACE inhibitors and ARBs in managing hypertension, with some studies suggesting that ACE inhibitors may be superior to ARBs in reducing cardiovascular events and all-cause mortality 4, while others find no significant difference in their effects on blood pressure control 2, 5.
- However, these findings do not address the question of blood pressure readings difference between arms, and therefore, there are no research papers to assist in answering this question.