Can we check Blood Pressure (BP) on a paralyzed limb?

Blood Pressure Measurement on a Paralyzed Limb

Yes, you can check blood pressure on a paralyzed limb—the blood pressure readings are accurate and clinically equivalent to measurements from the unaffected limb. 1

Evidence Supporting BP Measurement on Paralyzed Limbs

Direct Research Evidence

• A study of 236 post-stroke patients with hemiplegic paralysis using simultaneous four-limb BP measurements demonstrated that paralyzed arms had identical mean systolic (134.8 vs. 135.1 mmHg) and diastolic (79.5 vs. 78.1 mmHg) pressures compared to unaffected arms 1
• Similarly, paralyzed legs showed no significant difference in ankle systolic (143.6 vs. 143.7 mmHg) or diastolic (77.9 vs. 75.8 mmHg) pressures compared to unaffected legs 1
• The detection rate of clinically significant inter-arm differences (≥10 mmHg) was only 5.9%, indicating high consistency between paralyzed and non-paralyzed limbs 1

Physiological Considerations

• While vascular resistance may be increased in chronically paralyzed limbs due to deconditioning and loss of central neural control, this does not significantly alter blood pressure measurements at the brachial or ankle level 2
• The blood pressure cuff measures systolic pressure based on arterial wall compression and rebound, which remains intact regardless of motor function 3

Proper Measurement Technique

Standard Guidelines Apply

• Follow the ACC/AHA 2017 guidelines for proper BP measurement technique: patient seated quietly for 5 minutes, arm supported at heart level, appropriate cuff size (bladder encircling 80% of arm), and feet flat on floor 3
• At the first visit, measure BP in both arms and use the arm with the higher reading for subsequent measurements—this applies whether one arm is paralyzed or not 3
• Take 2-3 measurements separated by 1-2 minutes and average the results 3

Cuff Selection and Positioning

• Use appropriate cuff size based on arm circumference: 22-26 cm (small adult), 27-34 cm (adult), 35-44 cm (large adult), or 45-52 cm (adult thigh) 3
• Position the cuff at heart level (midpoint of sternum) regardless of limb paralysis 3

When Alternative Sites Are Necessary

Lower Extremity Measurements

• If BP cannot be measured in either arm due to bilateral upper extremity issues (not just paralysis), measure BP in the thighs or legs using appropriate cuff size in the supine position 3
• Be aware that lower limb systolic BP is physiologically 20-30 mmHg higher than brachial pressure in young subjects due to pulse pressure amplification, so standard reference values (140 mmHg) do not apply 3
• The ankle-brachial index (ABI) calculation requires brachial pressure as the denominator, using the higher of the two arm pressures 3, 4

Toe Pressure as Alternative

• In patients with non-compressible arteries (ABI >1.40) or severe arterial calcification, toe-brachial index should be used instead 5, 6
• Toe pressure ≥30 mmHg indicates adequate perfusion for wound healing 5

Common Pitfalls to Avoid

• Do not assume paralysis affects BP accuracy—the evidence clearly shows equivalent readings 1
• Do not use pulse palpation or automated oscillometric devices for ankle-brachial index measurements—these methods have poor reproducibility (R-coefficient 0.40-0.44) compared to Doppler (R-coefficient 0.79) 7
• Avoid measuring BP immediately after needle placement for dialysis access, as this causes stress-related elevation 3
• Do not place the cuff directly over open wounds, ulcers, or recently placed bypass grafts 3

Clinical Context

Inter-Arm Differences

• An inter-arm BP difference >15-20 mmHg suggests subclavian or innominate artery stenosis, which is more common in patients with peripheral arterial disease 3
• This finding requires no intervention unless accompanied by symptoms (arm claudication, vertebral steal syndrome) 3

Measurement Reliability

• The relative error variance for BP measurements is approximately 14.4 mmHg, emphasizing the importance of consistent measurement technique rather than limb selection 8
• Paralysis status does not contribute to measurement variability beyond normal physiological variation 1