Prognostic Significance of Between-Arm Blood Pressure Differences

  title={Prognostic Significance of Between-Arm Blood Pressure Differences},
  author={Rajiv Agarwal and Zerihun Bunaye and Dagim M Bekele},
Blood pressure (BP) recordings often differ between arms, but the extent to which these differences are reproducible and whether the differences have prognostic importance is unknown. We enrolled 421 consecutive patients from a medicine and a renal clinic at a veterans’ hospital. Three BP recordings were obtained in each arm using an oscillometric device in a sequential manner and repeated in 1 week. Patients were followed for all-cause mortality ≤7 years. The right arm had 5.1-mm Hg higher… 

Figures and Tables from this paper

Between-visit reproducibility of inter-arm systolic blood pressure differences in treated hypertensive patients: the coconet study

The reproducibility of sIAD determination between baseline and the 3-month follow-up measurements lacked agreement in the hypertensive patients, and the relevant variables and characteristics should be identified.

Inter-arm Differences in Simultaneous Blood Pressure Measurements in Ambulatory Patients without Cardiovascular Diseases

The Gangneung Asan Hospital clinical series of patients showed that the absolute IAD in SBP had a significant correlation with cardiovascular risk factors such as the 10-year Framingham cardiac risk scores and higher BP in men and higherBP in women, but theabsolute IAD had nosignificant correlation with the age, obesity, smoking, drinking, hyperlipidemia, diabetes, metabolic syndrome, and renal function.

Response to Prognostic Significance of Between-Arm Blood Pressure Differences: Between-Arm Blood Pressure Difference and Mortality and the Interarm Blood Pressure Difference: Between-Arm Blood Pressure Differences Are Important

The blood pressure device that was used is now discontinued but is substantially equivalent to the HEM-442C Manual Inflation BP Monitor, which has been validated using the International Protocol of the Working Group on Blood Pressure Monitoring of the European Society of Hypertension.

Inter-arm blood pressure differences compared with ambulatory monitoring: a manifestation of the 'white-coat' effect?

Compared with ABPM, use of the higher of the left and right arm readings measured sequentially appears to overestimate true mean blood pressure.

Four-Limb Blood Pressure as Predictors of Mortality in Elderly Chinese

In the elderly, above and beyond arm BP level and together with ankle-brachial index, the interarm and interankle BP differences improve prediction of mortality.

Interarm blood pressure difference, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in young adults

The presence of interarm systolic BP difference ≥10 mmHg and positive family history of hypertension and diabetes has a prognostic value in predicting cardiovascular events and should be measured routinely in both arms using automated oscillometric device in primary care setting.

The difference in blood pressure readings between arms and survival: primary care cohort study

Differences in systolic blood pressure between arms can predict an increased risk of cardiovascular events and all cause mortality over 10 years in people with hypertension, which could be a valuable indicator of increased cardiovascular risk.

Inter‐Arm Blood Pressure Differences in Young, Healthy Patients

Young healthy patients undergo annual evaluation that includes blood pressure measurement on both arms and inter‐arm BP difference is common in young healthy patients, is not dependent on which arm was measured first, and unrelated to age, body mass index, and heart rate.

Simultaneous blood pressure measurement in both arms in hypertensive and nonhypertensive adult patients

Although on average there was no clinically significant relative difference between arms, absolute differences at an individual level were often clinically significant.

Methodology of blood pressure measurements casts doubt on the validity of the conclusions

  • O. Jolobe
  • Medicine
    Journal of internal medicine
  • 2019
First, SBP was measured only in the right arm, which was not necessarily representative of the true blood pressure for that subject, and second, interarm SBP differences have prognostic value, as shown by a prospective cohort study comprising 421 patients.



Consistency of blood pressure differences between the left and right arms.

Although BP in the right arm tended to be higher than in the left arm, clinically meaningful interarm differences were not reproducible in the absence of obstructive arterial disease and are attributable to random variation.

Patient characteristics and factors associated with inter-arm difference of blood pressure measurements in a general population in Ohasama, Japan

The results suggest that there is considerable difference in the measured BP in the right and left arms and that large differences in the absolute SBP are associated with risk factors for arteriosclerosis such as hypertension, hypercholesterolemia, obesity, metabolic abnormalities and low ABI.

Inter-arm differences in blood pressure: when are they clinically significant?

It is emphasized the importance of measuring blood pressure in both arms initially to prevent this misdiagnosis of hypertension, due to normal differences in blood pressure between the arms, and mean inter-arm systolic and diastolic blood pressure are present.

The normal range for inter-arm differences in blood pressure.

The frequency of significant inter-arm systolic and diastolic blood pressure differences suggests that the blood pressure should be taken in both arms at the initial consultation and the higher of the two readings should be used to guide further management decisions.

A study of inter-arm blood pressure differences in primary care

In a primary care setting blood pressure should be measured routinely in both arms, and if one arm is to be preferred for pragmatic clinical purposes, then this should be the right arm.

Blood pressure. Assessment of interarm differences.

Bilateral upper-extremity blood pressure determinations, as measured by automated indirect measurement, have a wide degree of interarm variation.

Interarm differences in seated systolic and diastolic blood pressure: the Hypertension Genetic Epidemiology Network study

Obesity, higher heart rate, and higher systolic BP were associated with larger interarm BP differences, and these results have implications for blood pressure measurement in research settings and in screening programs.

Is the blood pressure the same in both arms?

No systematic difference of any consequence was found, although individual patients had mean between‐arm differences in blood pressure of up to 10 mmHg, which suggest that no significant bias is introduced in methodological comparisons that use both arms.

Differences between right and left arm blood pressures in the elderly.

A total of 12 blood pressure determinations in both arms of 174 elderly persons were taken and data was analyzed by a least-squares components of variance method for most people, finding the pressure difference between the arms is small.