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Is It Normal To Experience Interarm Differences In Blood Pressure?
Question: Hi there,
I had a question about interarm differences in blood pressure.
I've been working to try to reduce my blood pressure and have largely been successful (lately I'm getting a mix of some readings below 120/80 with some slightly above, but none in the full hypertension range...and average is still right around 120/80).
That said, I've read articles that a large interarm difference in blood pressure (more than 10 points, and especially 15 points, between arms) is associated with hardening of the arteries, etc., which is a worry for me.
I've noticed sometimes I have fairly large differences in blood pressures between arms (usually the left arm being higher than the right), and other times, hardly any or a reasonable amount (<5). It seems like the differences after waking up are fairly consistently smaller than the rest of the day, but the rest of the day can vary (sometimes big differences, but occasionally not). I've taken several readings over time and the average doesn't appear too alarming, but individual times, the differences can be 10, 15...even occasional 25 point differences (and other times very little to none, or even a few points in the other direction).
Is this something to be concerned about?
I can provide actual numbers of readings if it would be helpful.
Thanks much for your help!
I had a question about interarm differences in blood pressure.
I've been working to try to reduce my blood pressure and have largely been successful (lately I'm getting a mix of some readings below 120/80 with some slightly above, but none in the full hypertension range...and average is still right around 120/80).
That said, I've read articles that a large interarm difference in blood pressure (more than 10 points, and especially 15 points, between arms) is associated with hardening of the arteries, etc., which is a worry for me.
I've noticed sometimes I have fairly large differences in blood pressures between arms (usually the left arm being higher than the right), and other times, hardly any or a reasonable amount (<5). It seems like the differences after waking up are fairly consistently smaller than the rest of the day, but the rest of the day can vary (sometimes big differences, but occasionally not). I've taken several readings over time and the average doesn't appear too alarming, but individual times, the differences can be 10, 15...even occasional 25 point differences (and other times very little to none, or even a few points in the other direction).
Is this something to be concerned about?
I can provide actual numbers of readings if it would be helpful.
Thanks much for your help!
Brief Answer:
Nothing to worry about!
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand your concern, and would like to explain you that, facing your inter arm BP difference, you have nothing to worry about. On theoretical point of view, a difference as much as around 20 mm Hg is frequently seen, and is considered normal. No space for anxiety, this is a normal physiological finding in healthy young adults. And you seem to be just one of them. This is explained by a different angle of subclavian artery origin from the aorta regarding both body sides.
So, no need to read more scientific papers about that issue.
The only thing I would advice you, is to perform a routine medical check up, see your doctor (GP or internist), for a physical examination and routine blood tests.
Normally, a medical check up should be performed on a yearly fashion. This could give a comprehensive view of potential coronary risk factors like hyperlipidemia, high fasting blood glucose, smoking, etc and to prevent future potential cardiac events. Regarding inter arm blood pressure difference relax and don't worry at all! Nothing wrong!
You can send more information about further BP differences for the upcoming days, if you need a more extended judgement.
Hope to have been helpful! Greetings! Dr. Iliri
Nothing to worry about!
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand your concern, and would like to explain you that, facing your inter arm BP difference, you have nothing to worry about. On theoretical point of view, a difference as much as around 20 mm Hg is frequently seen, and is considered normal. No space for anxiety, this is a normal physiological finding in healthy young adults. And you seem to be just one of them. This is explained by a different angle of subclavian artery origin from the aorta regarding both body sides.
So, no need to read more scientific papers about that issue.
The only thing I would advice you, is to perform a routine medical check up, see your doctor (GP or internist), for a physical examination and routine blood tests.
Normally, a medical check up should be performed on a yearly fashion. This could give a comprehensive view of potential coronary risk factors like hyperlipidemia, high fasting blood glucose, smoking, etc and to prevent future potential cardiac events. Regarding inter arm blood pressure difference relax and don't worry at all! Nothing wrong!
You can send more information about further BP differences for the upcoming days, if you need a more extended judgement.
Hope to have been helpful! Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
Thanks much for your excellent reply!
It is relieving to know you feel this is completely normal and nothing to worry about! The reason I was worried was articles such as this:
http://www.health.harvard.edu/blog/big-arm-arm-difference-blood-pressure-linked-higher-heart-attack-risk-0000
What's not clear is why my interarm difference can vary day-to-day/different times of day.
Here are a few readings comparing systolic (diastolic is usually pretty close) over the last week to show you what I mean (keep in mind I have a nights schedule, so the times might seem weird). I have both a cuff and wrist monitor, and I tend to take readings in both; for this purpose, I'll just provide cuff readings (as they tend to be farther apart...wrist readings are generally closer together for some reason, but the trends are usually similar [though very occasional wrist is quite close together and cuff shows bigger differences]).
Taken April 12th at 3:30 AM (Evening for my schedule):
Left Cuff Readings:
1st - 127/76
2nd - 124/70
3rd - 123/74
Right Cuff Readings:
1st - 117/77 (10 points)
2nd - 112/74 (12 points)
3rd - 108/75 (15 points) [I have seen the rare occasion of 25]
Taken April 12th at 5:00 PM (Morning for my schedule; this is shortly after waking):
Left Cuff:
1st - 124/70
2nd - 118/71
3rd - 113/70
Right Cuff:
1st - 118/79 (6 points)
2nd - 115/74 (3 points)
3rd - 118/73 (Negative 5 points)
As you can see, the readings after sleeping are much closer together overall.
If you're sure this is nothing to worry about, I'll try not to. If it were due to something like atherosclerosis, would this be variable by time of day? Can subclavian artery angle still explain this?
I am seeing a doctor regularly (~twice a year), don't smoke, drink (mostly moderately), try to eat healthy, and exercise. My cholesterol is quite low (132 total; LDL 80, HDL 32) - my only risks are being obese (which I'm working on) and low HDL cholesterol (which there's only so much I can do about).
Thanks for your help and easing my worries! =)
It is relieving to know you feel this is completely normal and nothing to worry about! The reason I was worried was articles such as this:
http://www.health.harvard.edu/blog/big-arm-arm-difference-blood-pressure-linked-higher-heart-attack-risk-0000
What's not clear is why my interarm difference can vary day-to-day/different times of day.
Here are a few readings comparing systolic (diastolic is usually pretty close) over the last week to show you what I mean (keep in mind I have a nights schedule, so the times might seem weird). I have both a cuff and wrist monitor, and I tend to take readings in both; for this purpose, I'll just provide cuff readings (as they tend to be farther apart...wrist readings are generally closer together for some reason, but the trends are usually similar [though very occasional wrist is quite close together and cuff shows bigger differences]).
Taken April 12th at 3:30 AM (Evening for my schedule):
Left Cuff Readings:
1st - 127/76
2nd - 124/70
3rd - 123/74
Right Cuff Readings:
1st - 117/77 (10 points)
2nd - 112/74 (12 points)
3rd - 108/75 (15 points) [I have seen the rare occasion of 25]
Taken April 12th at 5:00 PM (Morning for my schedule; this is shortly after waking):
Left Cuff:
1st - 124/70
2nd - 118/71
3rd - 113/70
Right Cuff:
1st - 118/79 (6 points)
2nd - 115/74 (3 points)
3rd - 118/73 (Negative 5 points)
As you can see, the readings after sleeping are much closer together overall.
If you're sure this is nothing to worry about, I'll try not to. If it were due to something like atherosclerosis, would this be variable by time of day? Can subclavian artery angle still explain this?
I am seeing a doctor regularly (~twice a year), don't smoke, drink (mostly moderately), try to eat healthy, and exercise. My cholesterol is quite low (132 total; LDL 80, HDL 32) - my only risks are being obese (which I'm working on) and low HDL cholesterol (which there's only so much I can do about).
Thanks for your help and easing my worries! =)
Brief Answer:
I want to reassure you about that issue.
Detailed Answer:
Hi again dear XXXX!
After having the full picture of your both arms BP reading, I would like to reconfirm my opinion that there is nothing abnormal, or suggestive for a potential atherosclerosis process on that issue. Your arm-to-arm BP difference values could be seen in many and many healthy young adults, as well as from the other part, many and many cardiac patients, which now have a strong evidence of atherosclerosis (as they suffer from acute myocardial infarction, and other vascular accidents all over the body) do not show any significant inter-arm BP differences.
Massachusetts hospital study is really amazing (as it seems to be all the rest of their studies). But, their study is focused in a population >40 years old followed up for > 10 years (so in a subgroup that is more prone for overt atherosclerosis disease. Probably, it would be more interesting, and I would be very curious to see the difference between actually diseased people (with acute MI, stroke, etc) and their normal age-matched counterparts, regarding inter-arm BP differences. As it happens that I am a cardiologist, engaged in critically ill cardiac patients in my every day clinical practice, I would have my suspicions regarding the results of this hypothetical study design I suggested. Many acute cardiac patient do not show any such differences at all.
My only advice for you, is just keep following that healthy diet and life style pattern, as well as don't stop your immense efforts to lower your body weight.
Hope to have been helpful to you. Best Regards! Dr. Iliri
I want to reassure you about that issue.
Detailed Answer:
Hi again dear XXXX!
After having the full picture of your both arms BP reading, I would like to reconfirm my opinion that there is nothing abnormal, or suggestive for a potential atherosclerosis process on that issue. Your arm-to-arm BP difference values could be seen in many and many healthy young adults, as well as from the other part, many and many cardiac patients, which now have a strong evidence of atherosclerosis (as they suffer from acute myocardial infarction, and other vascular accidents all over the body) do not show any significant inter-arm BP differences.
Massachusetts hospital study is really amazing (as it seems to be all the rest of their studies). But, their study is focused in a population >40 years old followed up for > 10 years (so in a subgroup that is more prone for overt atherosclerosis disease. Probably, it would be more interesting, and I would be very curious to see the difference between actually diseased people (with acute MI, stroke, etc) and their normal age-matched counterparts, regarding inter-arm BP differences. As it happens that I am a cardiologist, engaged in critically ill cardiac patients in my every day clinical practice, I would have my suspicions regarding the results of this hypothetical study design I suggested. Many acute cardiac patient do not show any such differences at all.
My only advice for you, is just keep following that healthy diet and life style pattern, as well as don't stop your immense efforts to lower your body weight.
Hope to have been helpful to you. Best Regards! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks very much!
I'm relieved you don't think there's any risk for atherosclerosis. I'm probably a tad paranoid about this particular issue because my father died of a heart attack at 52. I did talk to my doctor about the possibility of a Doppler test, but she felt at my age, the chance of a false positive outweighted the benefit. (Also, there was little difference in the manual cuff measurements between arms at that time).
Thanks again for the excellent and thorough responses. If you think it's unwarranted, I will try not to worry when these numbers are farther apart than I'd like them to be. =)
I'm relieved you don't think there's any risk for atherosclerosis. I'm probably a tad paranoid about this particular issue because my father died of a heart attack at 52. I did talk to my doctor about the possibility of a Doppler test, but she felt at my age, the chance of a false positive outweighted the benefit. (Also, there was little difference in the manual cuff measurements between arms at that time).
Thanks again for the excellent and thorough responses. If you think it's unwarranted, I will try not to worry when these numbers are farther apart than I'd like them to be. =)
Brief Answer:
You are welcome!
Detailed Answer:
Hi!
You don't have to worry about this issue. The only point of view, that you should never miss, is to live a healthy life; that is a very balanced life style, diet, physical activity, optimal body weight, etc. and so on. This way, the potential risk for future atherosclerosis progression will be very insignificant.
Feel free to ask me whenever any kind of uncertainties disturb your mind.
Greetings! Dr. Iliri
You are welcome!
Detailed Answer:
Hi!
You don't have to worry about this issue. The only point of view, that you should never miss, is to live a healthy life; that is a very balanced life style, diet, physical activity, optimal body weight, etc. and so on. This way, the potential risk for future atherosclerosis progression will be very insignificant.
Feel free to ask me whenever any kind of uncertainties disturb your mind.
Greetings! Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Shanthi.E
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