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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is there a difference in blood pressure between arms?

Answered by
Dr. Bhanu Partap


Practicing since :2010

Answered : 2638 Questions

Posted on Wed, 6 Jun 2018 in Hypertension and Heart Disease
Question: Hi there,

Quick question about blood pressure.

I'm working to keep my blood pressure in check. Sometimes it's fine, other times it's well into the former prehypertensive range (which I guess is now considered hypertensive, but with a focus on lifestyle). Once in a great while I'll get a systolic above 140 or diastolic above 90, but that's very infrequent at this point and generally not repeatable. To compound issues, I also have pretty severe anxiety about taking my blood pressure, so it's hard to get an accurate reading. (I normally have to take repeated readings at home over a few days a few times a year, because I'm generally miserable with the equipment even in the house most of the time, and the first readings [as well as my pulse] are always high because of a panic attack feeling).

Anyways, for accurate reading sake, I have two monitors when I do take it. The first is a Panasonic arm cuff. The second is an Omron wrist cuff. Generally, when I take my BP, I take it in the left arm, then the right with the cuff, and then the left arm, then right arm with the wrist monitor. I then repeat the process a few times a few minutes apart. This gives me readings I can average together to hopefully get more accuracy.

Lately, I've noticed a trend. More often than not, the left CUFF reading is always quite a bit higher than any of the other readings, including the wrist reading on the left side. Wrist readings on left and right are often closer, and the right arm cuff usually is close to the wrist readings as well. Often, those three readings agree, and the only one substantially different is the left arm with the cuff. Very occasionally, arm cuff left and write are close, but it's not that often.

I know that arm-to-arm differences in blood pressure can be a red flag. However, since wrist measurements are usually quite close, I'm not sure what to think. Is there anything about my arm that might be interfering with an accurate reading with the cuff, but not with the wrist? Are you concerned about this? (My doctor once took a manual BP in both arms with a cuff and seemed to think they agreed).

Also, given my blood pressure fluctuates quite a bit, do you agree medication is not likely needed at this time. (I am exercising regularly, don't smoke, drink moderately most of the time, and have made great strides in improving my diet, as well as taking several heart-healthy supplements).

Thank you!

PS. Here's a couple sample reading so you see what I mean (a good one and a bad one I've had recently):

Reading A
Left Cuff: 127/76
Right Cuff: 114/80
Left Wrist: 113/80
Right Wrist: 114/76

Reading B
Left Cuff: 141/84
Right Cuff: 117/78
Left Wrist: 128/82
Right Wrist: 123/83
Answered by Dr. Bhanu Partap 48 minutes later
Brief Answer:
Please refer to the detailed answer below

Detailed Answer:

After going through your detailed medical query regarding your blood pressure I understand your concern for your health but I would like to tell you that all your blood pressure readings are alright and it's just your thought process that is troubling you. You are very much anxious which is not good your well being.

My personal advice on this is that first of all you should stop thinking about your blood pressure because it's all fine. The more you get anxious the more it will go high and fluctuate.

You should start practicing yoga/meditation daily as it will help you overcome this stress and anxiousness. If that will not work for you then you need to take the help of a behaviour therapist or psychologist.

You are following a good lifestyle just keep it up and there is no need for any medicine for bp.

I hope this information will be helpful.

Kind regards
Dr Bhanu partap
Above answer was peer-reviewed by : Dr. Kampana
Follow up: Dr. Bhanu Partap 53 minutes later
Thanks much for your reassurances.

I have been working on the anxiety and now only really have these worries right before a doctor appointment, where I take BP readings over 2-3 days to be able to show the doctor. This is because the reading in the office is sometimes high because of nerves, so this should give me a more accurate idea of where I'm at. This is the only workable solution I can think of.

I've also seen a therapist about this issue in the past and learned some breathing exercises that do help. I typically exercise and practice breathing a few times a week as well (not exactly yoga, but similar).

It's good to know you weren't too worried about the readings.

As a followup, what I'm still wondering if if there's any explanation of why the reading using the left cuff would be so far removed from the other 3 (right cuff and left/right wrist) readings?

My reason for asking is because I know when there's a large difference between arms, it could indicate atherosclerosis or some other issue.

Does the fact that it's most often similar at the wrists (and once and a while between cuffs) mean that is not a concern or I would be getting a similar discrepancy both at the cuff and wrists every time?

Answered by Dr. Bhanu Partap 1 hour later
Brief Answer:
Hello Again

Detailed Answer:
Yes there will always be some degree of variation between right and left sided blood pressure readings. Its because of the anatomical placement of the heart and great blood vessels in the thoracic cavity.

Also i would like to tell you that wrist is not an ideal site for bp monitoring. Usually a difference of 10 to 15 mmHg is considered to be normal between right and left side.

I dont think there is any reason to worry for all these things in your case. It will just increase your stress levels.

Kind Regards
Dr Bhanu Partap
Above answer was peer-reviewed by : Dr. Kampana

The User accepted the expert's answer

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