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What causes BP levels to differ between the left arm and right arm?

DOCTOR OF THE MONTH - Mar 2017
Mar 2017
User rating for this question
Excellent
Answered by

Cardiologist
Practicing since : 2010
Answered : 1435 Questions
Question
Dear Doctor,

I'm a 37 year old trying to keep from developing hypertension. I'm 5'11", 245 lbs. (working on losing), exercise most days of the week, am eating a whole foodnutritious diet, don't smoke, and drink moderately most of the time. I also take several heart healthy supplements (aged garlic, fish oil, CoQ10, D3, K2, red yeast rice, resveratrol+grape seed, pycnogenol, policosanol, and some others).

I have anxiety about my BP, so it's always a challenge to take and causes me stress as it tends to raise when I take it. Therefore, I only take it over the course of a few days before doctor appointments (every several months) to try to get some accurate numbers for her outside the office. I have been taking it to anticipate an appointment, but unfortunately my doctor had some travel issues and it has been moved until Feb.

I have two monitors I use to take it - a Panasonic upper arm cuff and an Omron wrist monitor (that makes you hold it heart level to get an accurate readings, so user error should not be an issue). This gives me some comparison and different readings, which I find helpful. I usually use both and do three readings with each, a few minutes apart.

The good news is, my average for all readings is 122/81, so while I'd like that to decrease a bit, that's better than it could be. What I am concerned about is interarm difference between left and right arms and a strange anomaly I can't explain.

Quite often, my left arm using the upper arm cuff is higher (10-25 points systolic) than my right using the same monitor. Generally the wrist monitor has some variance, but not nearly as much. In quite a few cases, I'll have a high left upper arm reading, but the upper arm right, wrist left, and wrist right are all pretty good and close to each other/in agreement. Once in a while upper arms are close together. Other times, my wrist monitor will agree with that first high upper left arm reading, but that also is quite rare.

I'm concerned because I know a large interarm difference >10 points can signify atherosclerosis (such as in the artery leading to the arm) or other major cardiovascular issues. I will say I was able to average together interarm difference (this is for both upper arm and wrist), and systolic IAD is 6.35 while diastolic is 2.13, so on paper that looks decent (though <5 would be ideal). If we were taking upper arm measurements only (no wrist measurements), it would be a little over 8 IAD on the systolic side.

I just don't get why sometimes readings match up perfectly (a few even the exact same), but more often the left arm is way higher than the right, but only with the upper arm cuff, not usually the wrist cuff. (It's happened a few times with the wrist, but not regularly). Readings are usually best soon after waking, decent midday, and highest before bed (though still often okay, except for left upper arm).

Does the fact that the wrist measurements are closer than upper arm measurements mean atherosclerosis is an unlikely cause? I would think if upper arm was always higher, wrist would always be higher to about the same degree if there was a blockage or plaque issue causing it?

Here's an example of three sets of readings, one good/close together, one pretty good overall but with that discrepancy, and one not-so-good overall and showing the discrepancy.

Good/Closer Together:
Cuff - Left Arm: 121/83
Cuff - Right Arm: 116/81
Wrist - Left Arm: 119/79
Wrist - Right Arm: 123/76

Good/Discrepancy:
Cuff - Left Arm: 134/81
Cuff - Right Arm: 119/73
Wrist - Left Arm: 115/78
Wrist - Right Arm: 120/82

Not-So-Good:
Cuff - Left Arm: 141/84
Cuff - Right Arm: 117/78
Wrist - Left Arm: 128/82
Wrist - Right Arm: 123/83

In addition to that, I just got my cholesterol numbers, and I'd like you to review those if possible. There's a lot to like, including low overall cholesterol, low LDL, low triglycerides, low particle number, low HS-CRP, low Apolipo B, and low lipoprotein(a). However, my HDL has ALWAYS been low [though my ratio seems okay given the low LDL], despite doing all the right things to try to elevate it (it is up 1 point from last time), and my particle sizes are also quite terrible, which I know some people say is more important than overall cholesterol level, but others say the particle number is more important than sizes.

What's your overall impression of my risk based on my cholesterol numbers?

Thanks. I know I'm anxious about this stuff, but I'm really trying to understand, and I get frustrated when I get these BP discrepancies or weird cholesterol numbers (either best category or worst for most) and can't make sense out of why.

The PDF attached is my cholesterol report by the way! Thanks!
Sat, 9 Jun 2018 in Hypertension and Heart Disease
 
 
Answered by Dr. Bhanu Partap 1 hour later
Brief Answer:
Please refer to the detailed answer below

Detailed Answer:
Hello XXXXXXX

As per our last discussion i again want to tell you that you blood pressure reading are all fine and the difference in the reading which you get is not worrysome.

However still if you want to be 100% sure then you have to go a test called ABI (Ankle Brachial Index). It helps to diagnose any atherosclerotic disease in the peripheral blood vessels which can cause a significant variation in bp readings.

Regarding your cholesterol reports they are slightly deranged and and very well be brought under normal range by strictly following healthy lifestyle habits regularly as you are already doing. You just need to bring down your weight ideally around 80 kgs according to your height.

The most important thing to take care for you is your anxiety. If you dont try to overcome it then even doctors will be helpless. I hope you will understand what am trying to convey you.

Just let everything go and enjoy your life dear, these days wont come back.

I hope this information will be helpful.

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