Two different blood pressure readings?

" A significant difference in the pressure recorded in the right and left arms can signal circulatory problems that may lead to stroke, peripheral artery disease, or other cardiovascular problems.

British researchers looked at the results of 20 studies in which blood pressure was measured in both arms. People with an arm-to-arm difference of 15 points or more were twice as likely to have peripheral artery disease-essentially cholesterol-clogged arteries in the arms, legs, or other non-heart parts of the body. The name may sound dismissive, but the disease isn't. Peripheral artery disease affects at least 12 million Americans, more than heart disease and stroke combined. It kills some, maims others, and makes life painful for countless more.

A blood pressure difference of 10 to 15 points or more between arms also boosted the chances of having a stroke or dying from cardiovascular disease. The results were published online in The Lancet.

In an editorial accompanying the article, Drs. Richard McMorifice and Jonathan Mant of the University of Oxford say that measuring blood pressure in both arms should be part of routine medical care.

Why does blood pressure differ between arms?

Different blood pressure readings in the right and left arms that vary by a few points aren't anything to worry about. It's actually quite normal. A difference of more than 10 points, though, could suggest trouble.

In younger people, side-to-side differences in blood pressure can occur when a muscle or something else compresses an artery supplying the arm, or by a structural problem that prevents smooth blood flow through an artery.

In older people, it's usually due to a blockage arising from atherosclerosis, the artery-clogging disease process at the root of most heart attacks, strokes, peripheral artery disease, and other cardiovascular conditions.

A less common cause of blood pressure that is different in each arm is an aortic dissection. This is a tear inside the wall of the aorta, the main pipeline of oxygenated blood from the heart to the body."

If your patient has 10 to 15 points different blood pressures between the right and left arm his PCP needs to be notified and he certainly has more significant problems than which numbers to use for giving him his blood pressure medication.

Not trying to criticize, but be careful with saying there is some overarching hold parameters. I have seen a hold parameter for SBP

Exactly...my husband suffered a stroke and had orthostatic hypotension and physician had systolic BP hold for less than 130...why the doctor's standard order was as stated as being more commonly seen.

I always think aortic dissection in critical care. If left is lower than right by 20 or more that is a cardinal sign of dissection, as it progresses it dissects the left arm on it's way to the cerebrals. I wouldn't normally consider this on a younger patient unless they had rheumatic fever as a child.

Cheers

Hey!

I've been told that if the Blood pressure is lower on one arm than the other and the patient is otherwise well, there is probably a circulatory problem in the arm with the lower BP so the arm that more accurately reflects the ''body's'' BP is the one with the higher blood pressure. So i would give the meds based on the higher BP

Great discussion! At a clinic where I've worked, the rule was use the higher reading. That doesn't really answer your question, perhaps. Below is from my Medsurg notes on measuring BP.

•Patient should not have smoked, exercised or had caffeine within 30 min of meas

•Measure on both arms to note any difference

•Deflate cuff at rate of 2-3 mm Hg/sec

•Two readings per arm - wait one minute b/w measuring

•Use arm with higher BP reading

•Inflate the cuff 20-30 mm Hg after the radial pulse disappears.

•Take HR and BP while supine, sitting (legs dangle), standing

•SBP should not decrease more than 20 mm from supine to standing

•HR should not increase more than 20 BMP from supine to standing

•With older clients, check for an auscultatory gap. Some elderly patients have a wide gap between the first Korotkoff sound and subsequent beats.

•Elderly patients experience a postprandial drop in BP; the greatest drop occurs approximately 1 hour after eating. The BP returns to preprandial levels 3 to 4 hours after eating.

For whatever that's worth!