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Blood pressure differences between arms and association of dominant hands with blood pressure differences and carotid
1Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan. myoshin33@hotmail.com
Insights
Blood pressure measurement in either arm is generally interchangeable. However, specific patient groups, including those with vascular risk factors, should have blood pressure measured in both arms to detect significant differences.
Area of Science:
- Cardiology
- Hypertension Management
- Clinical Diagnostics
Background:
- Current hypertension guidelines recommend bilateral arm blood pressure (BP) measurement at initial visits.
- Discrepancies exist between recommended BP measurement sites (e.g., right arm) and home BP monitor designs (e.g., left arm).
- The impact of dominant hand on BP readings and inter-arm BP difference (ΔBP) requires further investigation.
Purpose of the Study:
- To determine the most accurate arm for BP measurement using a sphygmomanometer in clinical practice.
- To evaluate the association between dominant hand, absolute inter-arm BP difference (|ΔBP| ≥ 10 mmHg), and early atherosclerotic markers.
Main Methods:
- Investigated BP measurements from different arms in daily medical practice.
- Assessed the correlation of dominant hand with |ΔBP| and early atherosclerotic markers via subanalysis.
- Analyzed systolic |ΔBP| (|ΔSBP|) and diastolic |ΔBP| (|ΔDBP|) in a cohort of outpatients.
Main Results:
- 6.4% of outpatients were left-handed.
- 14.4% and 7.2% of individuals exhibited |ΔSBP| and |ΔDBP| of at least 10 mmHg, respectively.
- No significant association was found between dominant hand and |ΔBP| ≥ 10 mmHg or early atherosclerotic markers.
Conclusions:
- BP measurements are largely interchangeable between arms due to the lack of dominant hand association with significant |ΔBP|.
- Bilateral arm BP measurement is recommended for new outpatients with specific risk factors (e.g., age ≥ 65, vascular disease, smoking) regardless of dominant hand.
Abstract:
Guidelines for the management of hypertension recommend that blood pressure (BP) should be measured twice at every visit; it should be measured in both arms at the first visit, and the right arm BP or higher BP should be recorded. Manufacturers of home BP monitors tend to design the device for measurement of left arm BP. The arm preferred for BP measurement differs according to the methods recommended by the society and according to the home BP monitors. The BP difference (ΔBP) is calculated by subtracting left arm BP from right arm BP. Here, we aim to first investigate which hand will give the most accurate reading by a sphygmomanometer in daily medical practice. Second, we wish to assess the association of the dominant hand with absolute BP difference (|ΔBP|) of at least 10 mmHg and with early atherosclerotic markers in a subanalysis. We found that 6.4% of outpatients were left handed, and the percentage of individuals with systolic |ΔBP| (|ΔSBP|) and diastolic |ΔBP| (|ΔDBP|) of at least 10 mmHg was 14.4 and 7.2%, respectively. The dominant hand was not significantly associated with |ΔBP| of at least 10 mmHg or early atherosclerotic markers. This study suggests that BP measured in one arm is substitutable with that of the other arm because of a lack of association of |ΔBP| with the dominant hand. However, BP of both arms should be actively measured in new outpatients with moderate fever, lifestyle-related diseases, vascular events, age 65 years and above, and smoking history, all of which are factors potentially associated with |ΔBP| of at least 10 mmHg, regardless of the dominant hand.
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