American Heart Association Journal: Published on February, 2021

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What Is New?

To determine the impact of differences in blood pressure between arms on cardiovascular outcomes (eg, heart attack, death), data from over 57 000 individuals from 24 studies around the world were collated into one large dataset and analyzed.

Results suggest that inter-arm differences above 5 mm of mercury (mm Hg) predict all-cause mortality, cardio-vascular mortality and cardiovascular events.

Results are based on a single pair of measurements with blood pressure measured in one arm and then the other, and challenge advice that inter-arm differences in blood pressure should be confirmed using a simultaneous method (blood pressure measured in both arms at the same time).

What Is Relevant?

Inter-arm differences in blood pressure identify additional risk of having a cardiovascular event beyond that predicted by existing cardiovascular risk scores alone; this could inform clinical decisions regarding primary prevention of cardiovascular disease.

Key Summary:

A 10 mm Hg difference in systolic blood pressure between arms should now be regarded as an upper limit of normal.

Checking blood pressure in both arms, beyond choosing which arm to measure for the detection and management of high blood pressure, is a key part of cardiovascular risk assessment and should become routine clinical practice.

Blood pressure should be measured in both arms during cardiovascular assessment. A systolic inter-arm difference of 10 mm Hg is proposed as the upper limit of normal.