Inter arm blood pressure difference: an indicator of cardiovascular risk

Seethalakshmi K., Biju Bahuleyan


Background: Overall prevalence of hypertension in India is 33% in urban and 25% in rural areas. For optimal health blood pressure of less than 120 mm of Hg systolic and 80mm of Hg diastolic is to be maintained. According to American heart association, inter arm BP difference of more than 20 mm of Hg systolic and 10 mmm of Hg diastolic are associated with peripheral vascular disease, vasculitis, connective tissue disorders and congenital anomalies. Though the guidelines quote that it is mandatory to examine pressure in both arms before diagnosing hypertension this system is not followed, which has led to increase in misdiagnosis of HT. The present study aims to determine the magnitude of interarm difference in young healthy individuals and to assess whether family history of HT and BMI is related to higher interarm difference.

Methods: 110 normal healthy medical students both males & females are recruited for the study .after obtaining institutional ethical clearance the participants in the study are informed about the study process and detailed history obtained .after 5 min of rest BP is assessed by sphygmomanometer first in right arm & then left. Statistical analysis done using paired t test, correlation between variables done with chi square test. 

Results: statistically significant difference p<0.0001 noted in interarm systolic and diastolic bp ,which shows that pressure difference exists between two arms hence it is mandatoty to assess bp in both arms and the higher of the two is taken as normal .subjects with family history of hypertension had interarm sytolic bp >10mm of Hg and diastolic interarm >5mm of Hg ,though this value is not statistically significant ,it shows that people with family history of hypertension is more prone to interarm BP difference.

Conclusions: Interarm difference exists in norma lhealthy volunteers and interarm difference  of >10 mm of Hg systolic & >5 mm of Hg diastolic should be investigated further as these subjects are more prone to develop cardiovascular morbidities .hence we conclude that interarm difference is a sensitive noninvasive and simple method of detecting individuals prone for cardiovascular morbidities.



Interarm blood pressure, Hypertension, BMI, CVS morbidity

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Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens. 2004;18:73-8.

CE Clark, JL Campbell, PH Evans, A Millward. Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review. Journal of Human Hypertension. 2009;20:923-31.

Kyoung Bog Kim, MiKyeong Oh, HaaGyoung Kim,

JiHoonKi, SooHee Lee, Su Min Kim. Interarm differences in simultaneous blood pressure measurements in ambulatory patients without cardiovascular diseases. Korean J Fam Med. 2013;34(2):98-106.

Christopher E Clark, John L Campbell, Roy J Powell, John F Thompson. The inter-arm blood pressure difference and peripheral vascular disease: cross-sectional study. Family Practice.2007;24:420-6.

Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT. (2004) Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society,* BHS IV. J Hum Hypertens. 2004;18:139–85.

National High Blood Pressure Education Program. Working Group on High Blood* Pressure in Children and Adolescents. The fourth report on thediagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555-76.

Christopher E Clark, Rod S Taylor, Angela C Shore, John L Campbell.The difference in blood pressure readings between arms and survival: primary care cohort study. British Medical Journal. 2012;344: e1327.

Agarwal R, Bunaye Z, Bekele DM. Prognostic significance of Between- arm Blood Pressure Differences. Hypertension. 2008;51:657-62.

Weinberg I, Gona P, O’Donnell CJ, Jaff MR, Murabito JM. The Systolic Blood Pressure difference Between Arms and Cardiovascular disease in the Framingham Heart study. The American Journal of Medicine. 2014;127(3):209-15.

Bursztyn M. Inter-Arm Blood Pressure Difference. The Journal of Clinical Hypertension. 2013; 15 (11):774-5.

Pesola GR, Pesola HR, Nelson MJ, Westfal RE. The Normal Difference in bilateral indirect blood pressure recordings in normotensive individuals. Am J Emerg Med. 2001;19:43-5.

Orme S, Ralph SG, Birchall A, Lawson – Matthew P, McLean K, Channer KS. The normal range for inter-arm differences in blood pressure. Age and ageing. 1999;28:537-42.

Cassidy P, Jones K. A study of inter-arm blood pressure differences in primary care. Journal of Human Hypertension. 2001;15:519-22.