BP measurement technique

[raildown]

I'm wondering what is the 'gold standard' for BP measurement specifically relating to which arm should be used; my long-time internist always took it in both arms on every visit...;

my new internist uses the right arm...;

if there is a consistent difference in BP in one arm versus the other is that something to be concerned about ?  

thank you in advance;

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[CCF-M.D.-RCJ]

Raildown,

Thanks for the post.

If a person has normal vasculature, then blood pressures measured from either arm will be equivalent.  However, if a person has a stenosis of one of the subclcavian arteries, for example, then that arm will have a lower blood pressure than the "central" blood pressure.

The most purely correct method to measure the blood pressure is a cumbersome process.  The patient needs to be calm and in a seated position for a minimum of 5 minutes.  Blood pressure measurements are taken from all 4 extremities with the appropriate cuffs for each arm.  Repeated measurements are taken on several visits to ensure consistency.  With the time pressure placed on physicians today, very few will (or can afford to) go through this procedure.

If a consistent difference in blood pressure is noted between arms, a person needs to be evaluated.  Several possibilities exist, and include normal variant, coarctation of the aorta, subclavian artery stenosis, aortic dissection, Takayasu's arteritis, and others.

Hope that helps.

[raildown]

thank you very much;

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