A significant difference in the systolic or upper blood pressure reading between the two arms could be a warning sign of a future heart attack or stroke, according to a new meta-analysis of 24 global studies published Monday in the journal Hypertension.
“Patients who require a blood pressure check should now expect it to be checked at least once in both arms,” said lead author Dr. Chris Clark, a senior clinical professor at the University of Exeter Medical School in the United Kingdom, said in a statement. .
Blood pressure is measured in millimeters of mercury (mmHg for short), which consists of two numbers: an upper, or systolic, value that indicates the maximum amount of pressure in your arteries, and the lower, or diastolic, that indicates the pressure in your blood vessels. your arteries when your heart muscle is at rest between beats.
The new study found that for every degree of difference between the two arms over 10 millimeters of mercury, the risk of new angina (chest pain), heart attack, or stroke increased by 1% over the next decade.
The study results indicate that differences of more than 5 millimeters of mercury between two arms “predict all-cause mortality, cardiovascular mortality and cardiovascular events.”
“We have long known that a difference in blood pressure between the two arms is linked to worse health outcomes,” said Clark.
This study “tells us that the higher the difference in blood pressure between arms, the greater the cardiovascular risk, so it’s really critical to measure both arms to determine which patients are at significantly increased risk,” said Clark.
Systolic differences are key
A difference of 10 millimeters of mercury or less between the arms is considered normal by the AHA and is not a cause for concern. However, higher values between the two arms can be a sign of a narrowing or stiffening of the arteries, which can affect blood flow.
Contrary to guidelines in the US, which is in both the UK and the European Union recognize “a systolic difference of 15 mmHg or more between the two arms as the threshold indicative of additional cardiovascular risk,” the study said.
Research associate Victor Aboyans, professor and chief of the cardiology department at Dupuytren University Hospital in Limoges, France, said the study shows that international guidelines need to be re-evaluated.
“We believe that a difference of 10 mmHg can now reasonably be considered as an upper limit of normal for systolic blood pressure between arms when both arms are measured sequentially during routine clinical appointments,” Aboyans said in a statement.
“This information needs to be included in future guidelines and clinical practice when assessing cardiovascular risk. It would mean that many more people would be eligible for treatment that could reduce their risk of heart attack, stroke and death,” added Aboyans .
In addition, health workers should measure blood pressure in both arms during checkups, the report said. Although international guidelines currently recommend this practice, it is “generally ignored”.
“While international guidelines currently recommend that this be done, it only happens about half the time at best, mostly due to time constraints,” said Clark.
“Checking one arm and the other with a routinely used blood pressure monitor is inexpensive and can be performed in any healthcare setting, without the need for additional or expensive equipment,” said Clark. “Our research shows that the little extra time it takes to measure both arms can ultimately save lives.”
Measure your own blood pressure
Anyone concerned about their blood pressure should check it at home and keep a diary, the AHA suggests.
The AHA says that blood pressure should be measured at the same time every day, such as in the morning or in the evening. Follow these steps to make sure you get an accurate reading:
Don’t smoke, drink caffeinated beverages, and don’t exercise for at least 30 minutes before taking your blood pressure. Go to the bathroom and empty your bladder.
Sit with your back straight and supported, which means sitting in a hard-backed chair at a desk or table, not a sofa.
“Your feet should be flat on the floor and your legs should not be crossed. Your arm should be supported on a flat surface (such as a table) with the upper arm at heart level,” advises the AHA.
Roll up your sleeve – do not measure over clothing. Rest there for at least five minutes before taking measurements.
Follow the illustrations on your blood pressure monitor – an important step is to make sure the bottom of the cuff is placed directly over the bend of the elbow.
Take multiple measurements and record the results. “Each time you measure, take two or three measurements one minute apart and record the results with a printable tracker. If your monitor has built-in memory to store your measurements, take it with you to your appointments. you to upload your measurements to a secure website after registering your profile, “advises the AHA.