Big arm-to-arm difference in blood pressure linked to higher heart attack risk

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The next time you have your blood pressure checked, ask your health care to check it in both arms, rather than just in one. Why? A big difference between the two readings can give you an early warning about increased risk of cardiovascular disease, a new study suggests.

Researchers at Harvard-affiliated Massachusetts General Hospital and colleagues measured blood pressure—in both arms—in nearly 3,400 men and women age 40 or older with no signs of heart disease. The average arm-to-arm difference was about 5 points in systolic blood pressure (the first number in a blood pressure reading). About 10% of the study participants had differences of 10 or more points. Over the next 13 years or so, people with arm-to-arm differences of 10 points or more were 38% more likely to have had a heart attack, stroke, or a related problem than those with arm-to arm differences less than 10 points. The findings, which appear in the March 2014 American Journal of Medicine, uphold earlier work on arm-to-arm differences in blood pressure.

Small differences in blood pressure readings between the right and left arm are normal. But large ones suggest the presence of artery-clogging plaque in the vessel that supplies blood to the arm with higher blood pressure. Such plaque is a signal of peripheral artery disease (cholesterol-clogged arteries anywhere in the body other than the heart). When peripheral artery disease is present, there’s a good chance the arteries in the heart and brain are also clogged, boosting the odds of having a heart attack or stroke.

While most cardiologists routinely measure blood pressure in both arms as part of an initial evaluation, most primary care doctors don’t. “Our study suggests that a baseline blood pressure measurement in both arms by primary care clinicians may provide additional information about cardiovascular risk prediction,” says study co-author Dr. Christopher O’Donnell, a cardiologist at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School.

Here’s another reason to check blood pressure in both arms: if the pressure in one arm is higher, that arm should be the one upon which to base any treatments and to check your blood pressure in the future. (The current guidelines for managing high blood pressure are discussed here).

This study didn’t look at whether more aggressive treatment in people with high arm-to-arm blood pressure differences would help protect them from heart attack or stroke. Still, it’s worth finding out if you face a high risk of heart disease. That might inspire you to redouble your efforts to improve your cardiovascular health. To that end, the top six steps are:

  • Don’t smoke. Tobacco smoke is as bad for the heart and arteries as it is for the lungs. If you smoke, quitting is the biggest gift of health you can give yourself. Secondhand smoke is also harmful, so avoid it whenever possible.
  • Be active. Exercise and physical activity are about the closest things we have to magic bullets against heart disease and other chronic conditions. Any amount of activity is better than none; at least 30 minutes a day is best.
  • Aim for a healthy weight. Carrying extra pounds, especially around the belly, strains the heart and tips you toward diabetes. If you are overweight, losing just 5% to 10% of your starting weight can make a big difference in your blood pressure and blood sugar.
  • Enliven your diet. Add fruits and vegetables, whole grains, unsaturated fat, good protein (from beans, nuts, fish, and poultry), and herbs and spices. Subtract processed foods, salt, rapidly digested carbohydrates (from white bread, white rice, potatoes, and the like), red meat, and soda or other sugar-sweetened beverages.
  • Drink alcohol in moderation (if at all). If you drink alcohol, limit your intake — one to two drinks a day for men, no more than one a day for women.
  • Ease stress. Finding ways to ease stress, such as exercise, meditation, mindfulness, and other techniques, can take a load off the heart and arteries.

Related Information: Harvard Heart Letter


  1. Keith

    On the Article Regarding Children Prescreen iPhone Apps

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    The effect that ipads, iphones, tablets, is of course having some effect on all of us that use them, but like all monetary valuable things, time will reveal its real wealth. The other important thing is every parent has a responsibility these days to at least review or critique what their child has fallen prey too.

  2. john

    god article as far as it goes, however, what can I do about a right arm bp of 189/68 left arm bp of 99/66,my consultant doesn’t seem too worried as long as I don’t have pain in my arms, this article indicates that something could be done to alleviate the problem, what??

  3. john

    Good article, but what do I do.
    My left arm bp is 99/66,right arm 189/68, I know that I have clogged up arteries, so does my consultant, all he seems interested in is whether I have pain in my arms,(I haven’t at the moment), I have no problem walking, but after half a mile, I get pain in both my calves, this wears off after a while. I am a smoker but am trying to give it up, I am 72years of age. What should my consultant do about it??

    • Richard Little

      John, you really need to STOP smoking immediately. And you need to get a second opinion with a highly respected Cardiologist right away, if you’re still alive right now.

  4. KathyC

    Thanks for the info — been suffering from HBP for the past few years. I’ll have my doc check both my arms next time!


  5. Derek Barrington

    A very interesting article. From persomnal experience I have only ever had blood pressure checks on one arm, never had both tested.

  6. Sentinel Med

    Really a great article. The tips mentioned here are very very helpful. I would like to add here that one must be very cautious about his/her health while traveling. To prevent any complications you must consult your doctor too. 🙂

  7. barben

    Most of person has blood pressure. This is big problem that if you have abnormal blood pressure in your two arms. You may be get heart attack. This information is more informatics. There are following all health tips that are very helpful for every person.

  8. Minaz Rattansi

    Very important, as most people do not realize the importance of having both arms measured. Secondly, often it is not practiced by health care professionals either! This applies to physicians and nurses equally – they should take both arms, rather than leaving it with only one.

  9. I recently went through 3 treatments of Chelation Therapy, I stopped it because of complications,now my blood pressure differs in both arms systolic by 40 points or more,left is normally 115 over 73 and right is 165 over 76 , my medical dr says my cholesterol & tryglicerides are now in a ok range, & said to check the BP Mach for accuracy my machine is accurate , I checked it with 4 other people ,there pressure was within 10 points difference arm to arm, please advise
    Thank You

  10. donohorcalvert

    Most horrifying is the fact that the entire world is becoming obese due to lifestyle changes and more and more people are prone to heart attack diseases due to high blood pressure. Articles like this should be more widely publicized to ensure that more common people read this. Thanks again.

  11. Ron

    I am tired of medical studies showing results only in %. If two died in the 10% different group and only one died in the lesser group that would be 50% increase in death!! GET MY POINT! Show the totals. That would be much more meaningful.

  12. Jual Mniatur

    Thank you very much Mrs. Julie Corliss on information already given, Granted to stimulate heart activity to stay healthy self We needed the will of its own, if there is a willingness to healthy surely We will always take good care, could not consume the cigarettes and alcoholic beverages. Maybe with a healthy lifestyle as well as the heart we would be much healthier. Perhaps unhealthy lifestyle such as the above can be minimized by doing activities that could make would forget it all, like entrepreneurship, helping others and doing good things.

  13. Vince Mioraglia

    Since I believe a recent review found no benefit in treating pressure less than 160 systolic would this procedure provide benefit even at those levels? Obviously central pressure is more important than biracial pressure . Since atenolol has not been shown to effectively reduce central pressure or for that matter events how would that play here. Perhaps statins would be indicated…. good for the industry….perhaps patients need more evidence based data

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    Finally, an issue that I am passionate about. I have looked for information of this caliber for the last several hours. Your site is greatly appreciated.

  15. Nadine

    Thanks for this information I will ask my doctor to check both arms.I have already been diagnosed with HBP,I’m working on losing weight and having a healthy heart.

  16. Ann

    Wow! really a great article. For people who suffer from high blood pressure most of them donot know what it is. It is a silent killer. It doesnot do any visible harm at first but the slow impacts on all organs have a long standing effect and tends to limit functions of multi organs. Most horrifying is the fact that the entire world is becoming obese due to lifestyle changes and more and more people are prone to heart attack diseases due to high blood pressure. Articles like this should be more widely publicized to ensure that more common people read this. Thanks again.

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