Tuesday, January 19, 2010 Lefty asks

Q: BP radically different in each arm on routine screening

I'm a 47yo male with Hypertension 1 for a couple of years now, but have had difficuly getting it managed because of drug interactions between the diuretic qualities of some of the antihypertensives and the Lithium I was taking. The Lithium took priority, I guess, at the time. My internist moved to the coast and I havent had any follow-up on the BP in a couple of years. I'm now taking Lamictal instead of the Lithium Carbonate.

Here's the thing. I tried to donate blood the other day and was rejected (in a nice way) because my pressure was 137/78 in my left (dominant) arm, but 187/108 in my right arm. I sat there for maybe 20 minutes and the results of additional measurments were consistant with the first. They told me to follow-up with my doc ASAP. I'm getting the same sorts of readings here at home albeit with one of those wrist monitors.

I've also had some numbness in my left hand and ringing in my ears over the last month and lots of these little red spots/bruises under my skin around my ankles. No wicked headaches, dizzyness, slurred speech or anything like that. My vision is a little more hazy, but it's been declining since I hit 40! I don't belive any of this to be an emergency of any kind, but it's going to take a couple months to get into see a new internist. How should I proceed... Take a chill-pill and wait, go to the immediate care or do not pass go and head directly to the ER?

Any guidence is appreciated.

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Answers (3)

Lisa Nelson, Health Pro

1/19/10 7:46pm

Hi Lefty,

It is not unusual for your blood pressure to be different in one arm than the other. Blood pressure may be slightly higher in your dominant arm. For example, if you are right-handed, you may get a higher blood pressure reading when taken on your right arm. Usually the difference between arms is 10 mm Hg or less. Now, if you have heart disease, studies show the difference between arms to be greater. The arm with the higher blood pressure, is the one you should monitor.

Here is a post that may help:

What if my blood pressure is different in both arms?

All the best,

Lisa Nelson RD

7 Natural Ways to Lower Blood Pressure

Dr PhD

8/15/10 11:41pm

Hi,

50mm Hg difference is quite an astonishing to explain by normal variation between arms and giving advice to monitor the arm with higher BP. There must be pathology behind this difference and you should seek professional help to find out what it is!

diana

8/10/10 1:06am

You may have some restriction in the blood flow in the arm with the lower reading. You should inform your doctor.

Dr PhD

8/15/10 11:51pm

What doctors say:

It is normal for the BP to vary between two arms, as the blood flows through different paths to both arms. Typically the left is higher.

Your arms show a much higher gradient than normal variation, and an underlying condition should be sought. Congenital conditions in the differential diagnosis include aortic coarctation and thinning of 1 of the subclavian, axillary, or brachial arteries. Acquired arterial conditions include aortic dissection, atheroma, thrombus, embolus, and extrinsic compression (as might be seen in association with a mass in the upper chest).

Interarm blood pressure difference is a key finding in dissection of the aorta, a life-threatening emergency. However, when considered in light of the characteristics of the general population previously described and the relative rarity of aortic dissection, the presence of interarm blood pressure differences has no significant positive predictive value in this condition.

Your may have a contrast-enhanced CT of the chest to effectively delineate among the possibilities mentioned above. A vascular ultrasound would be helpful as well, but the CT would better show an extrinsic compression.

Q: BP radically different in each arm on routine screening

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