"Arm position during blood pressure check may lead to wrong reading, study finds"

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I have hypertension and I was diagnosed when I was 18 years old. Twice in the last few years I've been in a doctors office and the medical assistant took my blood pressure and it was high, I'm on medication. The problem in both cases was they used the wrong size cuff, there is a larger cuff for males and a smaller cuff for females and children.

Most of the time when they take it, my arm is at my side dangling, because the blood pressure device is on wheels. According to this study the arm should be resting on a surface.
Blood pressure readings may not be accurate unless a person’s arm is positioned correctly, a new study suggests. A comparison of blood pressure readings taken while people held their arms three different ways — leaning on a surface, resting on the lap or hanging by the side of the body — showed certain positions could lead to a significant increase in systolic pressure, the upper number in a blood pressure reading, according to the study published Monday in JAMA Internal Medicine. Systolic refers to the amount of pressure in a person’s arteries, when the heart sends blood throughout the body. The size of the difference, nearly 7 points in the arm dangling position, was a surprise, said the study’s senior author, Dr. Tammy Brady, a pediatrician and epidemiologist and medical director of the pediatric hypertension program at the Johns Hopkins Children's Center. The researchers weren’t sure what to expect prior to running their experiment. “There was a chance that arm position was not important,” she said.

“One of my hopes is that this will help inform patients as to how to do this on their own and also to tell their health care provider the right way,” Brady said. “Patients should be empowered to make sure the blood pressure measurement is accurate.” The American Heart Association recommends that a patient’s arm should be supported to get an accurate reading. The guidelines also say: Avoid caffeine, exercise and smoking for 30 minutes. The blood pressure cuff should be positioned at mid-heart level. The patient’s feet should be flat on the floor, with the back supported. Nearly half of U.S. adults have high blood pressure, which occurs when the measured force of blood flowing through blood vessels is higher than what is considered normal: less than 120 systolic pressure and less than 80 diastolic. Diastolic is the pressure in the arteries between heart beats. Hypertension often causes minimal symptoms but untreated it can increase the risk for stroke, heart attack and other serious cardiovascular conditions. To learn whether arm position made a difference in blood pressure readings, Brady and her colleagues recruited 133 adults, 78% of them Black and 52% female. The study volunteers’ ages ranged from 18 to 80.

While all the participants had blood pressure measured in each of the three arm positions, they were randomly assigned to one of six possible groups that differed by the order in which the positions were assumed. The researchers found that when people had their arms hanging by their sides during the reading, their systolic pressure was 6.5 points higher than when their arms were resting on a desk, while the diastolic blood pressure — the bottom number — was 4.4 points higher than in the supported condition. Similarly when people’s arms were on their laps, the systolic blood pressure was 3.9 points higher than when their arms were supported by a surface, while the diastolic pressure was 4 points higher than in the supported condition. Those differences can lead to more diagnoses of hypertension and patients being prescribed medications they don’t need For example, if a person’s actual blood pressure is 134, and blood pressure is measured on a dangling arm, the reading could end up over 140, which is considered to be stage 2 hypertension. Mispositioning of a patient’s arm “unfortunately is a common experience,” said Dr. Karyn Singer, an assistant professor of medicine at New York University and assistant vice president of chronic disease and prevention at NYC Health + Hospitals. “As a patient, I’ve been there.”

The study provides a “piece of evidence that is really critical,” said Singer, who was not affiliated with the new research. “Until now it hasn’t been clear how much arm position changes blood pressure readings.” Singer’s main message for patients: “Be aware of the proper blood pressure measuring technique and to advocate for themselves if they think the blood pressure reading is higher than they think it should be.” As a patient, Dr. Megan Kamath has also had similar experiences at different health care settings and different offices. “There is a pretty significant difference in blood pressure readings depending on arm position,” said Kamath, a cardiologist at UCLA Health. “This is a fascinating study,” said Kamath, who was not involved with the research. “What I took from reading it was, wow, with a simple study design these researchers found some important real world implications that can make the difference between a patient being treated for hypertension or not.” Patients who receive blood pressure lowering medication that they don’t need may experience side effects, such as lightheadedness, dizziness, fatigue and blurry vision, Singer said. Dr. Matthew Tomey, a cardiologist at Mount Sinai Fuster Heart Hospital in New York City, said the findings support a patient asking for a doctor to measure blood pressure the "right way." The differences found by the researchers can be enough to move someone from one blood pressure category to another, said Tomey, who was not part of the new study.
https://www.nbcnews.com/health/heart-he ... rcna174245


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For an accurate reading, the arm should be resting on a surface. Your arm resting on your lap or by your side can result in a higher systolic number.

Systolic is the higher number in your blood pressure reading, as in 120/80.
Over the years, research has found that both numbers are equally important in monitoring heart health. However, most studies show a greater risk of stroke and heart disease related to higher systolic pressures compared with elevated diastolic pressures. That's especially true in people ages 50 and older, which is why doctors tend to monitor the top number more closely. The reason for the difference in risk may be related to the force put on the arteries when blood rushes out of the heart.
https://www.health.harvard.edu/staying- ... at%20rest.
"Everyone is entitled to their own opinion, but not their own facts." - Daniel Patrick Moynihan

Re: "Arm position during blood pressure check may lead to wrong reading, study finds"

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Good post. There’s also “white coat” syndrome. Mine elevates significantly every time I go to a doctor’s office. Still I do have high blood pressure that does need to be managed with medication. To confirm when my blood pressure has changed and meds need updating my doctors have had me do readings at home.
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"Resistance is futile. You will be assimilated!" Loquacious of many. Texas Chapter Chief Cat Herder.

Re: "Arm position during blood pressure check may lead to wrong reading, study finds"

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As it was taught back in the dark ages, the most accurate BP would be taken in the left upper arm at the level of the heart with the patient at a sitting or supine position. We now have the wrist BP cuff and they have proven to be accurate if used as directed with the BP Cuff on the left wrist and held over the heart.

Also the most accurate BP reading is taken after the person has sat or laid down for at least a few minutes. Taking a BP right after someone walks from the waiting area to a treatment room and immediately taking a BP reading can give a false reading especially if the patient is anxious or scared of the visit.
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Re: "Arm position during blood pressure check may lead to wrong reading, study finds"

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TrueTexan wrote: Wed Oct 09, 2024 2:19 pm As it was taught back in the dark ages, the most accurate BP would be taken in the left upper arm at the level of the heart with the patient at a sitting or supine position. We now have the wrist BP cuff and they have proven to be accurate if used as directed with the BP Cuff on the left wrist and held over the heart.

Also the most accurate BP reading is taken after the person has sat or laid down for at least a few minutes. Taking a BP right after someone walks from the waiting area to a treatment room and immediately taking a BP reading can give a false reading especially if the patient is anxious or scared of the visit.
I use a wrist one as you noted and the doctor’s office confirmed it’s accurate.
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"Resistance is futile. You will be assimilated!" Loquacious of many. Texas Chapter Chief Cat Herder.

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