Measuring Blood Pressure in Both Arms Can Reduce Hypertension
Author: University of Exeter
Published: 2022/08/04 - Updated: 2025/12/16
Publication Details: Peer-Reviewed, Findings
Category Topic: Cardiovascular - Related Publications
Page Content: Synopsis - Introduction - Main - Insights, Updates
Synopsis: This peer-reviewed research, published in the journal Hypertension and led by the University of Exeter, draws authority from a comprehensive meta-analysis of 53,172 participants across 23 international studies to demonstrate a critical gap in clinical practice that affects millions worldwide. The study reveals that measuring blood pressure in both arms - rather than the standard single-arm approach - and adopting the higher reading reclassifies 12 percent of patients as having hypertension who would otherwise fall below diagnostic thresholds, while also proving to be a better predictor of cardiovascular mortality and events.
For older adults and those managing chronic conditions who face elevated cardiovascular risks, this finding holds particular significance: the simple act of checking both arms during routine appointments could mean the difference between undetected high blood pressure and timely intervention. Despite existing international guidelines recommending bilateral measurement, the practice remains rarely implemented in clinics, representing a systemic oversight with measurable consequences for patient outcomes - Disabled World (DW).
Defining Blood Pressure
- Blood Pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. Blood pressure is usually expressed in systolic pressure (maximum pressure during one heartbeat) over diastolic pressure (minimum pressure between two heartbeats) in the cardiac cycle. Blood pressure is measured in millimeters of mercury (mmHg) above the surrounding atmospheric pressure.
Introduction
Blood pressure should be measured in both arms, and the higher reading should be adopted to improve hypertension diagnosis and management, according to a new study. The research, led by the University of Exeter, analyzed data from 53,172 participants in 23 studies worldwide to examine the implications of choosing the higher or lower arm pressure.
The study, published in Hypertension, found that using the higher arm blood pressure reading reclassified 12 percent of people as having hypertension, who would have fallen below the threshold for diagnosis if the lower reading arm was used.
Main Content
Although International guidelines advise checking blood pressure in both arms, the practice is currently not widely adopted in clinics.
Study lead Dr. Christopher Clark, from the University of Exeter, said:
"High blood pressure is a global issue and poor management can be fatal. This study shows that failure to measure both arms and use the higher reading arm will result in under diagnosis and undertreatment of high blood pressure and under-estimation of cardiovascular risks for millions worldwide."
The team found that using the higher arm measurement compared to using the lower arm resulted in the reclassification of 6572 (12.4%) of participants' systolic blood pressures from below to above 130 mm Hg, and 6339 (11.9%) from below to above 140 mm Hg, moving them above commonly used diagnostic thresholds for hypertension.
Dr. Clark continued:
"It's impossible to predict the best arm for blood pressure measurement as some people have a higher reading in their left arm compared to the right and equal numbers have the opposite. Therefore, it's important to check both arms as detecting high blood pressure correctly is a vital step towards giving the right treatment to the right people".
"Our study now provides the first evidence that the higher reading arm blood pressure is the better predictor of future cardiovascular risk."
The study also revealed that higher arm blood pressure readings better predicted all-cause mortality, cardiovascular mortality, and cardiovascular events compared to the lower arm reading. The authors stressed the importance of assessing both arms in diagnosing and managing hypertension and cardiovascular diseases.
The Paper
The paper is entitled 'Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration' and is published in Hypertension.
The research was conducted by the international INTERPRESS-IPD Collaboration. It was funded by the National Institute for Health and Care Research (NIHR), Research for Patient Benefit Program, and supported by the NIHR School for Primary Care Research, NIHR Oxford CLAHRC, NIHR Exeter Clinical Research Facility, Exeter Clinical Trials Unit, the National Natural Science Foundation of China, Beijing and Shanghai Commission of Science and Technology.
Insights, Analysis, and Developments
Editorial Note: The elegance of this research lies not in technological innovation or pharmaceutical breakthrough, but in exposing how a basic procedural oversight undermines healthcare delivery at its most fundamental level. We've developed sophisticated algorithms to predict cardiovascular risk, invested billions in treatment options, and crafted elaborate clinical guidelines - yet we're failing at the elementary task of measuring what we claim to be measuring. The study's finding that you cannot predict which arm will show the higher reading strips away any excuse for continuing single-arm measurements as standard practice. What makes this particularly troubling is the silence around implementation: international guidelines have recommended both-arm checks for years, yet clinics haven't adopted the practice, suggesting a disconnect between evidence and execution that likely extends beyond blood pressure monitoring. For patients, especially those already navigating complex health challenges, the message is clear: advocate for both arms to be checked, because the system hasn't yet caught up to its own recommendations - Disabled World (DW).Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by University of Exeter and published on 2022/08/04, this content may have been edited for style, clarity, or brevity.