Inter-arm Systolic Blood Pressure Difference of 15 mm Hg or More in Treated Hypertensive Patients

Blood pressure is generally measured on in one arm - usually the non-dominant arm. However, increasing data suggests that arm to arm difference in blood pressure is common and may indicate atherosclerotic peripheral vascular disease. Other causes of inter-arm blood pressure difference include vasculitis, fibromuscular hyperplasia, connective tissue disorders, radiation arteritis, thoracic outlet compression, dissecting aortic aneurysm, and congenital abnormalities. A recent meta-analysis of 20 studies revealed that a systolic blood pressure difference of more than 15 mm Hg between the right and left arm was associated with a 2.5 greater risk of peripheral vascular disease, a 1.7 fold increase in cardiovascular mortality, and a 1.6 higher risk of all-cause death. Its presence is therefore not benign.