Blood Pressure Differences Between Arms Correlate With Negative Outcomes

Dr. Ido Weinberg MD MSc MHA Massachusetts General Hospital, Vascular Medicine Interview with:
Dr. Ido Weinberg MD MSc MHA
Massachusetts General Hospital, Vascular Medicine What are the main findings of the study?

Dr. Weinberg: The study examined the relationship between blood pressure difference between arms and clinically meaningful outcomes such as death and new-onset (incident) cardiovascular disease including myocardial infarction and stroke. The main finding of the study was that an elevated inter-arm blood pressure difference correlated with these negative outcomes. We have also shown that the correlation was strong enough to be independent from the classic Framingham risk score. Adding an elevated inter-arm blood pressure to the risk score made it a more accurate. Were any of the findings unexpected?

Dr. Weinberg: In my opinion the findings were expected and in line with our hypothesis. However, this does not mean that they lacked in novelty. Overall the population that we studied was quite healthy. This means that there were relatively few cardiovascular events despite a prolonged period of observation. Previous studies have shown a more robust correlation between an elevated inter-arm blood pressure difference and cardiovascular outcomes in sicker populations. The novelty in our findings is that this is the first community based population study to show the correlation. What should clinicians and patients take away from your report?

Dr. Weinberg: For clinicians I would say that the main message is that they should make it a habit to measure blood pressure in both arms at least once. I also think that blood pressure measurement should be done after the patient has indeed relaxed. I think it has several advantages.

  • First, it is compliant with current recommendations.
  • Second, it is probably more accurate than measuring blood pressure in one arm only and immediately upon patient arrival.
  • Third, as our findings point out, this is a cheap and efficient way to estimate patients’ risk of having unwanted cardiovascular events. Basically, it is another, easy to use, tool in clinicians’ toolbox.

As for patients – I think many patients today are aware of the importance of blood pressure control. Many patients use home monitoring as a means to control their blood pressure. I think that patients can serve themselves right by following their own blood pressure and taking it in both arms. If a consistent gap keeps showing up, I think they should discuss it with their caregivers. What recommendations do you have for future research as a result of this study?

Dr. Weinberg: Blood pressure measurements, despite being widespread and ubiquitous with clinical encounters, have not been yet fully utilized. I see two obvious next steps in the study of this field.

  • First, we should try and correlate inter-arm blood pressure differences with markers of subclinical atherosclerosis such as intima-media thickness and coronary and aortic calcifications.
  • Second, it would be interesting to know if intervention after early detection can improve outcomes. In other words, should finding an increased blood pressure difference between arms dictate any management changes.


Am J Med. 2014 Mar;127(3):209-15. doi: 10.1016/j.amjmed.2013.10.027. Epub 2013 Nov 25.

The systolic blood pressure difference between arms and cardiovascular disease in the framingham heart study.

Weinberg I1, Gona P2, O’Donnell CJ3, Jaff MR4, Murabito JM5.