Pediatrics: Left and Right Arms Can Have Different Blood Pressures in Children Interview with:
Melanie Clark PhD candidate

Murdoch Children’s Research Institute
The Royal Children’s Hospital What is the background for this study? What are the main findings?

Response: Hypertension in children is a growing problem around the world, but when diagnosing hypertension, most of the time blood pressure is only measured in one arm. Our study showed that children can have a blood pressure difference between arms that may be considered significant in a clinical setting. One in four children had a difference between left and right arms that could mean that blood pressure appears normal in one arm, but in the other arm it would be classified as a high blood pressure. This means that if a doctor measures blood pressure in one arm only, a diagnosis of high blood pressure could be missed. Is blood pressure routinely measured during pediatric visits?

Response: American and European clinical guidelines do recommend screening for high blood pressure in children, but it’s not clear how often these guidelines are followed. These guidelines already recommend measuring in both arms, but the thinking has been that it should be done mainly to rule out certain types of congenital heart disease.

Our study showed that inter-arm blood pressure differences can be quite common even in kids without a history of heart disease. What should readers take away from your report? 

Response: If we continue to measure blood pressure in only one arm, we are likely to underdiagnose children and adolescents with high blood pressure. This is important because high blood pressure in childhood often leads to hypertension in adulthood, which is the leading risk factor for heart disease and death worldwide. Additionally, high blood pressure at any age can begin to damage the heart, arteries, and microvessels in organs such as the brain, eyes and kidneys.

To maintain a healthy blood pressure, it’s important that kids eat a healthy diet that is low in salt and sugar, and high in fruit, vegetables, and whole grains. We need to do everything we can to encourage and support kids in getting lots of physical activity, and kids also need to get a good night’s sleep, as children who have disturbed or insufficient sleep have an increased risk of developing high blood pressure. What recommendations do you have for future research as a result of this work?

 Response: Our group is now looking into what causes a blood pressure difference between arms. We’ve already shown that it is not about whether the child is left- or right-handed. We’re also looking to use this information in more specific clinical settings such as exercise stress tests, where blood pressure is a critical measurement.


Melanie M. Clarke, Hilary A. Harrington, Jonathan P. Glenning, Diana Zannino, Michael E. Holmstrup, Brock T. Jensen, Joseph J. Smolich, Michael M.H. Cheung, Jonathan P. Mynard. Magnitude and significance of interarm blood pressure differences in children and adolescents. Journal of Hypertension, 2021; Publish Ahead of Print DOI: 10.1097/HJH.0000000000002797



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Last Updated on March 12, 2021 by Marie Benz MD FAAD