WHY CERTAIN ARM POSTURES NORMALLY USED FOR BLOOD PRESSURE TESTS MAY RESULT IN ERRONEOUS READINGS. HERE IS THE CORRECT METHOD FOR DOING IT.

A new study discovered that having your arm in the wrong position during blood pressure checks, whether at home or at the doctor's office, can result in readings "markedly higher" than when your arm is properly supported on a table with the middle of the cuff positioned at heart level.

This implies that not constantly positioning and supporting your arm adequately during a blood pressure measurement may result in a mistake of high blood pressure, which some experts fear may lead to unneeded therapy.

The research, published Monday in the journal JAMA Internal Medicine, discovered that having your arm lying on your lap during a blood pressure assessment may result in a 3.9 mm Hg systolic and a 4 mm Hg diastolic reading.

Furthermore, hanging your arm by your side might result in an inflated systolic measurement of 6.5 mm Hg and an overstated diastolic reading of 4.4 mm Hg.

Blood pressure is measured in millimeters of mercury (mm Hg), which is made up of two numbers: the higher, or systolic reading, and the lower, or diastolic reading.

A person is regarded to have high blood pressure or hypertension if their readings are consistently 130/80 or above.

"Health care providers need to be reminded about the importance of taking the time to do these steps properly," said the study's senior author, Dr. Tammy Brady, who is vice chair for clinical research in the department of pediatrics at the Johns Hopkins University School of Medicine and medical director of the pediatric hypertension program at Johns Hopkins Children's Center.

"I just hope that it raises awareness regarding how important things like arm position are to blood pressure measurement accuracy," Brady said of the research.

"I also hope this study educates patients, empowering them to advocate for proper measurement when they're in a clinic setting," according to her. "But also, because so many patients rely on home blood pressure measurements for hypertension diagnosis, evaluation, and treatment, I hope this educates them on how to properly position their arms because our findings absolutely extend to measurements in the home."

The Johns Hopkins University researchers recruited 133 people from Baltimore, Maryland, between August 2022 and June 2023 to participate in the study.

Adults aged 18 to 80 were randomly allocated to have their blood pressure monitored while their arms were positioned in three ways: supported on a desk, as is typical procedure; supported on their lap; or hanging by their side, unsupported.

Each research participant had their blood pressure measured 12 times with their arms in each of the different postures.

When the individuals' arms were supported on a desk as indicated by current clinical recommendations, their average blood pressure measurement was 126/74, the researchers discovered.

However, while the participants' arms were resting on their laps during the measurements, the average blood pressure reading was 130/78, and when their arms were hanging by their sides, the average reading was 133/78.

"I didn't anticipate there to be such a significant difference when the arms were put in the two different positions.

We evaluated those postures because, according to statistics and personal observations, it is where most individuals get their blood pressure taken," Brady added. "We thought there'd be a difference, but I was surprised by how much of a difference there was."

According to the researchers, there are various physiological reasons why blood pressure readings may be incorrectly elevated when the arm is not properly positioned or supported.

A higher vertical distance between the heart and where the cuff is positioned may raise hydrostatic pressure in the arteries, or the pressure of the blood against the wall caused by gravity's pull, resulting in an overestimation of blood pressure.

In addition, an unsupported arm may induce muscular contractions, which can raise blood pressure.

How to check your blood pressure properly

The current study's results are similar to earlier research, which has indicated that unsupported arm postures or arm positions below heart level might overstate blood pressure readings.

"We know that arm position affects blood pressure readings; what this study does is give us a more precise measure of how much of an impact," Dr. Nichola Davis, vice president and chief population health officer at NYC Health and Hospitals, who was not involved in the study, said in an email.

CHECK OUT THE #1 SOLUTION TO BLOOD PRESSURE

"This is found in individuals with all blood pressure levels, although it is more noticeable in those with high blood pressure.

These are significant discoveries because we diagnose and treat hypertension based on blood pressure measurements, which must be reliable," Davis said in an email.

According to the report, the "latest clinical practice guidelines emphasize several key steps for accurate measurement," which include:

War the proper cuff size.

Keep your back supported.

Keep your feet level on the floor and your legs uncrossed.

Have the proper arm posture - the cuff should be at heart level, with the arm supported by a desk or table.

Wearing the right cuff size is critical because an incorrectly sized blood pressure cuff may affect blood pressure results recorded by automated blood pressure machines.

CHECK OUT THE #1 SOLUTION TO BLOOD PRESSURE

One research, published last year in the journal JAMA Internal Medicine, discovered that using normal, regular-sized blood pressure cuffs resulted in "strikingly inaccurate" results if a patient needed differently sized ones, especially for those who fit bigger cuffs.

Dr. Gail Adler, a cardiovascular endocrinologist and co-specialist in the Hypertension Clinic at Brigham and Women's Hospital who was not involved in the current research, advised individuals to take a few measures before having their blood pressure measured.

"For 30 minutes before taking your blood pressure, avoid smoking, exercise, coffee, alcohol, and big disputes. "Don't be psychologically stressed," Adler said.

"Then what you want to do is sit in the chair, get into the proper posture, and relax for five minutes, without talking, resting your arm comfortably, sitting erect with your back straight, legs uncrossed, and feet flat on the floor.

Make sure you don't need to pee or urinate; if you do, your blood pressure will rise," she said. "And you shouldn't talk while taking your blood pressure, and the cuff should be against your arm." So you don't want to wear it over clothing."

Because individuals are frequently more relaxed and comfortable at home, "what we're finding now is studies suggest that blood pressures measured at home are a better indicator of your usual blood pressure than blood pressures measured in the office," Adler said.

Blood pressure readings are often "suboptimally performed" in clinical practice, which may lead to mistakes that subsequently and wrongly influence physicians' recommendations about controlling a patient's blood pressure in around 20% to 45% of instances, according to the American Medical Association.

"Anecdotally, I believe all of us on the research team have begun to pay more attention to how our blood pressures are monitored.

"I've definitely paid attention to how my children's blood pressures are measured," Brady said.

'We should not make quick conclusions.'

High blood pressure increases the risk of heart disease and stroke, the main causes of mortality in the United States.

According to the US Centers for Disease Control and Prevention, about half of all individuals in the United States have high blood pressure, but only approximately one in every four have it under control.

"I don't think that we are aggressive enough with the treatment of hypertension in America," said Dr. Dave Montgomery, a cardiologist at Piedmont Healthcare in Atlanta, who was not involved in the current research, by email.

"One of the most frequent risk factors for cardiovascular disease is hypertension, which is also one of the most easily treated and managed. Still, hypertension is the cause or key contributor to a significant amount of cardiovascular illness and death," he said. "We too often miss the mark."

Regarding the current research, he said that he does not see a blood pressure measurement that is wrong by 4 to 5 mm Hg owing to arm posture, resulting in overdiagnosis or overtreatment, such as a new prescription or dosage change.

"If someone has normal blood pressure, 4 mmHg will not affect it. However, in someone with hypertension, 5-10 points may indicate that we do not have the desired level of control," Montgomery said.

He said that blood pressure might fluctuate minute by minute owing to physical reasons and a person's psycho-emotional condition.

"This indicates that we should not make hasty decisions based on a single blood pressure result. "However, consistently high blood pressure should be treated aggressively," he said. "This is how we lower the burden of heart disease."