Clinical relevance of double-arm blood pressure measurement and prevalence of clinically important inter-arm blood pressure differences in Indian primary care

Gurpreet S Wander, Sinead T J McDonagh, M Srinivasa Rao, R Alagesan, J C Mohan, Ajit Bhagwat, A K Pancholia, M Viswanathan, Manoj Bhavrilal Chopda, A Purnanand, P L N Kapardhi, Arun R Vadavi, R Selvaraj, Pankaj Aneja, Suhas Hardas, Neil Bordoloi, N Sivakadaksham, Nilesh Goswami, Christopher E Clark, Willem J Verberk*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Hypertension guidelines recommend measuring blood pressure (BP) in both arms at least once. However, this is seldom done due to uncertainties regarding measurement procedure and the implications of finding a clinically important inter-arm BP difference (IAD). This study aimed to provide insight into the prevalence of clinically important IADs in a large Indian primary care cohort. A number of 134 678 (37% female) unselected Indian primary care participants, mean age 45.2 (SD 11.9) years, had BP measured in both arms using a standardized, triplicate, automated simultaneous measurement method (Microlife WatchBP Office Afib). On average, there were clinically minor differences in right and left arm BP values: systolic BP 134.4 vs 134.2 mmHg (p < .01) and diastolic BP 82.7 vs 82.6 mmHg (p < .01), respectively. Prevalence of significant mean systolic IAD between 10 and 15 mmHg was 7,813 (5.8%). Systolic IAD ≥ 15 mmHg 2,980 (2.2%) and diastolic IAD ≥ 10 mmHg 7,151 (5.3%). In total, there were 7,595 (5.6%) and 8,548 (6.3%) participants with BP above the 140/90 mmHg threshold in only the left or right arm, respectively. Prevalence of participants with elevated BP on one arm only was highest in patients with a systolic IAD ≥ 15 mmHg; 19.1% and 13.7%, for left and right arm, respectively. This study shows that a substantial prevalence of IAD exists in Indian primary care patients. BP is above the diagnostic threshold for hypertension in one arm only for 6% of participants. These findings emphasize the importance of undertaking bilateral BP measurement in routine clinical practice.

Original languageEnglish
Pages (from-to)993-1002
Number of pages10
JournalJournal of Clinical Hypertension
Issue number8
Early online date10 Jul 2022
Publication statusPublished - Aug 2022


  • blood pressure
  • cardiovascular disease
  • hypertension
  • inter-arm blood pressure difference

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