Here's something I've run into periodically and wish we could get the
word out about somehow:

Not often, but occasionally, I see a patient with a significant
difference between brachial pressures from right to left, usually of
course lower on the left. (I've read that subclavian artery stenosis
leading to a vertebral steal occurs on the left 85% of the time, on
the right 15%, and we all see something like this proportion in our
work.) And the patient will tell me they're being medicated for
hypertension, based on the left-arm pressures.

Nurses seem to learn the prevailing common wisdom on this, which is
that the left arm is closer to the heart (not really) and that's the
arm one uses for representative blood pressure measurements. There's
a nationally-sponsored stroke screening program done by nurses--BP,
check cholesterol, listen for bruits--for which the instructions
specifically state "use the left arm." When I told the nurse running
this that the right arm was much more likely to represent systemic
pressure, she didn't believe me.

Anyone else seeing this? I wonder how many patients are being treated
based on falsely-low BP readings.

Don Ridgway
Grossmont Hospital
Grossmont College

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